Our Vision

Provincial EPI Cell, Heath Department Khyber Pakhtunkhwa vision is like in the world in which every child and mother attains the right to survival, protection, development and participation.

Our Mission
Provincial EPI Cell ,Heath Department Khyber Pakhtunkhwa mission is to reach every children, mother and create the demands for vaccination, inspire breakthroughs in the way the world treats children, mothers and to achieve immediate and lasting change in their lives.

 

  Expanded Programme On Immunization

Our Values

ACCOUNTABILITY: We take personal responsibility for using our resources efficiently, for immunization, achieving measurable results, and being accountable to Public, Government, Supporters, Partners, Civil Societies and, most of all, Children and Mothers.

AMBITION: We are demanding of ourselves and our colleagues set high goals, standards and are committed to improving the quality of life of all children and mothers.

COLLABORATION: We respect and value each other, thrive on our diversity, and work with partners to leverage our global strength in making a difference for children and mothers.

CREATIVITY: We are open to new ideas, embrace change, and take disciplined risks to develop sustainable solutions for and with children and mothers.

INTEGRITY: We aspire to live to the highest standards of personal honesty and behaviour; we never compromise our reputation and always act in the best interests of children and mothers.

 

Introduction
Thousands of children die each year due to infectious diseases globally, which is a major health problem in Pakistan as well. Many more are blinded, and crippled for the rest of their lives. Fortunately, administering respective vaccines by Expanded Programme on Immunization can prevent these diseases.

Expanded Programme on Immunization (EPI) was started in 1976, as a pilot project confined to Peshawar and Nowshera, soon after the successful eradication of small pox. It was included in regular Annual Development Programme (ADP) in 1978 - 79. Following two major groups of the population are on the target of the programme for vaccination against the targeted vaccine preventable diseases.
Children of 0 -1 year of age: These are 3.5% of the total population.
Pregnant women: These are 4.1% of the total population.
Besides pregnant women, vaccination services are also offered to the women in the Child Bearing Age (CBA), 15 – 45 years of age.
The programme provides vaccination services against the eight target childhood vaccine preventable diseases of Poliomyelitis, Neo Natal Tetanus, Measles, Diphtheria, Purtussis, Tuberculosis, childhood pneumonia and meningitis, and Hepatitis B. Up to the year 2000 target diseases were six, in the year 2000 Hepatitis B vaccine and in 2009 Hib vaccine was also included for the target age group, thus making the vaccine preventable diseases eight in number. In future there are plans for the inclusion of other vaccines.

Strategies
Vaccination services are provided through the fixed EPI centres, established within the health facilities and through outreach sessions, in the catchment area of the health facilities.
Staff
Expanded Programme on Immunization, at the Provincial level is implemented through Deputy Director EPI (Provincial Manager), assisted by 2 Assistant Directors. At the district/agency level, Executive District Officer (Health) looks after the programme. Supervisors at various levels supervise implementation of activities. The grass root work force of EPI is EPI technicians who vaccinate the target population in the field.
Logistics
 
In 1995 the EPI Programme was included in the recurrent budget with the understanding that the Federal Government shall be responsible for the supply of vaccine, syringes and other cold chain equipments while the Provincial Government shall bear the operational cost.
Vaccines, being sensitive biological substances are sensitive to heat and are stored in special equipment at the recommended temperature of +2 – +8 degree centigrade. As a policy, Federal EPI Cell, National Institute of Health (NIH), Islamabad provides vaccine, in conformity with the target population. The vaccine used in EPI is BCG, Pentavalent, Measles, Tetanus Toxid (TT) and Oral Polio Vaccine.
After its collection from NIH Islamabad, vaccine is stored in the cold room, situated at provincial EPI headquarters. Besides the provincial cold room, there are 5 other cold rooms installed at divisional level, one each at Malakand, Kohat, Bannu, D.I.Khan and Mansehra, catering to the needs of the respective divisions. The vaccine is supplied from provincial to the divisional cold rooms and further distributed down to the districts/agencies stores. While working in the field, EPI technician keeps vaccine in vaccine carriers, especially designed for the purpose to maintain temperature at the recommended level, during outreach sessions.

EPI KHYBER PAKHTUNKHWA did a tremendous job over the years to vaccinate the target population. Year 1990 was declared as the year of Universal Child Immunization (UCI). EPI KHYBER PAKHTUNKHWA was committed to achieve at least 80 % vaccination coverage by the end of 1990. According to the results of a national coverage survey conducted in January 1991, EPI KHYBER PAKHTUNKHWA achieved 96 % immunization coverage and stood on top in Pakistan.

Besides routine vaccination, EPI also runs Supplemental Immunization Activities for eradication of polio as part of global polio eradication efforts. Special campaigns for elimination of Maternal and Neo Natal Tetanus have been organized and more are on the plan. Campaign for reduction of measles is planned during the current year (2007).
At the moment, Global Alliance for Vaccine and Immunization (GAVI) provides additional assistance to the programme and that is in the process of utilization through an approved PC-1. Major partners of EPI are UNICEF, WHO, JICA and GAVI.

   
  Objectives
 

The overall objective of EPI is reduction in morbidity and mortality among children causing due to 8 target diseases by offering vaccination services. Specific objectives/target of the programme are as under.

General Objectives

Reduction of mortality and morbidity resulting from EPI target diseases (Poliomyelitis, Tetanus, Measles, Tuberculosis, Diphtheria, Pertusis, Hepatitis-B and Hib) by immunizing children under one year and pregnant women.

Specific objectives and targets

  • Stop indigenous poliovirus transmission.
  • Elimination of Neo-Natal Tetanus, by the year 2010.
  • Reduction in Measles mortality by 95 % and Measles morbidity by 90% by 2011.
  • Reduction of Diphtheria, Purtussis, Hepatitis B, and Childhood Tuberculosis to a minimum level.
  • Control of other diseases by introducing new vaccines in EPI.
  Current Status  
 
During the current calendar year 2011, 885729 children of the target age group, 0 –11 months of age will be provided with EPI Vaccine. Similarly target of the pregnant women during the current year is 1027877. They will be provided with 2 doses of TT vaccine to protect them as well the infants from the deadly disease of Tetanus.
 
  Challenges  
 
  • Security issues
  • Inaccessible areas
  • Poor monitoring/supervision due to security
  • Poor outreach activities.
  • Missed opportunities.
  • Low coverage of routine immunization in most of the districts
  • Lack of awareness regarding routine EPI.
  • Other priority activities (NIDs, SNIDs, SIAs)
  • Clustering and un-even distribution of workers.
  • Propaganda against vaccines
 
  Number of cases reported during the year 2008- 09 (Measles, Diphtheria, Purtussis, Hepatitis B, and Childhood Tuberculosis)  
 
Dieseses
Cases reported during the year
2008
2009
Measals
288
337
Diphtheria
24
18
Partosis
66
50
Hepatitis b
4
4
Childhood Tuberculosis
67
26
 
  Vaccination coverage 2009-10 and 2011.  
 
Antigen
Coverage
2009
2010
2011
BCG
88
100
96
Penta-3
70
87
90
Measles
69
75
77
TT-2
46
69
60
 
     
 
  • Induction of new vaccine i.e Hib Influenza type-B for pneumonia and meningitis.
  • TOT for Pentavalent vaccine completed all over the province.
  • Introduction of 2nd dose of measles and ToT for Measles case base surveillance (almost completed).
  • Mid Level Managers Training conducted for newly appointed EDOs-H & EPI Coordinators.
  • Special Measles & Polio campaigns were conducted for IDPs.
  • Computers along with UPS for Provincial EPI Cell through UNICEF support.
  • Recruitment of Finance Manager through UNICEF support.
  • Recruitment of District Health Communication Support Officers with the support of UNICEF.
  • Recruitment of Programme Analyst & Monitoring Coordinator through GAVI support.
 
  Involvement of LHWs in routine EPI  
  LHWs trained by UNICEF  
 
LHWs have been trained and involved in routine EPI in UNICEF Phase-I districts (Bannu, DIKhan, Dir Upper, Charsadda, Swabi, Mardan, Peshawar, Nowshera, Swat)
 
  LHWs trained by JICA  
 

LHWs have been trained and involved in routine EPI in Buner, Shangla and Haripur with the support of JICA

 
  LHWs trained by WHO  
  LHWs have been trained and involved in routine EPI in Mansehra, Karak, Kohat and Lakkimarwat with the support of WHO.  
     

 

 

 

 

 

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