Project Goal:

Support to Global Polio Eradication Initiatives.

Project Objectives:

• Strengthening childcare practices.
• Strengthening service delivery mechanisms.
• Mobilizing Communities for better health service management.

Background
The Expanded Programme of Routine Immunization and the impact of supplemental vaccination campaigns have reduced the number of endemic polio infected countries in the South Asia Region and rest of the world. Nepal, as a member of the World Health Organisation is committed to the eradication of polio and has been working with government and private voluntary organisations on polio eradication initiatives. As an indication of Nepal's success, there has not been any reported new cases of polio since 2000. However, this has not been the case for Nepal's neighbour, India, particularly the States of Uttar Pradesh and Bihar which are known to be among the few remaining "hot spots" of polio left in South Asia. With an open border between Nepal and India the risk of polio transmission to Nepal is ever present.

What is CORE?
The Child Survival Collaboration and Resources Group or the CORE Group is a network of more than 35 Private Voluntary Organisations (PVOs) working together to promote and improve primary health care programmes for women and children and the communities in which they live. The mission of the CORE Group is to strengthen the capacity of member organisations to improve the health and well being of children and women in developing countries through collaborative NGO action and learning.

CORE Group Nepal is a consortium of five international non-governmental organisations, namely CARE Nepal, Save the Children US, PLAN Nepal, World Vision and ADRA, who are actively working to stop the transmission of poliovirus and paralysis among children. First initiated in 2000, currently the activities of the CORE Group are being implemented in the six Terai (low-land) districts of Bardiya, Dang, Nawalparasi, Dhanusa, Mahottari and Jhapa. CARE Nepal is working in three districts, namely Dhanusa, Mahottari and Nawalparasi.

CORE Group Nepal is working to reduce child mortality and morbidity occurring due to vaccine preventable diseases. This will be achieved through strengthening routine and supplemental immunization systems; improving community participation in immunization and surveillance systems, and by using a Geographic Information System (GIS) to monitor and document immunization services information.

Activities
Adhering to WHO polio eradication strategies, the CORE Group supports supplemental immunization activities, AFP surveillance and routine immunization. The project supports the involvement of district line agencies, NGOs, CBOs, teachers, traditional healers, religious leaders etc in supplemental immunization through the utilization of local media, language and tools suitable for communities to increase awareness of polio eradication, AFP surveillance and routine immunization.

Focussing on the promotion of social mobilisation activities (e.g. street drama, banners, puppet shows etc), technical as well as managerial support is given to the project districts for improving immunization and surveillance systems.

Supporting Community Based-Integrated Management of Childhood Illness (CB-IMCI) Programme:
The project supports the government in strengthening and expanding CB-IMCI through empowering Health Facility Operation and Management Committees and helping communities to plan, implement and assess community health programmes. This is also being achieved through regular supervision and monitoring of health facilities, health workers and female community health volunteers.

Integrating Geographic Information System in Health Programmes:
The CORE Group has initiated the application of a Global Positioning System (GPS) and a Geographic Information System (GIS) to develop district health GIS and VDC health service digital maps. GPS has been used to supplement current readings of health facilities and clinics etc and the GPS is used to develop social and health maps of VDCs indicating the location of vulnerable communities and coverage of routine immunization, which have been analysed using GIS generated maps.

Implementing LQAS Survey:
Lot Quality Assurance Sampling is a user friendly technique for the assessment and monitoring of immunization coverage using random sampling principles. Since the introduction of CORE Group activities CARE is extensively using LQAS for assessment and monitoring of immunization service and coverage. Health workers have been oriented to apply the LQAS tool for public health programme monitoring. More than 140 mid-level health workers are trained in LQAS and have completed more than 50 of LQAS surveys.

CARE Nepal's Efforts
Regular review and coordination workshops with district counterparts are held at district level. These have been useful for monitoring VDC wise immunization coverage status. HFOMC workshops have sensitised the role and responsibilities of communities for optimal utilization of immunization services. PVOs have also emphasised the strengthening of Acute Flaccid Paralysis (AFP) and other vaccine preventable diseases surveillance. Community surveillance training has been carried out for community level volunteers in all project districts. PVOs are also focussing on routine immunization strengthening and supplementary immunization as well as providing technical support through monitoring and supervisory visits to outreach services within the District (Public) Health Offices. Unreachable areas and communities were identified and necessary action was taken to improve the immunization coverage in these areas within the project districts.