HYDERABAD: The Sindh health department is going to launch a comprehensive measles-specific vaccination campaign in collaboration with Global Alliance for Vaccines and Immunisation (GAVI) at a cost of over Rs400 million from May 19 across Sindh to vaccinate and immunise children especially in rural areas.

Health directorate officials told Dawn here on Tuesday that while the campaign mainly focused measles to target children from six months to under 10, other children would be administered polio drops in 11 districts and some high risk union councils in the selected districts.

Children are vaccinated against measles irrespective of their previous immunisation status. Likewise, they would be vaccinated in case they were missed or refused to have one in routine coverage.

GAVI is funding handsomely for this vaccination campaign commencing from May 19 and would continue till May 31. Health officials have been engaged with GAVI in this regard for this campaign for the past few months.

Sindh DG Health Services Dr Hafeez Memon said teams would work in three-tier system, including fixed centres, outreach and mobile teams. “Every village will hopefully be covered by 5,274 outreach teams which include skilled/vaccinator and social mobiliser,” said the DG.

He said mobiliser was preferably a woman from local area. “Her role is vital for health education of rural women,” he said.

He said 1,539 teams would be available at fixed centres and another 117 were mobile ones. During the campaign children in 72 selected UCs of Karachi and eight other districts would be inoculated polio drops in addition to measles vaccine, he said.

The health department has confirmed 13 deaths caused by measles so far with eight in Sujawal, four in Thatta and one in Tando Mohammad Khan districts. Around 696 measles cases have been reported across Sindh to date. In 2011 and 2012, according to the DG, measles outbreak figures varied between 3,000 to 4,000.

Vaccination is handled by the health department’s Expanded Programme on Immunisation (EPI) wing. However, there are question marks over EPI’s performance. This became more evident in 2012 when measles – a preventable and treatable disease – claimed close to 250 to 300 lives of children in the upper Sindh region. Currently, measles outbreak is reported mainly in Thatta and Sujawal districts where close to 60 deaths of children have been reported.

According to the Pakistan Demographic Health Survey 2012-13, Sindh’s coverage of all vaccines is 29.1 per cent. Officials working in field said children got 85 per cent immunity with first doze of measles vaccine usually. Its second dose increases the level of immunity to almost 98 per cent.

“Fifteen per cent of the children still don’t develop immunity for factors like malnourishment or refusal. These 15 per cent remain vulnerable to measles and post measles complications like pneumonia, diarrhoea, high grade fever,” an official said.

Vaccinators often complain of not getting fuel expenses and try to avoid their duties or lady health workers engaged for exercise do not ensure the required coverage. Resultantly, the rural community living in areas away from health facilities fail to get any advantage of the outreach activity.

“There are some grey areas in vaccination component of health sector under EPI which need to be addressed as well,” Sindh secretary health Iqbal Durrani told Dawn.

EPI working, he said, would have to be improved as well to achieve desired results of vaccination. He explained that campaign beginning on May 19 was being launched under a master plan and it involved funding of Rs170 million from the Sindh government to match financial support of Rs258 million by GAVI.

He said GAVI’s funding was for children under five years of age while the Sindh government would cover children of above five years of age The EPI wing had been in conflict with People’s Primary Healthcare Initiative (PPHI), a programme run by the Sindh Rural Support Programme (SRSO), under an agreement with the Sindh government for the past several years. According to sources, since the PPHI is having control of primary healthcare component of health system in Sindh, it has to ensure immunisation. The PPHI does not have trained vaccinators and it basically runs BHUs.

But the PPHI rejects claim as according to PPHI programme director Dr Riaz Memon, the component of EPI has not been transferred to him at all. “It is for the first time that the PPHI will take care of vaccination/immunisation in Tharparkar and Tando Allahyar from this July as a pilot project under a separate Memorandum of Understanding (MoU),” said Dr Memon.

Published in Dawn, May 14th, 2014.