Cross-Border Coordination between Afghanistan and Pakistan

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining cross-border polio communication efforts in Afghanistan and Pakistan. In support of the final global push towards polio eradication, regional presentations were given by in-country communication and health practitioners working on either side of the shared border. These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented through September 2007
2. Detailing activities on national and sub-national levels, specific to collaboration between Ministries of Health, mobile populations, campaign synchronisation, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support both Pakistan's and Afghanistan's polio eradication efforts

This presentation gives an overview of cross-border communication activities related to the polio eradication initiative (PEI) in Pakistan and Afghanistan, and was presented by representatives from the Pakistan team. It outlines the status of wild poliovirus (WPV) and sharing of the virus between the two countries. Risks and challenges are described, including those related to mobile populations and immunisation refusals. Immunisation activities and coordination between country teams is detailed, as is the impact of these interventions.


According to the presenters, epidemiological data reflects frequent virus-sharing between Pakistan and Afghanistan; the countries are therefore considered as one epidemiological block. Of particular concern, access issues in border areas have lead to population immunity gaps and active WPV circulation. Multiple entry points in mobile populations on the shared border are documented, as are their major transit routes. A reported 0.2 million children were vaccinated from these mobile populations in August 2007.


Security is of particular concern in both countries, and almost all reported cases in 2007 have originated in areas of compromised access due to security. Immunisation coverage data for 2007 reflects that coverage in children below 6 months of age is consistently sub-optimal in those districts in Pakistan bordering Afghanistan.


To date, according to this presentation, the following activities have been implemented:

• Increased number and quality of vaccination posts at border points
• Cross-border meetings at national and provincial levels
• Inter-country programme review meetings (Pakistan)
• Synchronisation of immunisation campaign schedules
• Cross-notification of acute flaccid paralysis (AFP) cases

The team indicated that the quality of cross-border vaccination teams should be improved through implementation of the following:

• Work schedules of two shifts per week
• Cross-checking of children entering each country
• Increased visibility and recognition of the teams
• Improved working environments

In addition, suggestions to improve border coordination were offered. These included the following:

• Regular monthly meetings on alternating sides of the border (securing of multiple-entry visas)
• Joint micro-planning of immunisation activities
• Mapping of border villages
• Regular sharing of data

The synchronised schedule detailing national and sub-national immunisation days in Pakistan and Afghanistan for 2007 was presented. A total of four national immunisation days is planned for each country, as well as six sub-national days in Pakistan and five in Afghanistan. The cross-border strategy accounts for 237 villages with a target population of over 16,500 individuals.


In conclusion, the presenters outlined the following suggestions to lead the cross-border immunisation programme forward:

• Continued excellent cross-border coordination
• Joint risk-analysis for highly mobile populations
• Increased activities in high-risk border areas
• Locally appropriate communication strategies
• Increased advocacy for peace to allow passage of vaccination teams (i.e. Days of Tranquility)

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