 Author – Dr Hafeez, Executive Director North Waziristan is a mountainous region of northwest Pakistan, bordering Afghanistan. Due to large displacements because of military operations, immunisation and health systems have been greatly disrupted. According to a Rapid Coverage Assessment (RCA) conducted in September, 2017, only 10 % children were immunized in the selected basic health units (BHUs) catchment area. In the assessment no pregnant women were found to have had their maternal tetanus for pregnant women vaccine. The survey found the main reasons for not immunizing children were lack of parents’ knowledge on the whereabouts of vaccination center (55%), vaccination centers being too far away (15%), and non-availability of vaccinator at the center (30%). People in the catchment area were returning from residential camps where there were no arrangements for immunizations to be delivered. In North Waziristan more widely, low literacy rate especially among women, their lack of empowerment and inadequate involvement in decision making, early marriages, high fertility rates with lack of birth spacing, myths, poor access to health care facilities and non-deployment of vaccinators on part of Government, were enormous barriers to immunization. KAMORE, a development welfare organization, with assistance of UNOCHA/Pakistan Humanitarian Pooled Fund (PHPF) has been working to revitalize primary healthcare services in the areas – primarily in three health facilities (Nitassy, Shertalah & Hassain Khel). KAMORE has established vaccination centers, which undertake both static and outreach vaccinations. They also hired EPI technicians, and male and female social mobilizers, who work with other local community stakeholders, to increase the number of people available in the local area to deliver vaccines and raise awareness of the importance of getting vaccinated. KAMORE as part of their immunisation services were able to provide baby kits and medicines (without any cost) when they delivered immunisation services – providing an integrated package of care to families. One of the biggest achievement of this project so far is the formation of Male and Female Local Quality Team Health (LQT-Health) in BHUs catchment area for the support of static and outreach EPI Program in the tribal community. This has helped increase immunization services in areas health services typically don’t reach. KAMORE have also been working to build the capacity and knowledge of existing health workers to ensure immunization is part of primary healthcare services when they are being provided. KAMORE Team identified 30 Traditional Birth Attendents (TBAs) from the catchment area of health facilities to undertake refresher training. Due to inaccessibility of health facilities and local customs, home births supervised by TBAs is very common, making them a critical point person in the local community for health. Refresher training was used to make sure the TBAs unlearned harmful practices and now had increased knowledgeable on safe health practices. The TBAs were equipped to give advice on immunization to expectant mothers, and about the importance of immunisatin of babies at birth. They were also provided with basic safe birthing midwifery kits – another key improvement to primary healthcare services in this remote community. The TBAs use their contact points with expectant and post-partnum mothers to to conduct awareness sessions on the importance of immunization and maintain records for referral and tracking missed individuals. The TBAs have a responsibility to initiate routine immunization at birth, as well as encouraging pregnant women to get their maternal tetanus vaccine. According to a RCA in March 2018 data, now in the target areas of Netasey, Sheratala and Hassain Khel where KAMORE has been working, BCG coverage is 89%, with 98% of children receiving at least one does of the polio vaccine. Likewise, Pentavalent (the five in one vaccine which protects against diphtheria, tetanus, pertussis, hepatitis B, and haemophilus influenzae type b) coverage is 98%. 75% of pregnant women were also now vaccinated against maternal tetanus. Now the number of on-track children with vaccination cards and fully immunized children with vaccination cards has also increased. This would not have been possible without KAMORE and dedicated efforts to improve immunization as part of their primary healthcare initiative.
Female social mobilization session
Using the Vaccination Card
KAMORE Development Welfare Organization-KDWO was registered in Peshawar in 2001 and in FATA in 2013. The organization is based in Peshawar with Field Offices in Kurram Agency, Mohmand Agency, Khyber Agency, Bajaur Agency, North Waziristan Agency and FR-Peshawar. Since 2002 KDWO is working on PHC, MNCH, Static and Outreach Vaccination, Social Mobilization and Capacity Building of EPI Technicians. |
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