Angola : Lessons Learned in Interruption of WPV transmission

1. REPUBLIC OF ANGOLA MINISTRY OF HEALTH Angola: Lessons Learned in Interruption of WPV transmission Dr. Alda Morais Pedro de Sousa EPI Manager ARCI meeting 10-12 December 2012

2. Outline • Background and current epidemiological situation • Strategies implemented to interrupt WPV transmission • Lessons learned • Way forward to sustain the polio free status

3. Polio in Angola 2001-2010 2008- 3rd importation Multiple exportations of WPV to neighboring countries 2007- 2nd importation 2005- 1st importation 2001-2005 No polio

4. Reported WPV cases by month of onset and SIAs Angola. 2008-2012* * Data up to December 9thth 2012

5. Bengo Luanda Norte Luanda Luanda Sul Bie Huambo Progress in the interruption of WPV transmission in Angola Jan-Dec 2010 Jan-Dec 2011 Jan-Dec 2012* Uige Kuando Kubango • 0 WPV cases • 05 WPV cases • in 02 municipalities • In 02 provinces • 33 WPV cases • in 18 municipalities • In 09 provinces WPV cases * Data up to December 9thth 2012

6. Strategies to interupt WPV transmission

7. Political Commitment and Ownership • The President, Provincial Governors, and Municipal Administrators demonstrated full commitment and ownership to interrupt polio transmission by end of 2011, under the new Polio Emergency plan • National Health Authorities provided technical guidance to implement high quality polio campaigns • A commitment to conduct bi-weekly ICC meetings chaired by the Minister/Vice Minister of Health was realized with close follow up of key Polio indicators defined • Municipal Administrators were directly involved in polio activities, particularly monitoring SIAs

8. Political engagement & high level oversight Advocacy visit to HE President of Republic of Angola, 25 January 2011 Mr. Ban Ki-Moon launching Polio NIDs in Luanda, 28 February 2012 UNICEF Executive Director & Director of Bill and Melinda Gates F. Visit to Luanda, 25 January 2011

9. National Resource Mobilization • As a result of Government commitment, 88% of polio SIAs operational costs was covered by government funds • Decentralization of funds directly to the municipalities, for Polio SIAs and Intensification of routine immunization activities • The Government further contributed to 5 Millions USD for Polio Emergency Plan 2012-2013

10. Implementation of community based SIA strategy (new approach) Responsibility given to municipal/communal Administrators and community leaders to organize and implement campaigns includinglocal recruitment of vaccinators and supervisors Subdivision of vaccination areas into blocks in order to reduce the workload of the vaccinators and for better supervision Local Administrators and community leaders to certify the total vaccination of children in their areas of responsibility Daily review meetings during the campaigns, chaired by the communal/municipal Administrators Discussion of independent monitoring results post campaign with Governors and Administrators to improve the subsequent rounds Implementation of LQAS in Uige and Luanda Collaboration with the armed forces and police for accesssing hard to reach areas with the support of helicopters, and increased vaccinators support with civil society and churches collaboration Cross border planning and implementation done in DRC and Namibia bordering provinces • Strategies to Improve SIA Quality

11. Proportion of Missed Children IM Polio 1st, 2nd and 3rd round, 2012 - ANGOLA 1st Round 2nd Round 3rd Round

12. Intensification of Routine Immunization • Outreach activities conducted country wide with focus on high risk districts • Increased suportive supervision at field level • Expansion of the cold chain network, with funds provided by local donors and the Government

13. OPV 3 Coverage by Municipality(Jan-Sept 2010- 2012) 2012 2010 2011 < 50% 50-79% >80%

14. Engagement of Red Cross Volunteers, CORE Group and Church members for interpersonal communicatons/social moblization to support SIAs and routine immunization activities . Involvement of public figures for promoting campaigns and routine immunization through mass media Studies on Reasons for missed children, Motivation of Vaccinators, and the use of Treated Water for Families in Luanda These studies resulted in the adjustment of strategies of communication materials and social mobilization for polio Training and media packages developed for journalists Results of all campaigns are shared via an advocacy bulletin with Provincial Governors and Municipal Administrators Communication and Social Mobilization

15. Improve AFP Surveillance • Surge capacity increase for surveillance activities at central and municipal levels (focus on Luanda Province) • Increased vehicles and motor bikes which has improved the number of active surveillance visits and supervision activites • Expansion of community based surveillance in provinces, with a strong focus on Luanda; engagement of traditional healers and birth attendants. • Studies conducted on the reasons of late reference of supected AFP cases to health facilities and results use for corrective action

16. Surveillance indicators – 12 months rolling, ANGOLA NP AFP rate 03 Dec 2010 to 02 Dec 2011 03 Dec 2011 to 02 Dec 2012 Stool Adequacy rate 03 Dec 2010 to 02 Dec 2011 03 Dec 2011 to 02 Dec 2012

17. Lessons Learned • Political leadership by the Government, including ownership and financial support of the program is critical for the success of interruption of polio transmission • Involvement of local administrators and community leaders in planning and implementation of polio activities has resulted in better campaign quality • Decentralization of funding empowered local municipalities to fund and implement their own routine immunization outreach which is more sustainable • Use of findings from studies can help identify and improve gaps in communication and social mobilization

18. Way forward to mantain Angola Polio free status

19. Way Forward to sustain Polio free status • Maintain high commitment of Government and partners: • Renewed advocacy with the national authorities and partners to sustain the financial contributions to Polio Eradication Initiative • Regular feedback to Provincial Governors on the EPI progress • Continuing involvement of the tradicional leaders, churches and grasroot organizations in EPI activities • Improve and sustain the population immunity: • Maintain countrywide outreach and mobile teams immunization activities focusing on 42 districts with largest unvaccinated children • Strengthen cold chain and human resource capacity • Reduce the number of missed children during Polio SIAs with the continuing involvement of local authorities and leaders in all the process.

20. Way Forward to sustain Polio free status • Improve the AFP surveillance performance: • Reinforce community based surveillance activities • Implementation of environmental surveillance • Intensification of active surveillance visits in low performing areas • Continue the work started with civil society organizations, to strengthen their capacity through trainings and supportive supervision, in order for them to plan and implement activities independently and with the government • Continue conducting studies that will give insight into community needs in order to improve communications, materials, and social mobilization activities

21. Muito Obrigada !!