Report on Polio eradication cross-border meeting for Afghanistan, Islamic Republic of Iran, and Pakistan, Zahedan, I.R. of Iran, October 2015
In 2015, only 2 countries (Afghanistan and Pakistan) remain polio-endemic, down from more than 125 in 1988. As long as a single child remains infected, children in all countries are at risk of contracting polio. Most of Afghanistan is polio-free. The country has not yet interrupted transmission of wild poliovirus. While most cases in 2014 were due to poliovirus imported from neighboring Pakistan, there is also ongoing transmission of virus within Afghanistan. Similarly, most of Pakistan is polio-free. The country has never interrupted transmission of wild poliovirus. Transmission is intense in the Federally Administered Tribal Areas (FATA), and periodically spreads to other parts of the country and internationally. In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.
Report on Polio eradication cross-border meeting for Afghanistan, Islamic Republic of Iran and Pakistan, Zahedan, Iran, October 2015
Seyed Mehdi Tabatabaei
Deputy for Health, Zahedan University of Medical Sciences
Kaydokht Kaykavoosi
International Affairs Office, Zahedan University of Medical Sciences
Contents
Field Visit to Seyed-Al-Shohada Urban Health Center in Suburban Areas of Zahedan
Community Health Volunteers and Communicable Diseases Preventive measures
Boo-Ali Infectious Diseases Specialty Hospital
Infectious Diseases and Tropical Medicine Research Center
Meeting with the Governor General of Sistan & Balouchestan Province of Iran
Technical session on Regional Public Health Challenges
Visiting the Disaster Risk Management Center
Visiting the Vaccines Cold Chain and Biologicals at the ZAUMS Deputy for Health Building
Technical Joint meeting on polio eradication in the region
Introduction
In 2015, only 2 countries (Afghanistan and Pakistan) remain polio-endemic, down from more than 125 in 1988. As long as a single child remains infected, children in all countries are at risk of contracting polio. Most of Afghanistan is polio-free. The country has not yet interrupted transmission of wild poliovirus. While most cases in 2014 were due to poliovirus imported from neighboring Pakistan, there is also ongoing transmission of virus within Afghanistan. Similarly, most of Pakistan is polio-free. The country has never interrupted transmission of wild poliovirus. Transmission is intense in the Federally Administered Tribal Areas (FATA), and periodically spreads to other parts of the country and internationally. In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.
In the context of the framework of mutual cooperation to foster polio eradication in the region , a two-day International Border meeting was planned by the Office of Acting Minster for International Affairs , Ministry of Health, Iran and hosted by Zahedan University of Medical Sciences, Zahedan, Iran. The final program of the meeting has been presented in Table 1.
Table 1- International Border Meeting to Foster Polio Eradication in the Region ZAUMS Final Program
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Wednesday 30/September/2015 |
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Time |
Program |
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06:30 |
Departure from Tehran Mehrabad Airport |
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08:30 |
Arrival at Zahedan Airport |
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8:45-9:00 |
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9:00 - 9:30 |
Breakfast & Opening Session |
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9:30-11:30 |
Visiting an Urban Health Center and a Health Post in Zahedan Suburban areas |
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12:00 -13:00 |
Boo-Ali Infectious Diseases Hospital & Infectious Diseases & Tropical Medicine Research Center |
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13:00-15:00 |
Lunch & Prayer Break |
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16:30-17:30 |
Meeting with Sistan & Balouchestan Province Governor General |
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17:30-18:00 |
Prayer break |
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18:00-20:15 |
Technical session on Regional Public Health Challenges |
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Holy Quran Recitation & National Anthem |
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An Introduction to the Iranian Primary Health Care System |
Dr Tabatabaei Deputy Chancellor for Health, ZAUMS |
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Capabilities of ZAUMS & Regional Public Health Challenges |
Dr Miri Chancellor of ZAUMS |
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Capabilities of Zabol UMS & Regional Public Health Challenges |
Dr Nasiri Chancellor of Zabol UMS |
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Capabilities of Iranshahr Faculty of Medical Sciences & Regional Public Health Challenges |
Dr Zareban Dean of Iranshahr Faculty of Medical Sciences |
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Capabilities of I.R. of Afghanistan MoH & Areas for Future Cooperation |
Representative of I.R. of Afghanistan MoH |
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Capabilities of I.R. of Pakistan MoH & Areas for Future Cooperation |
Representative of I.R. of Pakistan MoH |
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Discussion & Conclusion Remarks |
Dr Miri Chancellor of ZAUMS |
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20:30-21:00
21:00-22:00 |
Visiting ZAUMS Provincial CDC & Vaccines and Biological Cold Chain Reception Dinner Hosted by ZAUMS Chancellor |
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Thursday 1/October/2015 |
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Time |
Program |
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6:00- |
Departure from Tehran Mehrabad Airport (Dr Asadi Lari & Dr Gooya) |
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8:00 |
Arrival at Zahedan Airport |
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8:30-11:45 |
Regional Joint meeting (ZAUMS PHC meeting Hall) |
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Holy Quran |
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Introducing Invitees & Welcome Speech |
Dr Asadi Lari Acting Minister for International Affairs Depart. |
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Vaccine Preventable Diseases Program in I.R. of Iran/ Achievements & Challenges |
Dr Zahraee Vaccine Preventable Diseases Office, I.R. of Iran, Ministry of Health, CDC |
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Discussion |
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Communicable Diseases Control with Focus on polio Disease in Sistan & Balouchestan Province |
Dr Tabatabaei Deputy for Health, ZAUMS |
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Discussion |
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Polio Eradication Initiative in Afghanistan Population immunity, surveillance activity and endgame strategies |
Representative of I.R. of Afghanistan Ministry of Health |
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Discussion |
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Polio Eradication Initiative in Pakistan Population immunity, surveillance activity and endgame strategies |
Representative of I.R. of Pakistan Ministry of Health |
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Discussion |
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Polio Importation Risk Reduction |
Dr Gooya I.R. of Iran, Ministry of Health, CDC Director General |
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Discussion |
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Wrap up & Conclusion Remarks |
Participants |
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Delegations from Pakistan and Afghanistan ministries of health ,as their names appear in the Annex, visited the following public health units, hospitals and research centers affiliated with Zahedan University of Medical Sciences.
Field Visit to Seyed-Al-Shohada Urban Health Center in Suburban Areas of Zahedan
In the past three decades, the Islamic Republic of Iran has adopted a policy aimed at more strongly addressing the needs of its population, and substantial progress has been achieved both in the social and economic sectors. Since the revolution of 1979, a Primary Health Care network has been established throughout the country. In rural areas, each village or group of villages contains a Health House, staffed by trained "Behvarz" or community health workers - in total, more than 17,000, or one for every 1,200 inhabitants. These Health Houses, which constitute the basic building blocks for Iran"s health network, are the health system"s first point of contact with the community in rural areas.
In addition, Rural Health Centers were put in place. They include a physician, a health technician and an administrator, and deal with more complex health problems. On average, there is one Rural Health Center per 7,000 inhabitants. In urban areas, similarly distributed urban health posts and Health Centers have been established. The whole network is managed and administered through District Health Centers, answerable to the Ministry of Health and Medical Education. The universities of medical sciences, of which one exists in each province, play an important role in medical education and in the provision of health services. The Chancellor of the university as executive director of the provincial health services is also in charge of all district health centers and hospitals.
One of the basic public health services provided by urban health centers and health post is immunization, which is carried out according to the Iranian Expanded Program on Immunization, that has been launched more than 30 years ago.
During this visit the delegations from Afghanistan and Pakistan visited Seyed-Al-Shohada urban health center that included maternal and child health clinic, Community Health Volunteers section, Vaccination Unit, Diseases control unit, General Practitioner Clinic, Dentistry.
Some of demographic characteristics of the population served by this health center have been presented in Table 2.
Table 2-Demographic characteristics of the population covered by Seyed-Al-Shohaha Health Center, Zahedan, Iran
Community Health Volunteers and Communicable Diseases Preventive measures
Health volunteers are community members who work as a strong link between the health system and people in different levels of community. They participate in health training classes which is took place in health centers on a weekly base. They pass their knowledge to the community, particularly their relatives and neighbors. They do not expect any financial support for what they do sincerely to improve health condition of the community.
Presence of qualified and enthusiastic volunteers in the community has enabled Zahedan University of Medical Sciences to engage them in health care activities and implementing health plans in a close collaboration with health staffs. They transfer health messages to the community in a simple understandable way, in local languages.
Health volunteers main activities include:
- Public Health training
- Screening the population and referral of suspected identified cases
- Community mobilization and participation in vector control
- Cooperation in treatment and follow up
- CHVs participation in polio mopping-up campaigns ( Two rounds each year)
- Vaccine Buddies: Vaccination promotion by secondary school students
- Active malaria case finding by CHVs
- Setting up "Health Stations" to disseminate information regarding infectious diseases prevention & control
- Door-to-door filed visit for cholera prevention and drinking water sanitation
Boo-Ali Infectious Diseases Specialty Hospital
This is a 79 beds infectious diseases hospital that includes 19 beds for women and 18 for men wards, 14 TB beds, 5 ICU beds, 4 respiratory isolation, and 19 emergency ward beds. The hospital offers imaging services including ultra-sonography and CT scan. Diagnositc laboratory tests are being done in Boo-Ali hospital as well.
The average occupancy rate is 45%, with more than 17000 to 18000 emergency outpatient admissions per month. More than 250 patients with notifiable infectious diseases were hospitalized during the first six month of the current Iranian calendar year.
These included:
-69 cases of TB+
-35 cases of CCHF
-15 cases of HIV+
-18 cases of suspected measles (including 4 laboratory confirmed cases)
-1 cases of imported vivax malaria
-2 cases of Rabies that leaded to death
-6 cases of HBS Ag+
Infectious Diseases and Tropical Medicine Research Center
Infectious Diseases and Tropical Medicine Research Center, was established in 15th April 2006 to promote and conduct quality research in the field of infectious diseases. This research center provides consultative services to the healthcare providers, clinicians, public health managers and policy-makers in term of the diagnosis, treatment, prevention and control of infectious diseases in order to improve the health status of the people of this region.
This research center aims to apply the research findings in all aspects of infectious diseases and to promote research and provide solutions for health care that could result in tackling infectious and tropical diseases that exist in this area. Laboratory services include; Molecular Diagnostics tests( Hepatitis C, Hepatitis B,HIVI/II,HSV I/II,CCHF, Hepatitis B viral load, Hepatitis C viral load ,Mycobacterium tuberculosis), Flow Cytometry (CD4/ CD8 Absolute Count, ...),ELISA, etc.
The board of directors includes 6 infectious diseases specialist and an epidemiologist. The executive Board of this research center includes 5 staff with MSc degrees in microbiology, genetics and chemistry. Also this research center has 15 expert members as Scientific Advisory Board.
Meeting with the Governor General of Sistan & Balouchestan Province of Iran
The Governor General of Sistan and Baluchistan in the joint meeting with the delegations from ministries of health of Afghanistan and Pakistan and Afghanistan and Pakistan Consulate authorities in Zahedan, expressed that in fields of medical science and public health collaborations, our universities are ready for full collaboration with neighboring countries because human rights knows no boundaries. Human rights knows no borders and we have special attention towards our neighbors , as their weakness in any field will be our weakness and their strengths is our strengths as well.
Mr. Hashemi governor of Sistan and Baluchistan in this joint meeting said all three countries, Iran, Afghanistan and Pakistan are Muslim and religious teachings have taught us to appreciate the blessings of health and safety as the two great gifts bestowed upon us by Allah, the Almighty.
He added with developing viable strategies and planning we can improve health indicators in the border areas and if not it can endanger the health and lives of many human beings. For instance the mismanagement of the Hajj pilgrimage buy Saudi authorities resulted in the Mina stamped that claimed the lives of hundreds of innocent Muslims.
The Governor General mentioned the hadith of the Holy Prophet that everyone who wakes up in the morning and does not care about the affairs of Muslims , in fact is not a Muslim. He also added that neighboring countries are the best friends in need and we should be there for them.
Their weakness in any field will be our weakness and their strengths is our strengths as well.
He said scientific capabilities of Iran is already known to the neighboring countries. So we are fully prepared to develop cooperation with all other sectors, particularly in health with of both Afghanistan and Pakistan countries and it will bring success to all of us .
The governor said the development of relations with our neighbors and our neighbors is on top of our plans . In the field of medicine the gates of health, education , and treatment are open to our neighboring countries and we are sure that all of the abilities together can lead to the better performance of three countries in field of health
The Governor General said that we should think of a solution that could keep our borders clear from any infectious diseases and unfortunately illegal cross-border movements across the neighboring countries has been influencing the health status of the people in the region.
He expressed his hope that the legalizing and organizing the population movement across the borders in the region in near future will result in tackling the communicable diseases in the region.
Technical session on Regional Public Health Challenges
This meeting was chaired by the Chancellor of Zahedan University of Medical Sciences (ZAUMS) and participated by the board of executives from ZAUMS including deputies for Health, Research and Technology, Education, Food and Drug, and Cultural and Student affairs. Dean of Iranshahr Faculty of Medical Sciences and deputy for health and authorities from Pakistan Consulate in Zahedan also attended this meeting. Different areas for future collaboration between Pakistan and Afghanistan ministries of Health and ZAUMS and Iranshahr Faculty of Medical Sciences were discussed.
Dr Miri, Chancellor of ZAUMS announced that this university is ready to train more than 100 students from Afghanistan in different under and post-graduate disciplines, with 30 of them will be receiving a government of Iran free scholarships. He also mentioned that ZAUMS is ready to train community healthcare workers from Pakistan with particular emphasis on training vaccinators and primary healthcare workers.
He also added that because of relatively good hospital facilities in the Sistan and Blouchestan province, health tourism could be a great opportunity for offering quality and affordable treatment services to the people of the region. Similarly, because of great experience in Karachi hospital regarding kidney and heart and other transplantation procedures, clinicians from Iran can attend training courses to improve their skills. The subject of join research proposals to address the regional issues including communicable diseases were also discussed.
Visiting the Disaster Risk Management Center
This center was established in May 2015, in a building with an area of 100 square meter. All the health staff have been organized into a standardized Incident Command Center (ICS) chart proposed by the Ministry of Health. Emergency Operation Procedures (EOPs) for environmental health, Communicable diseases control, Family health, Nutrition and mental health have been developed. Community Health Volunteers have already received training on Disaster Risk Assessment and Training for (DART) for households under the coverage.
A recent outbreak of Typhoid fever in Saravn was managed through this center that mainly involved communicable diseases and environmental management activities.
Visiting the Vaccines Cold Chain and Biologicals at the ZAUMS Deputy for Health Building
This includes three cold rooms, one for below zero and two for 2-8 degrees vaccine storage. The capacity of each cold-room is 34000 cubic meter. All cold-rooms are equipped with an automated alarm panel which issued SMS signals in the case of changes in the cold-room temperature beyond the pre-defined limits. The cold room temperature is recorded twice a day.
Technical Joint meeting on polio eradication in the region
On the second day of the visit a technical meeting on the current status of the polio eradication was chaired by Dr Zahraee, Vaccine preventable Diseases Office, Ministry of Health of Iran. The achievements of the Islamic Republic of Iran were presented the possible areas for cooperation in order to tackle polio in the region were discussed. Representatives from Afghanistan and Pakistan ministries of health presented the progress toward polio eradication in their countries and the challenges they are facing the prevent them from achieving the eradiation goal.
An experience of regular joint meetings and the achievements were discussed. Assembling all institutes working toward polio eradication including WHO, UNICEF, and Melinda & Bill Gates Foundation under the umbrella of Emergency Operation Center was mentioned as a success story in better utilization of the available recourses in Pakistan.
Some of Recommendations include:
Develop strategies for overcoming current challenges related to surveillance of the virus in bordering areas
Strengthening of permanent transit points to ensure polio vaccination is administered to travelers to Iran, Afghanistan or to Pakistan at main entry and exit points.
Develop a plan of action for the coordination of polio eradication activities in the bordering areas and the selection of focal points in each country;
Develop a mechanism for polio information exchange between Afghanistan, Islamic Republic of Iran and Pakistan and select focal points in each country;
Establish a mechanism to develop a joint grant proposal to WHO for the implementation of polio eradication in the border areas.
PARTICIPANTS
Pakistan
Mr . Abdullah Khan
Additional Secretary, Health Department, Government of Balochistan
Dr. Aftab Hussein Kakar
National Polio Transmission Stop officer, Ministry of Health , Pakistan
H.E. Taher Mahmood Qureshi
I.R. of Pakistan Consulate, Zahedan, Iran
Afghanistan
Dr. Maiwand Ayoub Ahmadzai
Polio Eradication Department, MoH, Afghanistan
Islamic Republic of Iran
1. Ministry of Health & Medical Education
Dr. Seyed Mohsen Zahraee
Vaccine Preventable Diseases Office, I.R. of Iran, Ministry of Health, CDC
Dr. Susan Mahmoodi
National Polio Eradication Program Manager, MoH, Iran
Dr. Mohsen Asadi Lari (apologies)
Acting Minister for International Affairs Department
Dr. Mohammad Mehdi Gooya (apologies)
Director General of CDC, I.R. of Iran, Ministry of Health,
2. Zahedan University of Medical Sciences
Dr. Mahmoodreza Miri
Chancellor of Zahedan University of Medical Sciences
Dr. Seyed Mehdi Tabatabaei
Vice Chancellor for Health, Zahedan University of Medical Sciences
Dr. Yousef Mehdipour
Director of International Office, Zahedan University of Medical Sciences
Dr. Hosseinali khazaee
Advisor to the Chancellor of Zahedan University of Medical Sciences
Mrs. Kaydokht Kaykavoosi
International Affairs Office, Zahedan University of Medical Sciences
Dr. Hooshang Rafighdoost
Vice Chancellor for Research & Technology, Zahedan University of Medical Sciences
Dr. Alireza Mobaraki
Vice Chancellor for Drug & Food, Zahedan University of Medical Sciences
Dr. Manizheh Khalili
Vice Chancellor for Education, Zahedan University of Medical Sciences
Dr. Mohesn Mesgarani
Vice Chancellor for Cultural & students" Affairs, Zahedan University of Medical Sciences
Dr. Hadi Abbasi
Director of Chancellor Office, Zahedan University of Medical Sciences
Dr. Masoud Salehi
Advisor to the Chancellor of Zahedan University of Medical Sciences
3. Iranshhar Faculty of Medical Sciences
Dr. Iraj Zareban
Dean of Iranshahr Faculty of Medical Sciences
Dr. Rasoolizadeh
Deputy for Health, Iranshahr Faculty of Medical Sciences
4. Zabol University of Medical Sciences
Dr. Nasiri (apologies)
Chancellor of Zabol University of Medical Sciences
Dr. Akbarizadeh
Deputy for Health, Zabol University of Medical Sciences
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