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Enhancing Synergies to Expand Immunization Coverage by Reaching Every Last Child

By Fatima Shahryar

Peshawar, Khyber-Pakhtunkhwa – November 2017: “I feel our collective productivity has improved manifold, ever since we started working together with the Community Based Vaccinators (CBVs) from the Polio Program,” says Syed Mussayab Shah, with a tone of pride and happiness in his voice. Shah is a vaccinator, posted at Gulbahar Civil Dispensary, Peshawar district, Khyber Pakhtunkhwa (KP). “We are determined to reach and vaccinate every child in our area. And to ensure this, we exchange information and notes with the CBVs twice every week.”

The Civil Dispensary is the only government health facility in the area that caters not only to the residents of Gulbahar but also those living in adjoining slums. The CBVs from adjoining areas are attached to the government health facility where they share their micro plans containing housing maps and vaccination details of children under five, with EPI vaccinators. The CBVs also refer clients from their communities to the health facility, where immunization record is updated regularly. This is done to promote synergy between the Expanded Program on Immunization (EPI) and the   Polio Eradication Initiative (PEI). 

EPI Vaccinator Syed Mussayab Shah and Community Based Vaccinators, exchange information and data, at Civil Dispensary, Gulbahar, Peshawar.  © UNICEF/Pakistan/Kyinat Motla

Referring to the PEI-EPI Synergy Initiative, Shah says, “Earlier we worked without defined plans and targets. Now, due to the information sharing from CBVs, we have plans with identified areas and targets, that help us monitor our own progress as well as the vaccination coverage.”

Despite the residents living in concrete housing units in urban slums, access to health care is still a persisting challenge. The urban and peri-urban slums are often unrecognized, lack required infrastructure and are given low priority by local health authorities. This translates into low and unequitable coverage of social services in urban areas.

Pakistan is the most urbanized country in South Asia and the population living in urban slums continues to increase. “I feel our collective productivity has improved manifold, ever since we started working together with the Community Based Vaccinators from the Polio Program,” says Syed Mussayab Shah, a vaccinatorThe urban population has risen from an estimated 43 million in 1998 to 73 million in 2014. Peshawar is the provincial capital and the biggest city of KP hosting migrant population from all over KP including FATA. Increased migration of populations from rural areas of KP and neighboring provinces to Peshawar has made it the 6th biggest city of Pakistan. 

With ever increasing population in urban slums, it had become a challenge for the EPI program to cover children living in these areas, especially those of the migrant families. To address this issue, the two programs – EPI and PEI collaborated to benefit from each other’s resources and reach all pregnant mothers and children under five years of age.

EPI Vaccinator, administers vaccine to a child, Sikandar Town, Peshawar. © UNICEF/Pakistan/Kyinat Motla

UNICEF, with funding from Gavi – the Vaccine Alliance is supporting the Government of Pakistan in improving Routine Immunization coverage in urban slums with a focus on seven major cities in Pakistan in collaboration with PEI.
“Record keeping of families in urban slums is a very difficult job,” shares Tabassum Shuaib, the CBV from Peera Gaib, UC Sikandar Town, Peshawar. She further explains, “Families are constantly moving in and out from here – and many of those that move in, usually do not have an EPI/vaccination card. They can only recall the number and time of vaccination. However, now I have all the families, pregnant mothers and children under five from this community, registered and their data is maintained at the Gulbahar Civil Dispensary.”

EPI Vaccinators and CBVs refer to Routine Immunization Register during visit to an urban slum, Sikandar Town Peshawar.
 © UNICEF/Pakistan/Kyinat Motla

Reflecting on the challenges faced to establish this synergy and subsequent achievements, Dr. Akram Shah, Director EPI, KP says, “Peshawar offers the same challenges as any other major city of Pakistan. With increased migrant population and urbanization during the past decade, the burden of ensuring access to basic life and health resources to all has also increased. The synergy between the two programs has been a blessing as we are reaching more children with vaccination every day, including those living in urban slums. Our spirits are high and we are determined to reach every last child.”




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