#1Country Presentation: Pakistan FUNCTIONS & COMPETENCIES, CHALLENGES & OPPORTUNITIES Dr. Syed Saqlain Ahmad Gilani, National Program Manager- EPI Pakistan Expanded Program on Immunization Government of Pakistan 1#2Population: 200 M Half a dozen major ethnic groups with their own language BALOCHISTAN FATA KHYBER PAKHTUNKHWA PUNJAB GILGIT- BALTISTAN AZAD KASHMIR Province Pop. Comparable Countries (population-wise¹) Philippines: 102.3 M Punjab 100.6 M Ethiopia: 101.9 M Saudi Arabia: 32.2 M KP 32.9 M SINDH Sindh 55.3 M Afghanistan: 33.4 M Morocco: lochi 34.8 M Tanzania: yberF55.2 Mkhwa Myanmar:git-B54.4 M South Africa: 55 M 1.Population - Both Sexes". World Population Prospects, the 2015 Revision. Unit ed Nations Department of Economic and Social Affairs, Population Division, Pop ulation Estimates and Projections Section. July 2015. Retrieved 1 June 2016. Cambodia: Balochistan 14.2 M Senegal: 15.8 M 15.6 M#32011: 18th Constitutional Amendment Devolution: implementation/execution delegated to provinces Before devolution • • . • Direct involvement in the implementation Federal government: coordination, monitoring & supervision of the provinces & areas Coordination with donors and partners Role of National EPI programme team was limited to tackling managerial issues . . Immediately after devolution Lack of clarity in roles and responsibilities • Lack of coherence: national goals and policies not aligned with provincial plans and strategies Coordination issues with provinces, donors and partners Lack of leadership/guidance Weak programme capacities (federal and provincial level) ● ● 3#4• • Roles & responsibilities Federal National planning and strategies Technical guidance and support Donor/partner coordination Compliance to global/regional targets and agreements Surveillance, monitoring & evaluation . Provincial/District Provincial/district planning Implementation and execution Financing operations · Surveillance & response ● ● • Purchase and supply of vaccines/ syringes and logistics ● Supervision, monitoring and reporting to federal EPI Storage and distribution of vaccines/other supplies Repair and maintenance of cold chain equipment Regular capacity building of staff Training of trainers 4#5Challenges for the EPI programme after Vaccine procurement issues leading to stock-outs devolution Ambiguity in federal vs. provincial responsibilities ToRs did not change with new roles Data quality issues; weak VPD and AEFI surveillance CHALLENGES AFTER DEVOLUTION Inadequate monitoring capacity Aged cold- chain infrastructure insufficient capacity Limited operational resource allocation, ad hoc financing#6• • ● • . Improvements in EPI programme since 2015 Change in roles at federal level: greater focus on management, leadership and donor coordination Federal EPI responsible for decisions on new vaccines for the entire country (PCV10, IPV, tOPV-bOPV switch, Rota) New mechanisms for donor funds evolved New procurement mechanisms particularly for Gavi co-financed vaccines (pool procurement, single source exemption; UNICEF) Use of technology for programme performance monitoring Uniform reporting mechanisms and improved data quality Approved applications to Gavi (Measles SIA, HSS, CCEOP) 6#7Current functions for the National EPI team Expanded Role of National EPI: From Leadership to Technical guidance and Policy making Main functions at federal level are: Vaccine and cold chain procurement Annual budget of EPI is ~USD 160M, including vaccine procurement on Result based disbursement to provinces behalf of the provinces by Verification of Performance through Third Party Co-ordination with provinces & international donors Monitoring data quality, training & supportive supervision VPD and AEFI Surveillance 7#8Main capacities needed Capacity/Skills Needed Leadership with right qualifications & technical skills Coordination with different Ministries, Department of Health, provincial programmes, Donors/partners Capacity for financial management and funds utilization Vaccine and supply chain management: Forecasting and procurement M&E, Using data for policy making and surveillance 8#9Remaining challenges and gaps Inadequate technical capacity in surveillance and M&E Financial sustainability Sustaining the surveillance system Capacity of HR particularly at Provincial level Quality data Service delivery mostly outreach based, Demand promotion and trust of the community Implementation of the CCT 9#10• Country level support needed Developing the programme capacity in the line with recent strategic/functional review supported by GAVI Comprehensive HR review to assess need/scope Strengthening ICC for better coordination To continue the support for the sustainability to strengthening VPD and AEFI surveillance Support in developing EPI dashboard for data from district to provincial and federal level for strategic decision making. 10#11Summary The Year 2011 devolution initially led to a great deal of confusion The roles at different levels in the system were clarified There is now better coordination and collaboration between provinces and the national level Since 2015 several new improvements have been implemented Advice for countries undergoing restructuring 1. Clear functions and capacities at every level 2. Good coordination and communication between the levels Right person in the right job 11#12BEFORE AND NOW 18-M www 12 12#13CAMERAO USE OF TECHNOLOGY CAMERADE CAMERA7 CAMERAOS CAMERA10 CAMERA11 USAIDEEUVER CAMERA04 VLMIS CONTROL ROOM MONITORING OF COLD AND DRY STORE (24-HOUR CCTV) LOGISTICS LOGISTICS LOGISTICS HDMI3/DVI LOGISTICS LOGISTICS HDM13/DVI LOGISTICS 13#14THANK YOU 14