Reaching the Hard-to-Reach

1. Reaching the Hard-to-Reach
Migrants, Nomads, IDPs & Border Communities
Lessons from the CORE Group Polio Project in India,
South Sudan, and the Horn of Africa

2. Session Objectives
By the end of this session, participants will have:
(1) Examined strategies to reduce inequity in local
health systems by reaching marginalized groups and
improving immunization systems
(2) Considered how these strategies can be applied to
other public health initiatives

3. Current CGPP country
Past CGPP country
647
2,710
319
4,296
1,238
9,210 community mobilizers in five countries

4. CORE Group Spring 2015
Global Health Practitioner Conference
Hilton ,Alexandria , VA
16 April 2015

5. Reaching the hard – to – reach population
Lessons from India Polio Eradication Program.

6. Presentation outline
• About CORE Group Polio Project India
• Inequity
• Strategies to reach out to marginalized
groups
• Communication Package
• Lessons learnt

7. The CORE Group Polio Project (CGPP)
– Partners : ADRA, PCI and CRS and 10 national
NGOs
– The secretariat works in close collaboration with
the Ministry of Health, WHO, UNICEF, Rotary
International and USAID.
– In 2003, UNICEF & CGPP started working together
as the ‘Social Mobilization Network’ (SM Net) to
provide concentrated support in high risk areas
(for polio) of Uttar Pradesh state.
– CGPP reaches about 600,000 under 5 children in
12 districts of UP through 1300 + mobilizers

8. 01
42
741
559
874
676
66
134
225
268265
1126
0
300
600
900
1200
1500
1800
2100
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*
P1 wild P3 wild* data as on 14 September 2012
P2 wild
Polio : Progress in India – A snapshot
• 1995: Polio SIAs (campaigns) launched
• 1997: Acute Flaccid Paralysis (AFP) Surveillance initiated
• 1999: Last case of Wild Polio Virus (WPV) type 2 – (U.P)
• 2010: Last case of WPV type 3 - (Jharkhand)
• 2011: Last case of WPV type 1 - ( West Bengal)
• 2012: India removed from list of endemic countries
1600
mOPV 1 bOPV 1 & 3

9. Location of poliovirus by type, 2011*
Wild Poliovirus
13 January, 2011
Howrah, West Bengal
Rukhsar : The Last
case of polio in Inida

10. Dr Poonam Khetrapal Singh, Regional Director, WHO SEARO receiving
the polio-free certificate from the Chairperson of Regional Certification
Commission for Polio Eradication
27 March 2014
WHO South-East Asia Region certified polio-free

11. India/Uttar Pradesh
Polio Stats
NIDs started from 1995.
2.3 million vaccinators reach about 175 million <5 children on each
NID.
Govt. of India contribution to Polio Eradication 1985- 2012
$1237.28 million
U.P State
75 Districts
Population: 199.6 million
Under 5 population: 25 million
33 million houses visited by polio vaccination teams per SIA round

12. Non-
migratory
93%
Migratory
7%
Non-
migratory
98%
Migratory
2%
Uttar Pradesh
(N= 111)
Bihar
(N= 83)
WPV cases by migration status, 07-09*
Non-
migratory
58%
Migratory
42%
Rest of India
(N= 31)
* data as on 30 october 2009
Non-
migratory
85%
Migratory
15%
Non epidemic UP*
(N= 54)
*Non epidemic UP excludes Moradabad, JP Nagar,Badaun, Kanshi ram nagar, Bareilly and Rampur dists of UP
Inequity :
disproportionate
number of Polio
cases were
reported among
migrant
population

13. 4 - 6 doses
12%
>=10 doses
65%
1 - 3 doses
5%
7 - 9 doses
18%
0 dose
0%
(N=171)
Migratory * Non-migratory
* data as on 31 October 2009
4 - 6 doses
8%
>=10 doses
77%
1 - 3 doses
1%
7 - 9 doses
14%
0 dose
0%
(N=20458)
Immunization status among 6 months to 5 years :
2009
• Urban slums have been excluded from the migratory category
• OPV coverage among Non-Polio AFP cases

14. Marginalized Groups
Brick Kilns workers
Construction sites
Nomads

15. Reaching out to marginalized
groups: Bringing equity in Health
System

16. Tracking of High Risk Groups
• Mapping of HRGs
sites.
• Regularly updating the
data
• Joint validation of data
with WHO & Govt.

17. Tracking of High Risk Groups (HRGs)
• Identifying informers
 Brick kiln
owners/managers
 Construction contractors
 Barbers
 Gate keepers in slums

18. HRGs Tracking Format

19. 1. Inclusion of > 400,000 high risk settlements with
Routine Immunization micro plans
~ 257,000 Migrant sites
Migrant sites
High risk areas in
settled population
~ 154,000 HR areas in settled
population
= 10 Migrant sites = 10 HR sites

20. Unreached
the

21. Barbers
Shopkeepers
Brick kiln owners
Small contractors
Identification
of informers
More than 1000
informers identified

22. Need to shift from
extensive mass awareness
approach to addressing
specific conditions/needs
of specific groups

23. Tailor made strategies

24. Revised communication package

25. Focus on skill
building of
communicators
Shift from instructive to
negotiation approach

26. A strong MIS supported activity
planning and implementation

27. 2. Orientation of informers
These platforms helped clarify
myths/misconception related to the program.

28. Role of informers
Inform the mobilizers immediately about
new settlements and families

29. 3. One to one and group meetings
Went as per their convenience

30. 4. Pictorial materials displayed at strategic locations
Any where you go
Give shots & polio drops

31. 5. Health camps/outreach services held

32. Tapping opportunities for
announcements of key messages
Tapping opportunities for
announcements of key messages

33. More than 250000 sites were
identified

34. Lessons learnt
• Working in partnership works!
• Strong Government ownership at all levels
• Synergistic & non-overlapping support by partners
enhances programme effectiveness
• Data driven decision making to identify and respond to
unreached areas/populations
• Communication strategies need to be tailor made as per
audiences profile
• Simple, picture & action oriented communication
materials works better
• Tracking system can used in other programs like TB, Ebola.

35. Thanks

36. Community volunteers support in strengthening weak
health system in South Sudan to reach the hard to reach
population
Core Group Spring Meeting
Presenter: Anthony Kisanga
Core Group South Sudan
April 13-17, 2015

37. Presentation outline
• Definition of terms
• Brief introduction on the health situation in South
Sudan
• Background to CGPP Sudan
• Contribution of community volunteers
• Outcome of community volunteers contribution
• Challenges
• Lessons learnt
• Conclusion

38. Definition of terms
• Community Volunteers: a group of individuals who has
undergone basic or no formal education at all but provides
significant community health intervention. They are
selected, trained and working for their own communities
but not necessarily part of the formal health system, they
include vaccinators, cold chain assistants, community
mobilizers and independent monitors.
• Hard to reach communities: communities who are not
easily accessible to health services due to one or more
adverse conditions: distance from the nearest health
facility, difficult terrain (mountainous areas, forested
areas), flooding, insecurity, poor or unreliable road
networks, nomadic lifestyle.

39. Cont….
• Weak health system: a health system which is
unable to meet the basic health needs of its people.
Weakness in light of insufficient qualified health workers,
diseases surveillance, public awareness, chronic shortage
of supplies e.g. vaccines, inequality in distribution of health
workers and health facilities, limited or no community
outreach programs and engagement of the local
population.

40. Brief introduction on the health situation in
South Sudan
• South Sudan become independent in July 2011, 10 States
and 79 counties
• Population project (2012) puts the figure for South Sudan
at 11,532,241
• Only one third of the country has access to basic health
services
• It has 1,090 functional health facilities with 37 of them
being hospitals.

41. Cont…..
• It has the worst shortage of health workers put at 1.5
doctors and 2 nurses per every 100,000 population.
• Extreme inequality in distribution of health facilities and
health workers with urban areas most favored
• Its maternal mortality ratio stands at 2,054/100,000 and
under five mortality rate was estimated at 135/1,000 live
births. (Sudan HH Survey 2006/2010)
• 2011 EPI survey shows 16.5% of children under the age of
one fully vaccinated and only 22.1% completed OPV3.

42. Background to Core Group South Sudan
• Started operations in 2011, within eight worst performing
counties in immunization mostly based at the Southern
borders of South Sudan.
• Core Group South Sudan has three partners: American
Refugee Committee, World Vision South Sudan and Amref
Health South Sudan.
• It supports comprehensive EPI services that focuses on;
1. Routine immunization both at facility and community level
2. Support Polio National Supplementary Immunization Days
3. Community-based disease surveillance

43. Cont…
• Works in Eight counties ( Western, Central and Eastern
Equatoria States)
• 955 volunteers (358 vaccinators, 54 cold chain assistants,
319 community mobilizers and 224 independent
monitors)

45. Why these counties?
Selected by MoH
Criteria of selection:
Poor performance routine
immunization.
Along the border areas to
Interrupt transmission
Hard to reach
(MOH Administrative Data)

46. Contribution of community volunteers
• Under this theme we shall be looking into the following areas of
health system strengthening that community volunteers have
supported:
1. Community-centered planning
2. Service delivery
3. Supply chain
4. Monitoring and evaluation (disease surveillance, monitoring
quality of polio immunization campaigns)
5. Cross border initiatives

47. Community-centered planning
• Engagement of community
leaders in social mapping
• Wealth of knowledge by the
community
• Trust in whatever is done
• Acceptance
• Ownership
• Accountability

48. Service delivery
Shortage in professional trained health
workers.
Only 30% of South Sudanese have
access to basic health service.
Inequality in health facility and health
workers distribution.
Outreaches: 5 kms and above
Other facilities with no cold chain
Vaccination under trees, churches,
schools in the villages

49. Improving knowledge on immunization services using local
acceptable means in the community
Mothers group dialogue
Drama
Local music
Community leaders meetings

50. Overcoming challenges in transport means to reach the unreachable
during polio campaign

51. Improving vaccine stock outs in the remote health facilities
Reduced stock out of
vaccines from 100% in 2011
to less than 10% in 2014
By using the cost effective means of
transport .
Delivering vaccines from county
Vaccine stores to the most remote areas

52. Community disease surveillance
319 community mobilizers
Conduct active AFP case search
Report other diseases e.g. measles
Report to the nearest health center or WHO
Field assistant for investigation
Educate households
Refer mothers & children for vaccination
Organize for outreach in their villages in
Collaboration with vaccinators

53. 48%
41%
45%
32%
36% 34%
76%
59%
78%
118%
109%
88%
120%
116%
74%
104%
0%
20%
40%
60%
80%
100%
120%
140%
Magwi Morobo Kajo-Keji Nzara Yambio Ibba Kapoeta East Kapoeta
South
Coverage(%)
Counties
DPT3 Performance in Core Group supported counties from 2011-2014
Baseline
2014
(MOH Administrative Data)
Using resources in the polio
eradication to support routine
immunization
Outcome of the contributions of the
community volunteers

54. Contribution of community volunteers in surveillance 2012-2014
54
2012
2014
Data source: WHO & project reports

55. Monitoring of polio campaigns
• 224 independent monitors
• Reaching every town and village
• Focus on hard to reach areas-hard
to reach communities.
• Report all missed areas to
campaign supervisor-map ups
• Use information for planning

56. Cross border vaccination • To interrupt transportation of wild polio
virus.
• Implementing partner-Implementer
• Done in collaboration with MoH, WHO
and UNICE

57. Challenges
• Inadequate funding to strengthen the already improving
services and scaling to other poorly performing counties
• Due to the level of poverty in the community, the
expectation of pay among project volunteers
• Poor transport infrastructure- poor roads, flooding,
inadequate transport means.
• Insecurity in the remote areas- arrest of volunteers in
doing their work in some insecure areas.

58. Lessons learnt
• Integration of the community volunteers’ activities into the
formal health system is critical for the success of the
program.
• Collective planning with the community leaders, facility
based health workers and volunteers results to ownership
of the program
• Community volunteers play a very pivotal role in
strengthening the health system through their engagement
and participation.

59. Cont…..
• Working with community volunteers who hail from that
community leads to a lot of trust resulting in acceptance of
the program and improved uptake of vaccine which
culminated in improvement in immunization coverage in
most of the counties.
• Strong collaboration between community leaders, the local
health authorities and presence of supporting partner on
the ground

60. conclusion
• Due to the weak health system in South Sudan resulting in
worsening health indicators, there is no doubt that
involving community volunteers and linking them to the
formal health system is important if we are to reach the
unreached with lifesaving health interventions.

61. 61
Questions?
Photo: Gatesfoundation.org

62. Reaching Border Communities for
Polio Eradication in Horn of Africa
CORE Group Spring Meeting 2015
Virginia, USA
Bal Ram Bhui, CGPP HOA

63. Presentation Objectives
• To provide an overview of process of Cross
Border Initiative for Polio Eradication in Horn
of Africa
• To describe various tools for planning,
reporting and monitoring.
• Progress, challenges and plans ahead

64. Outline
• Overview of PEI in HoA
• Overview of cross border efforts for polio
eradication in HOA
– Cross border issues in HoA for polio eradication
– Cross border meeting for SIA in HoA
• Cross border initiative for polio eradication
– CORE Group model for reaching hard reach/high
risk and mobile population in along borders

65. Confirmed Polio Cases, Kenya,
2006 — 2014*
South
Sudan
Ethiopia
Somalia
Uganda
19 Cases onset on
3rd Feb to 30th July
2009; in 3 Turkana
districts
2 Cases reported in 2006,
Sept and Nov Garissa District
1 Case onset on 30th July 2011;
Kamagambo , Rongo District
14 Cases reported in 2013 in
Dadaab & Hulugho Districts
; Onset of latest case 14 July
2 Cases cVDPV reported in
2012, June Dadaab District
1 environmental Sample
positive for WPV1 Oct
2013

66. 4/27/2015 66
Outbreak following importation, 2004-08
Outbreak started
04 April 2008;
Latest Case
27 April 2008
N=3

67. Somali Region WPV-1 Outbreak Affected Woredas
from July 2014 up to January 14

68. • The total polio cases during the 2008-09
epidemic were 64 cases
– 24 cases in 2008
– 40 cases in 2009
• The last polio case in South Sudan was on
27/6/2009 (Aweil West).
• During the period June 2008 to
December 2012 a number of 29 SIAs
were conducted
2008 2009
19 Cases onset on 3rd
Feb to 30th July 2009; in
3 Turkana districts
1 Case onset on 30th July 2011;
Kamagambo , Rongo District
History of polio out break in HOA – 2008-2009 Outbreak
in SSD
Exportation of the SSD
outbreak to Kenya
(2009)

69. Border Population at Risk
• The cross border community and population at high risk for
outbreak and transmission of infectious diseases including polio
• Border communities share ecology, epidemiology, culture and
values
• Borders are only politically divided
• Borders are likely to be
– Hard to reach
– Left out
– Socio-economically disadvantaged
• Borders are porous, free movement
• People move for trade, pastures, health care, education, cultural
reasons, recreation, migration, conflict and security reasons

70. Cross border meetings for polio
eradication
• 2012 Cross border meetings of Ethiopia, Somalia, South
Sudan, Sudan and Kenya
• Cross border meetings by CORE Group South Sudan with
Ethiopia, Kenya, DRC, Uganda
• Achievements:
– Awareness and commitment of MOH, increased
– Synchronized SIAs along the borders
• Challenges:
– Meeting was one time before SIA, no follow up
– Action plan not implemented
– No reporting, monitoring and evaluation
– No plan to improve PEI efforts in border communities on
ongoing basis

71. Source: http://kenya.iom.int/about-iom/iom-kenya-strategic-focus
Major Migration
Routes
Strategic, irregular
Multitude of factors
o Political/Conflict
o Environmental
o Economic
Monthly
Updates

72. CORE Group in HoA
• HOA regional secretariat in Nairobi
• CGPP Project in Ethiopia since 2001
• CGPP Project in South Sudan since 2010
• CGPP in Kenya and Somalia
– Kenya Border counties – Turkana, Marsabit, Wajir,
Mandera, Garissa
– Nairobi
– Lower Juba, Gedo, Mudug in Somalia
– CORE Group NGOs and National NGOs implement the
project

73. Cross border initiative (CBI) for Polio
Eradication
• What is CBI
– Understanding about border
communities, border crossing points
and transit hubs and addressing them
for polio eradication internally as well
as with border counterpart
– Initiative at operational border health
authority levels
• Who are involved in CBI
– National MOH
– County government and health office
– Local immigration and security
authorities
– Polio Partners and NGOs
• Where is CBI institutionalized
– Border between Kenya, Somalia,
Ethiopia, South Sudan and Uganda

74. Goal and Objectives of CBI
• Goal: Contribute to global eradication by improving
population immunity in cross border communities and
populations with effective AFP surveillance
• Objectives: Improve cross border collaboration between
health, administrative authority of border regions and the
partners to
– Improve PEI efforts in border communities and populations
– Improve coverage and synchronization of SIAs at cross border
points
– Establish permanent vaccination points at major crossing points
– Improve PEI efforts in transit hubs and routes
– Improve communication and collaboration between border
health offices

75. CORE Group CBI approach
• Country internal approach
– Situation assessment of polio eradication in border
health facilities and populations
– Polio eradication action plan for cross border
communities and populations
• Cross border joint approach
– Identification of populations and areas for cross
border collaborations
– Joint action plan
– Cross border health committee and TOR
– Cross border planning and review meetings

76. Country internal approach
• Situation assessment
– Profiling of border communities, crossing points, transit hubs
– Mapping of border communities, crossing points, transit hubs
– Capacity assessment of border health facilities
– Micro planning for SIA, RI, AFP Surveillance for border areas
• Country action plan to address cross border issues for polio
eradication
– Action plan to support border health facility improve SIA
coverage, Routine Immunization Coverage and AFP surveillance
sensitivity
– Cross border health committee members designated
– Regular review and reporting on implementation of action plan

77. Show Table data – CBI tools

78. 1. List of Fixed posts, Villages, Markets, Nomadic/Pastoral camps and Border communities and crossing posts by health facility in a Location
NB: List ALL villages in each location with their target populations. Also list markets, seasonal camps (pastoralists, nomadic, etc.), schools, transports stations, re
1 LIBOI Hc-SALAT MOHAMMED 1 DAMAJALEY DISPENSARY.-EVANS ARIAM 1 HAMEY DISPENSARY-SAMUEL CHEPSAIG 1
Health Facility (name) (Subsidiary) Health Facility (name) (Subsidiary) Health Facility (name) (Subsidiary) Health Facility (name) (Subsidiary
1.1 1.1 1.1 1.1
1 1.2 1.2 1
Village/Estate - Target populatioon 3484Village/Estate - Target population 925 Village/Estate - Target population 666 Village/Estate (Name/Target
1 Bula safaricom-190 1 Bula sheikh-75 1 Bula borehole-65 1
2 Bula makabul-210 2 Bula Tuhun-80 2 Bula banaan-70 2
3 Bula Sambule-220 3 Bula Daidei-90 3 Bula Primary-62 3
4 Bula Torotoro-210 4 Bula Hodhan-68 4 Bula labi-58 4
5 Bula Mohamed Zubeir-180 5 Bula Towfiq-74 5 Bula mosque-55 5
6 Bula Oji-90 6 Bula Primary-85 6 Bula camp-60 6
7 Bula Celtel-190 7 Bula Labatule-70 7 Bula Sheikh-52 7
8 Bula Sufi-215 8 8 Bula daidai-58 8
9 Bula Maseer-200 9 9 9
10 Bula Dana-230 10 10 10
11 Bula hursan-210 11 11 11
12 Bula Haji-174 12 12 12
13 13 13 13
14 14 14 14
15 15 15 15
16 16 16 16
Markets including supermarkets,
transport stations, schools and
religious places (Day and place): Markets (place & day) Markets (place & day) Markets (place & day)
1 Liboi Primary School 1 Damajaley market centre 1 Hamey market centre 1
2 Madina Academy 2 Damajaley Primary sch 2 Hamey Primary school 2
3 Liboi Airstrip 3 Damajaley mosque 3 Hamey animal watering point 3
4 Liboi Madrssa 4 Damajaley animal watering point 4 Hamey mosque
5 Liboi Mosque 5 5
6 Liboi KDF camp 6 6
7 Liboi Market centre 7 7 4
Seasonal Settlements Seasonal Settlements / Hard-Reach Seasonal Settlements / Hard-Reach Seasonal Settlements / Hard-R
1 Wardaklow-25 1 Abaq dam-10 1 Guba athey-28 1
2 Ali gabey-30 2 Gari gubane-12 2 Gadable-22 2
3 Welcadcad-30 3 Tarsis-18 3 3
4 4 Daryolle-13 4 4
5 5 Dobale dam-23 5 5
6 6 6 6
7 7 7 7
Hard to reach/high risk
village/settlements
Hard to reach/high risk
village/settlements
Har
d
to
Hard to reach/high risk
village/settlements
H
ar
d
Hard to reach/high risk
village/settlements
1 Deg-elema-750 1 Magudo- 65 1 Deq-athey-70 1
2 Harhar-200 2 Aden santur-72 2 Homijo-65 2
3 Dat-quran-100 3 Ali dakane-60 3 3
4 Indatha Dam-30 4 Abdi sugow-110 4 4
5 5 5 5
6 6 6 6
7 7 7 7
Health Facility (name) (Responsible) Health Facility (name) (Responsible) Health Facility (name) (Responsible) Health Facility (name) (Responsible
Mapping of villages

79. Bordering country(ies): KENYA/SOMALIA Bordering location/districts: LIBOI DIVISION/DADAAB SUB COUNTY
DOBLEY/HOSUNGOW
Date: 27/3/2015
Border country Name/area: Somali
SN Name of border
crossing/entry-exit
points
Name of
village along
the border
crossing
points
Name of
health facility
that the
crossing points
belong to
Is crossing
point
formal or
informal?
1-Formal,
0-
Informal
Average
number of
people
crossing
the
border in
a day
How will this crossing point be
covered during SIA? (A static
vaccination team, mobile
vaccination team designated
for cross border points, none)
Name of border
crossing/entry-exit points if
different
Name of village
along crossing
points in other
side of border
Name of health
facility that the
crossing points
belong to in other
side of border
How will this
crossing point be
covered during SIA?
(A static vaccination
team, mobile
vaccination team
designated for cross
border points, none)
Comments
Deg-elema Deg -elema Liboi Hc 0 60 Mobile Deg- elema Deg- elema None
Coverage to be
discussed with CB
country/WHO
Harhar Harhar Liboi Hc 1 150 Mobile Dobley Dobley Dobley hospital
Coverage to be
discussed with CB
country/WHO
Magudo Magudo Damajaley disp 0 Mobile Magudo Magudo None
Coverage to be
discussed with CB
country/WHO
Aden santuir Aden santur Damajaley disp 0 10 Mobile Aden santur Aden santur None
Coverage to be
discussed with CB
country/WHO
Ali Dakane Ali Dakane Damajaley disp 0 10 Mobile Ali Dakane Ali Dakane None
Coverage to be
discussed with CB
country/WHO
Abdi sugow Abdi sugow Damajaley disp 0 30 Mobile Abdi sugow Abdi sugow None
Coverage to be
discussed with CB
country/WHO
Deq-athey Deq-athey Hamey Disp 0 70 Mobile Deg-athey Deg-athey None
Coverage to be
discussed with CB
country/WHO
Harmujo Homijo Hamey Disp 0 25 Mobile Hosungow Hosungow None
Coverage to be
discussed with CB
country/WHO
Total
1.2. INTERNATIONAL CROSS BORDER PLAN - Border crosing points
Kenyan villages covered by Kenyan teams are
in Kenya's microplan. Other villages will be in
border country's microplan
KENYA
Mapping of cross border communities

80. 1.1. INTERNATIONAL CROSS BORDER PLAN - Border communities
Bordering country(ies): KENYA/SOMALIA Bordering location/districts: LIBOI /DAMAJALEY/HAMEY LOCATION
Date:
Border country NamSomalia
Kenyan villages
along border
Name of Health Facility
Target Pop.
(Polio SIAs)
Country
covering
Date of
vaccinati
on
Border country's
villages
to be covered
by Kenyan teams
Border Health
facility name
Target Pop
(Polio SIAs)
Kenyan
Team ID
Date of
vaccinati
on
OPV
required
(doses)
LIBOI HEALTH CENTRE
Deg-elema
LIBOI HEALTH CENTRE
Kenya 20/4/15 Deg-elema
Harhaar
LIBOI HEALTH CENTRE
Kenya 20/4/16 Dobley
Dat-quran
LIBOI HEALTH CENTRE
Kenya 21/4/15
DAMAJALEY DISPENSARY
Magudo
DAMAJALEY DISPENSARY
Kenya 20/4/15
Aden santur
DAMAJALEY DISPENSARY
Kenya 20/4/16
Ali Dakane
DAMAJALEY DISPENSARY
Kenya 21/4/15
Abdi sugow
DAMAJALEY DISPENSARY
Kenya 21/4/16 Hosingow
HAMEY DISPENSARY
Deq-athey
HAMEY DISPENSARY
Kenya 20/4/15
Homijo
HAMEY DISPENSARY
Kenya 21/4/16
Total
KENYA
Kenyan villages covered by
Kenyan teams are in Kenya's
microplan. Other villages will be
in border country's microplan
Mapping of border crossing points

81. Cross border mapping

82. Social map of a border health facility

83. Profiling of border communities

84. Cross border joint approach
• Cross border initiative operation guide
• Joint action planning workshop
• Review, reporting and documentation of cross
border activities
• Quarterly cross border health committee
meetings
• Regular information sharing between border
county/district health office
• Engagement of border immigration, security and
other border stakeholders

85. Implementation
• Monthly meeting of cross border health committees on
each side
• Joint quarterly meeting of cross border health committee
• Semi-annual and annual review meetings
• Implement and report on action plan
– Synchronization of vaccination at border crossing points
– Actions to improve AFP surveillance of border health facility
catchment areas
– Actions to improve routine immunization in border health
facility catchment areas
– Permanent vaccination points
– Regular communication between parties

86. Progress to date (1)
• Initiated in October 2014 as a process
• Developed necessary assessment, planning and
reporting tools
• Microplanning for cross border issue at border health
facility level initiated
• Cross border Initiative Operation Guide developed
• High level of commitment and support from MOH,
County Health Office, Immigration and Security offices
• High level of commitment from polio Partners – WHO
and UNICEF and NGOs

87. CBI Progress (2)
Country Dates of meeting Venue Countries attended Key objective
Kenya September 22-23,
2014
Turkana Kenya, South Sudan,
Uganda
To map border points to cover in upcoming SIA
and to have a joint action plan for
synchronization of SIA
Kenya October 29-30, 2014 Moyale Kenya and Ethiopia To map border points to cover in upcoming SIA
and to have a joint action plan for
synchronization of SIA
Djibouti October 28 – 29
2014
Djibouti Djibouti, Yemen,
Somalia, Ethiopia
To review the implementation of
recommendations of last workshop and plan for
upcoming SIA in the region
Kenya January 21, 2015 Moyale Kenya and Ethiopia Cross Border Health Committee meeting: To
review cross border collaboration in last SIA, To
review terms of reference for the committee
South Sudan 8 cross border committees in 8 counties are functional
South Sudan Permanent transit vaccination point established in Lotiimor, Nadapal, 2,042 children
moving between countries were vaccinated in Aug-Dec 2014
South Sudan Vaccination teams in 20 border crossing points in 6 counties in Nov and Dec SIA 2014
vaccinated 11,242 children moving between countries

88. Plans ahead
• Plan to expand
– North Horr, Kenya between Kenya and Ethiopia
– Mandera, Kenya between Kenya, Ethiopia and Somalia
– South Central Zone, Somalia with Kenya
• Provide field support to county health offices for CBI through Sub Grants
to NGOs
• Complete profiling and mapping of cross border communities, border
crossing points and transit hubs.
• Improve SIA coverage, Synchronization of campaigns, routine
immunization , and improved AFP surveillances in border communities
• Regular review and planning meetings on CBI internal and with cross
border area
• Improve communication between cross border health facility and
authorities
• Improve Polio Partners Collaboration on cross border initiative