FUNDING PROPOSAL FOR

THE DEPARTMENT OF INTERNATIONAL DEVELOPMENT

(DFID)

PROJECT TITLE:
Polio eradication in Pakistan
CONTENTS

Page No.
EXECUTIVE SUMMARY. . . . .

CONTEXT . . . . . .

APPROACH . . . . . .

GOAL & OBJECTIVES . . . . .

MANAGEMENT & ADMINISTRATION . . .

OUTPUTS & BENEFICIARIES . . . .

REFERENCES . . . . . .

APPENDICES . . . . . .
EXECUTIVE SUMMARY:

In the previous 3 years, Pakistan has gained huge ground towards polio destruction, with its
most reduced actually amount of affirmed wild poliovirus (WPV) cases revealed a year ago.
This advancement comes as serious arranging and organization has yielded numerous way
breaking techniques: from network based inoculation (CBV) to new reconnaissance
strategies for destruction; from a solid operational stage and full authoritative responsibility,
to developments in observing and assessment that give deceivability into the developer's
hardest difficulties. However even with this advancement, Pakistan stays one of just two
nations actually detailing WPV cases; the other nation is neighboring Afghanistan. In 2018, 9
and 15 cases were accounted for from Pakistan and Afghanistan, individually. As of June
2019, an aggregate of 14 cases–4 from Pakistan and 11 from Afghanistan – have been
accounted for. All cases in Pakistan were recognized in Dukki, a country locale in
Baluchistan. These cases clarify that neither Pakistan nor Afghanistan can kill polio without
the other, and all of Pakistan stays in danger as long as WPV keeps on flowing in one or the
other Pakistan or Afghanistan. Until the two nations reach and support 'zero' polio, the
program can't celebrate. While the decrease in the quantity of WPV cases exhibits positive
advancement, the kept announcing separation of WPVs from natural observation (ES) tests
in Peshawar and Karachi gives calming proof of industrious transmission in numerous pieces
of the nation. Regardless of the decrease in the general level of positive examples in the
previous a year, the dissemination of irregular positive examples across various geographic
regions and epidemiological squares and the determined separation of WPV from natural
examples in some center supplies show proceeded with difficulties to annihilation. Program
evaluations additionally highlight hidden operational issues that have made holes in the
nature of beneficial inoculation exercises (SIAs), found in the extent of unvaccinated and
under immunized youngsters.

CONTEXT:

The WHO Section of the America was articulated without polio in 1995, WHO Western
Pacific Region in 2001, WHO European Region in 2003, and WHO South-East Asia Region in
2015. The accomplishments scratch a huge hop on the way to polio annihilation. Polio
antibody consumes been assessed to have protected an expected 1.7 million youngster
expiries. Pakistan is taking place over the rundown of three polio-endemic nations alongside
Afghanistan and Nigeria. Pakistan and Afghanistan, which self-possessed have underwrote
86% of biosphere polio cases. Generally speaking, the quantity of polio gears has diminished
essentially in Pakistan in the most recent couple of years yet not yet destroyed because of
numerous coordination obstructions. In 2012, 59 gears were accounted for although in 2013
the figure expanded to 94. In 2015, 308 cases were accounted for, which is the most
noteworthy amount of polio belongings in the nation lately. In 2016, 53 cases were
accounted for, 21 out of 2017, 9 of every 2018, 13 out of 2019, and 7 so far in 2018. 3 On 23
April 2019 in each of the five territories of Pakistan, in excess of 270,000 polio laborers were
sent to regulate polio immunization to 38 million youngsters younger than 4 years. Be that

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as it may, during the main day of mission, an unexpected frenzy emerged in Peshawar, the
capital of KPK, once as per nearby besides global newspapers, many younger students were
hospitalized whining of sickness and heaving after polio inoculations. As an outcome, furious
relatives reacted by raging a nearby wellbeing office in Peshawar (Beda), Monday and locale
it on fire. This episode managed one more hit toward endeavors near kill the sickness, which
has been impeded through boundless doubt now certain territories. Later the mishap,
authorities of KPK Emergency Operations Center (EOC) claimed that polio immunization
remains protected besides stressed the situation significance. Administration authorities
announced that this progression usual Pakistan 21 ages happening reverse in the battle in
contradiction of polio. This isn't the major occasion when that individuals in Pakistan
responded compared to polio immunization. Numerous polio laborers plus safekeeping
faculty consume executed in the past during polio immunization movements, besides such
occurrences have been one of the significant motives that polio remains as yet endemic in
Pakistan. Public authority of Pakistan and wellbeing specialists desires to yield actions near
maintain a strategic distance from such circumstances and bits of gossip approximately
polio immunization. This is emphatically prescribed on the way to fortify the feature
mechanism arrangement of the immunization formerly organization. In certain regions of
the nation, present is not any legitimate conveyance besides capacity of inoculation, which
might influence nature of antibodies. Pakistan and Afghanistan consume confronted huge
safety trials beside the boundary regions remembering focused on assaults for polio
laborers and safety officers and in specific regions a through and through restriction on
polio vaccination. Frailty in the district is regularly recorded as a significant snag toward
worldwide polio annihilation. In such manner, extremely restricted data and proof are
accessible on how instability influences polio inoculation. During seasons in elevation
uncertainty, the immunization amount aimed at polio was 4% inferior. Furthermore, the
rate of polio was 74% more prominent in territories through great uncertainty times
contrasted and protected ages. This is extremely vibrant, up to solitary contaminated kid
stays through polio, altogether youngsters’ stand in danger of polio. These sorts of
disappointment might bring about numerous innovative circumstances each time.
Maximum nations extended worldwide endeavors to battle irresistible infections by building
powerful illness observation and inoculation. Support of the board techniques and
inoculation are expected to accomplish the objective of polio annihilation. Polio destruction
has been assessed to have the option to save in any event US$40–50 billion, generally in
helpless nations.

RATIONALE & APPROACH

Meanwhile dispatch of the Global Polio Eradication Initiative (GPEI) in 1989 the worldwide
rate of poliomyelitis takes dropped by almost 98 %. After a circumstance someplace
uninhabited sort poliovirus remained endemic in 126 nations diagonally five landmasses,
spread is presently restricted in the direction of districts of only four nations – Pakistan,
Afghanistan and Nigeria. A piercing expansion in Pakistan's poliomyelitis circumstances in
2015 provoked the International Health Regulations Emergency Committee just before

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pronounce the circumstance a 'general wellbeing crisis of worldwide concern'. Worldwide
polio destruction relies on Pakistan's capacity to give a lecture the strict, political and
financial hindrances to inoculation; remembering disparities for immunization inclusion, a
chronic weakness framework, and strife in polio-endemic areas of the state. This
investigation stretches a diagram of the GPEI, zeroing in happening the authentic and
current difficulties provoking Pakistan's polio eradication package besides the effect of
contention and weakness, besides reveals insight into methodologies to battle
immunization reluctance, connect with neighborhood networks and expand on late
advancement towards polio destruction in Pakistan. Pakistan's polio eradication platform
has departed below universal inspection because of the situation as the code motorist of
universal bare poliovirus blowout as of late. This is established in monetary and hierarchical
deficiencies, just as dynamic clash and frailty, which has brought about the constant
disappointment of successful inoculation missions then SIAs near arrive at entirely
territories of the nation.

Pakistan is partitioned into five regions, the Islamabad Center Part, the Federally
Administered Tribal Areas (FATA) and two authoritative regions (Gilgit-Baltistan and Azad
Jammu and Kashmir). The situation is the most crowded nation in the WHO's Eastern
Mediterranean State and one of the most un-created, through an enormous populace of
around 189.9 truck load folks with 24.6 million kids below 5 years of age and 72.5 million
youngsters below 17 years of age, putting forth it basic to polio destruction attempts.

Pakistan's Prolonged Program on Immunizations (EPI) was officially started after the WHO
dispatched its Expanded Program on Immunization. Public EPI strategy is directed through
the direction of the Nationwide Immunization Technical Advisory Group (NITAG), that sorts
proof founded suggestions to recover the program. The inoculation program is conveyed by
the help of 13,000 vaccinators, 6000 Lady Healthiness Companies besides additional
paramedical workforce. Likewise, additional 120 thousand Female Well-being Labors uphold
the package from end to end communal meeting endeavors, subsequent vaccination
dodgers besides every so often directing antibodies. Nearby are around 7000 secure EPI
places however their adjustable topographical appropriation on region and sub-region
stages type public vaccination ambitions then SIAs the pillar of polio annihilation endeavors.
The polio destruction exertion in Pakistan is additionally subsidized and upheld by various
worldwide associations counting the WHO, UNICEF, the Bill and Melinda Gates Foundation
and the Global Alliance for Immunization.

GOAL AND OBJECTIVES

To reach at a conclusive unbiased of polio eradication, Pakistan's polio devastation platform

is objectifying an intensified vaccination crusade strategy zeroed in happening working

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promotions to achieve extraordinary masses struggle in the midpoint stores of Karachi,
Khyber-Peshawar and Quetta Hunk, though observing the rest of the state polio free.

1. Stop poliovirus transmission in all leftover WPV stores through engaged, escalated public
endeavors and facilitated techniques across global lines.

2. Quickly identify, contain, and take out poliovirus from any recently contaminated zones.
3. Ensure the general strength of populaces by keeping up and expanding invulnerability to
poliovirus disease through actualizing quality SIAs and routine EPI.

MANAGEMENT AND ADMINISTRATION

• The work with accomplices as "one group under one rooftop" under the
administration of the Government at crisis tasks focuses has been basic in guaranteeing
upgrades across all parts of program activities, hazard the board and oversight exercises.
Because of the focuses, the program is presently additionally upheld by the accessibility of
excellent information and exhaustive, constant danger evaluation and observing, bringing
about better mission quality and better reaction to flare-ups. Changes to the timetable,
structure and dividing of polio destruction missions to guarantee adequate time for crusade
arrangement exercises, including social assembly, network commitment and limit building
endeavors. According to the NEAP plan, around will be four NIDs and four Subnational
Immunization Days (SNIDs) in 2021.

• The presentation of changes in the developer's building, information, cycles and HR.
These changes are the consequence of complete administration and correspondence
surveys that remained attempted in 2018. These changes require a correction of jobs and
duties, hierarchical constructions, working series, information assortment and custom at
entirely degrees of the polio destruction exertion.

• The advancement and turn out of Message for Extinction (ME) exercises which
consume to be intended to recover faith in the Pakistan Polio Abolition Platform and in
immunizations. Procedures have been concocted to draw in partners and influencers,
disperse confusions from place to place antibody security and adequacy, speech main
drivers for guardians and parental figures declining the immunization.

• The making of another Part of Labor which focuses on construction cooperative

energy with the Delayed Database on Vaccination. Over this Zone of Effort, Pakistan desires
to progress Vital Vaccination inclusion of kids while tending to more extensive wellbeing
needs through the arrangement of extended bundles included wellbeing, nourishment, and
WASH administrations. These mediations will build admittance to and use of wellbeing
administrations in networks influenced by numerous kinds of hardships.

• Continued arrangement of Pakistan's inoculation plan by Afghanistan's immunization

plan, by way of organization amid both of these nations is basic to intruding on poliovirus
inside and crossways the communal epidemiological four-sided.

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 • The work with accomplices as "one group under one rooftop" under the
administration of the Government at crisis tasks focuses has been basic in
guaranteeing upgrades across all parts of program tasks, hazard the board and
oversight exercises. On account of the focuses, the program is currently additionally
upheld by the accessibility of excellent information and complete, constant danger
appraisal and observing, bringing about better mission quality and better reaction to
flare-ups. Alterations to the timetable, structure and dispersing of polio annihilation
missions to guarantee adequate time for crusade readiness exercises, including
social assembly, network commitment and limit building endeavors. According to the
NEAP plan, there will be three (3) NIDs and three (3) Subnational Immunization Days
(SNIDs) in 2020.

• The presentation of changes in the developer's structure, information, cycles and HR.
These changes are the consequence of far reaching the executives and
correspondence surveys that were attempted in 2019. These changes require an
amendment of jobs and duties, hierarchical structures, operational cycles,
information assortment and use at all degrees of the polio annihilation exertion.

• The advancement and turn out of Communication for Eradication (C4E) exercises
which have been intended to improve trust in the Pakistan Polio Eradication Program
and in immunizations. Methodologies have been concocted to connect with partners
and influencers, dissipate misguided judgments around immunization wellbeing and
adequacy, and address the underlying drivers for guardians and parental figures
rejecting the antibody.

• The production of another Area of Work which focuses on building collaboration

with the Expanded Programe on Immunization. Through this Area of Work, Pakistan
desires to improve Essential Immunization inclusion of youngsters while tending to
more extensive wellbeing needs through the arrangement of extended bundles
contained wellbeing, sustenance, and WASH administrations. These mediations will
expand admittance to and usage of wellbeing administrations in networks influenced
by numerous sorts of hardships.

• Proceeded with arrangement of Pakistan's inoculation plan with Afghanistan's

immunization plan, as coordination between these two nations is basic to intruding
on poliovirus inside and across the shared epidemiological square.

OUTPUTS AND BENEFICIARIES

Wild sort poliovirus has been killed by the biosphere because of frame inoculation
dispatched by the Universal Polio Extinction Inventiveness (UPEI) in 1989 aside from 3
nations; Afghanistan, Pakistan, and Nigeria. Pakistan is as yet battling in contradiction of the
poliovirus extinction. Since 2016, the Pakistan polio platform has achieved commendably
thriving acquiring 307 circumstances 2015 to just 55 gears in 2018, 20 of every 2019,
decreasing to an altogether‐period low-slung of 8 revealed cases in 2016, 10 out of 2017 and

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afterward flooding up to 148 cases in 2019. As of July 2020, 51 cases have been accounted
for up until now, the ecological examples gathered starting nearby the nation recommended
that 66% of them remained optimistic for poliovirus existence most elevated in Sindh and
Baluchistan. Scheduled quarter July 2019, the representative official (DC) of Multan gave
polio alarms subsequent to distinguishing poliovirus in sewerage liquid. Through nineteenth
June 2020, single polio incident has been accounted for in together Chapman and Upper Dir
District of KPK. Due to the COVID‐19 flare-up, forty million kids in Pakistan have lost the
polio vaccination meanwhile April at what time every immunization programs were
suspended. These accepted procedures in microplanning for polio annihilation depend on
numerous long stretches of accomplishment and disappointment in intruding on poliovirus
transmission in numerous assorted circumstances. The components depicted, and the
suggested steps and structures, are totally pointed toward keeping the miniature
arrangement as basic as could be expected under the circumstances and pertinent to the
circumstance in the field. There is no ideal miniature arrangement; there are just models.
Indeed, probably the best accomplishment of polio microplanning has been its ability to stay
adaptable and change quickly, even starting with one day then onto the next, when issues
emerge. For polio destruction, accomplishing 80–90% of the objective isn't a choice – the
lone objective is 100%. Each kid should be inoculated, regularly through independent
dosages regulated in progressive rounds. Kids missed outcomes in proceeded with
transmission, and a pocket of neighborhood transmission, if not stopped quickly, can before
long turn into a global episode.

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REFERENCES

1.World Health Organization. Poliomyelitis: fact Sheet. Geneva(Switzerland): World health

Organization; 2019. https://www.who.int/news-room/fact-sheets/detail/poliomyelitis.

2. End polio Pakistan. Polio cases in provinces 2019 [accessed 2019April 25].
http://www.endpolio.com.pk/polioin-pakistan/poliocases-in-provinces.

3. The Express Tribune. Fake news hinders anti-polio campaign in K-P. 2019 Apr 23
[accessed 2019 April 24]. https://tribune.com.pk/story/1957206/1-fake-news-hinders-anti-
poliocampaign-k-p/.

4. BBC News. Pakistan polio: seven killed in anti-vaccination attack.2016 Apr 20

[accessed 2019 April 23]. https://www.bbc.com/news/world-asia-36090891.

5. CNN. Two polio workers killed in attack in Pakistan. 2018 Mar 18[accessed 2019 April
23]. https://edition.cnn.com/2018/03/18/world/polio-workers-killed-pakistan/index.html.

6. Vermaa AA, Jimenezd MP, Tangermanne RH, Subramanianf SV,Razak F. Insecurity,

polio vaccination rates, and polio incidence in Northwest Pakistan.

7.Wasif S. Coordinated Pak-Afghan efforts for polio eradication bear fruits. The Express

Tribune. Published April 9, 2017 https://tribune.com.pk/story/1378570/coordinated-

pakafghan-efforts-polio-eradication-bear-fruit/ (accessed June 25, 2017). 8.Polio worker shot

dead in NW Pakistan. The Nation, July 2, 2017 http://nation.com.pk/national/02-Jul-

2017/polio-worker-shot-dead-in-nw-pakistan

9. Polio worker shot dead in NW Pakistan. The Nation, July 2, 2017

http://nation.com.pk/national/02-Jul-2017/polio-worker-shot-dead-in-nw-pakistan

10.Monetary incentives in primary health care and effects on use and coverage of preventive
health care interventions in rural Honduras: cluster randomised trial. Lancet
2004;364(9450):2030–7.

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11 Owais A, et al. Does improving maternal knowledge of vaccines impact infant immunization
rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC Public
Health 2011;11(1):239.

12. Sattar A, Baig R. Civil society in Pakistan: a preliminary report on the CIVICUS index on civil
society project in Pakistan. Karachi: The Aga Khan Foundation; 2001.

13.GAVI support for civil society organizations in Pakistan; 2010, GAVI Alliance.

14.Kaufmann JR, Feld Baum H. Diplomacy and the polio immunization boycott in Northern
Nigeria. Health Aff (Millwood) 2009;28(4):1091–101.

15. Polio this week – as of Wednesday 11 May 2011; 2011.

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Narrative summary
GOAL To stop all wild poliovirus (WPV)
correspondence in Pakistan, unequivocally.
PURPOSE Stop poliovirus transmission in all excess WPV
supplies through engaged, strengthened public.
endeavors and composed methodologies
across global boundaries
OUTPUTS PV type 3 removed internationally by end-2017 At least
20% yearly expansion in DTP3
inclusion accomplished in 90% of high danger regions of
all center nations from 2015 to 3
Wild poliovirus transmission stopped
by end-2014. All new polio virus
outbreaks stopped within 120 days with
vaccine
ANNEXURE
LOGICAL FRAMEWORK (Log Frame) MATRIX
Objectively verifiable indicators (OVI)
Quickly distinguish, contain, and take
out poliovirus from any recently tainted
regions.
.
Ensure the general strength of
populaces by keeping up and
expanding insusceptibility to
poliovirus disease through actualizing
superiority SIAs and routine EPI.
Touchy reconnaissance to recognize all
polio cases through dynamic AFP
reconnaissance and recognize
low-level poliovirus transmission through
natural reconnaissance (ES).
Increment ES snatch tests gathered
and tried from 55 to 60
Inoculation Systems Strengthening
and OPV Withdrawal: Strengthen
vaccination benefits in "center
nations", present IPV and pull out
OPV2 internationally Monitored by
the SA
Poliovirus Detection and Interruption
Complete the interference of wild
poliovirus transmission all around the
world and that's only the tip of the
Means of verification
(MOV)
At any rate 90% of anticipated daily
schedule (week by week or month to
month) AFP observation reports ought to be
gotten on schedule, including zero reports
where no AFP cases are seen.
The dissemination of revealing destinations
ought to be illustrative of the geology and
demography of the nation.
• Weekly meeting reports of
health minister
in their meetings.
• Monthly reports of social
workers on polio issue.
• • Quarterly reports of the
project.
• School records. Savings records
of polio team members.
• through testing of every men
and women in Pakistan
1.New machines introduced to
detectthe polio in all the sectors
Assumptions
Poliovirus is sent by contaminated people straightforwardly
or in a roundabout way by beads or vaporizers from the
oropharynx and by fecal tainting of hands, eating utensils,
food, and water Epidemiologically,
Expanded basic inoculation (EI) administration
conveyance through continuous cooperative
energies with EPI in network based immunization
(CBV)– covered Union Councils and backing for
creative execution of RI tasks in a select number of
high-hazard regions.
Here we assume that 10th person in Pakistan is effected by
the polio and after vaccination will got polio free
Other than that natural immune system is also included
in the assumptions
The vaccine was introduced in Pakistan with in 2014 so to
stop more cases
 iceberg rapidly detect and interrupt any 2.Modern technology is introducedin
new outbreaks due to vaccine-derived Pakistan to detect patients more

polioviruses quickly

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ANNEXURE

Maintain
certification standard Global polio eradication certified Global polio eradication team
surveillance down to the first in by global community verified this
all provinces in certified and non-certified regions

Gender based testing of polio cases in Pakistan All men & women tested in: • Polio reports.
Pakistan according to gender ratio • Health progress reports.
by Polio team management .

INPUTS 1.1. Setting up community based organisations of 1 team formed of Men & 1 of women by • Health log-book. Community takes responsibility of infected patients of
men and women, with sub-committees for the end of Month 1 • Polio organization weekly minutes Polio
generating local reports of polio. Once formed, weekly meeting of the The proper structure of community is made and each
of meeting. person will be assign their job according to their level
. polio organization (of men & women)
of skill.
1.2. Provision vaccines for men and vaccine for every men and • health report And they will make sure to look over total number of
current cases in Pakistan of polio.
women in every province women by the polio team. Vaccine update
And will also inform the Govt of Pakistan and will be
1.3. Provision of polio vaccine and injections Polio vaccine facility for both • Health report in touch with the International Global Community of
through polio eradicated team . men and women. • vaccine update
Provision of new labs and hospitals
by Govt And Health polio organization to make sure
that polio is finished from almost every sector
Participation based salary for men and women
in every province
2.2. Skill development trainings to women & men for
to do vaccination
Distribution of polio vaccine in every
province equally and providing new
labs and hospitals to every sector
Most of the men and women has
started taking more interested in
the polio community because
salary is base on participation
all men and women are train to vaccinate Training records.
the children in one week
• Community mobilise log-book. •
Polio community log-books • Survey
reports.
Minutes of meetings of Polio
community
Monthly reports of every team
member and analysis will be made
how much every member has
participate
.
Attendance sheets
Polio. These teams will be divided in the provinces
states and cities by the management .
The participation of men is more as compare to
women and the parents do not allow most of the
girls to be part of these kind of communities
so the participation of men is more and their is also
more as compare to women
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