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Routine Immunization: R ecent initiatives and progress in high risk areas

Routine Immunization: R ecent initiatives and progress in high risk areas. 23 rd India Expert Advisory Group 13-14 July, 2011 Dr Pradeep Haldar, MoHFW, GoI. Presentation outline. Status and performance of RI Efforts to strengthen RI Continued challenges Way forward.

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Routine Immunization: R ecent initiatives and progress in high risk areas

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  1. Routine Immunization:Recent initiatives and progress in high risk areas 23rd India Expert Advisory Group 13-14 July, 2011 Dr Pradeep Haldar, MoHFW, GoI

  2. Presentation outline Status and performance of RI Efforts to strengthen RI Continued challenges Way forward

  3. Routine immunization performance

  4. Proportion of Fully immunized children (12 – 23 months) CES 2006 CES 2009 FI: 62% • OPV3: 68% • DPT3: 68% • Measles: 71% FI: 61% • OPV3: 70.4% • DPT3: 71.5% • Measles: 74.1% Source: http://www.mohfw.nic.in

  5. Full immunization coverage: CES 2009 vs CES 2006 Only 12 states improved 23 states declined Rajasthan: +6 % Maharastra: +6 % Punjab: +8 % Bihar: +11 % UP: +4 % Jharkhand: +7 % WB: - 5 % Haryana: -3 % Delhi: - 14 % MP: - 11 %

  6. OPV3 coverage: CES 2009 vs CES 2006 28 states improved 7 states declined UP: +34.4 % Jharkhand: +27.8 % Rajasthan: +28 % Maharastra: +20.7 % Punjab: +14.8 % Bihar: +17 % MP: - 14.2 % Haryana: -7.7 % WB: +4.2 % Delhi: - 1.6 % Tamilnadu: - 7 % Andhra Pradesh: - 8 %

  7. Full immunization coverage: RI monitoring UP & HR Blocks, June’10 – May’11 Data not available <= 40% 40% to 60% 60% to 80% >= 80% Not monitored UP State State Average = 51% Children 12-23 months: 207,811 HR Blocks Cumulative Average = 43% Children 12-23 months: 39,346

  8. Full immunization : RI monitoring Bihar & HR Blocks, June’10 – May’11 Data not available <= 40% 41% to 60% 61% to 80% > 80% Not monitored HR Blocks cumulative Average = 66% Children 12-23 months: 9,733 Bihar State State Average = 66% Children 12-23 months: 87,474

  9. Immunization status through RI monitoring: June 2010 – May 2011 *WB data for May & June, ’11 only

  10. Reasons for being partially immunized: June 2010 – May 2011 *WB data for May & June, ’11 only

  11. % RI sessions not held: UP & HR blocksJune’10 to May‘11 % Sessions not held > 20% 15% to 20% 10% to 15% < 10% HR Blocks State Average: 8.6% Sessions not Held: 1,196 out of 13,856 UP districts – cumulative State Average: 8.5% Sessions not held: 6,613 out of 70,851 Source: RI monitoring data, GoUP and NPSP

  12. Due list available: Bihar & HR blocksJune ’10 to May ‘11 < 40% 40% to 60% 61% to 80% > 80% HR Blocks Cumulative HR blocks average = 52 % 1,770 out of 3,386 Bihar districts Cumulative State average = 42 % 13,294 out of 31,736

  13. Availability of hub-cutter: UP & HR blocks June ’10 to May ‘11 < 40% 40% to 60% 60% to 80% > 80% HR Blocks Average = 20% Hub-cutter available: 2,513 out of 12,660 UP districts Cumulative State Average = 29% Hub-cutter available: 20,234 out of 70,851

  14. Mobilization of beneficiaries at monitored RI session sites, Uttar Pradesh April ’10-March ‘11 < 20% 20% to 40% 40% to 60% > 60% By ASHA By ICDS UP districts - cumulative State Average = 63.5% ASHA found present: 44,981 out of 64,653 UP districts - cumulative State Average = 34.2% ICDS found present: 24,249 out of 64,653 Source: RI monitoring data, GoUP and NPSP (Apr’10 to Mar’11)

  15. Efforts to strengthen RI

  16. Risk scoring: Karnataka, 2011 (Score 7-16) (Score 4-6) (Score 1-3) Criteria for risk categorisation (Karnataka): A summed scored index is computed on following criteria- • Estimated unimmunized for OPV3 in 2010-11 (coverage assumed at DLHS-3 levels) • WPV importations in previous years since 2002 • Bordering WPV importation districts • Clustering of compatibles in the past 3 years • AFP Surveillance quality: surveillance index & • Migratory population (<5 yr children) • Suggested additional criteria for states: • Measles outbreak data • Vacancy status of service providers • VDPV data • Hard-to-reach areas

  17. Mapping RI sites in Polio SIA plan: Karnataka, 2011 RI session information added to polio SIA microplan Planning for Migrants/ high-risk populations Nearest RI session site for each HtH team day area identified

  18. Percent validated migrant sites included in RI micro plan, India Data being compiled • Emergency Preparedness and Response Plan, 2011 emphasizes mapping migratory / mobile populations to cover them in both SIA & RI • Mapping & validation of migrant sites is ongoing in states • Following mapping, sites are being incorporated in RI plan • Final data is being compiled from UP, Bihar, Maharastra, Gujarat RI microplans should be updated every 6 months to ensure the inclusion of shifting migrant populations

  19. Harmonization of Polio SIA & RI MicroplanDistrict: Bulandshahr, Uttar Pradesh Village visited by SIA team SIA component Every polio SIA team carries this plan and must inform parents of when and where RI sessions are held RI component

  20. Special RI session for Brick Kilns in Meerut, UP Special initiatives must to be sustained & incorporated in regular RI microplan Brick Kilns Village Distance from PHC Owner & manager of Kiln ANM 4 monthly drives

  21. Improving and expanding RI monitoring • In 2011, more than 9,000 session sites and 90,000 children monitored per month in 3 high priority states • RI monitoring expanding to other states: West Bengal, Karnataka, Rajasthan, Punjab, Orissa, Delhi, Assam

  22. Use of data for action • RI monitoring systematically shared with District and Block health officials • DTFs pre/post polio SIA • Quarterly DIO review meetings • Jharkhand: • RI Cell meetings held bi-monthly chaired by Director Health • Development Partners attend the meeting • 2 DIOs (one from better & one from weaker district) are invited by rotation • Bihar: • At the PHC/Block Level by FVs (every day) • At the District level by SMOs (every week) during District Control Room meetings • At the State Level (both weekly & monthly) • Other states are instituting RI Cell Meetings

  23. Initiatives in cold chain and vaccine management Strengthening • Human Resource • Recruitment of National vaccine Logistics manager • Cold chain Consultants in state of UP , Jharkhand and Orissa • Regional Vaccine Logistics mangers in Orissa • 221 state trainers, 762 district trainers and 6586 CC handlers trained • Infrastructure strengthening (Dec ’10 – July ’11) • 27 WIC, 8 WIF, 4650 ILR, 6070 DF supplied • 300 combo solar equipment supplied to 16 states • Temperature monitoring devices installed in 9 State vaccine stores • National Cold Chain and Vaccine management Resource Center at NIHFW initiated • National Cold chain MIS developed by SHTO-Pune • Reviews and Monitoring • National partners and experts subgroup meeting in Jan 2011 • CCOs review in April 2011

  24. Improving AEFI surveillance • National AEFI guidelines revised in 2010 • 25,000 copies disseminated to all the states • Training package with revised AEFI guidelines prepared, workshops conducted in several states to date • 50,000 copies of SOPs on AEFI operational guidelines for BMOs in print • Post Marketing Surveillance (PMS) network in Maharashtra • Training on causality assessment is scheduled for September/ October

  25. New vaccine introduction • Hepatitis B vaccine expansion • Ongoing in 15 states/UTs • Expansion to all remaining areas • Pentavalent (DPT-HepB-Hib) • Introduction to TN and Kerala • Measles 2nd dose in RI • Given with 1st DPT booster (16-24 months) in 21 states • MCUP in phases in 14 states • MCV2 in RI for districts that have completed MCUP 6 m back

  26. Continued challenges

  27. Involvement of Govt in RI monitoring: HR blocks of Jharkhand, June ’10 – May ‘11 HR Blocks monitored (2 Blocks) HR Blocks not monitored (28 Blocks) n=number of sessions monitored

  28. Involvement of Govt in RI monitoring: HR blocks of Bihar, June ’10 – May ‘11 HR Blocks monitored (3 blocks) HR Blocks not monitored (38 blocks) n=number of sessions monitored Jun10 to May11

  29. Involvement of Govt in RI monitoring: HR blocks of UP, June ’10 – May ‘11 Utilisation of Govt manpower for RI monitoring – still scope for improvement HR Blocks monitored (39 blocks) n=number of sessions monitored Jun10 to May11 HR Blocks not monitored (27 blocks)

  30. Way forward • States are to convene quarterly review meeting of DIOs on RI with participation from GoI and partners • Continued RI-polio convergence: • Migrant & mobile mapping • Updating RI microplan with polio microplans • Polio SIA newborn tracking for RI – link with MC tracking • Intensifying RI monitoring: • All states to initiate monitoring • Adapt GoI strategy and tools to local context • Ensure feedback and use of data for programme decisions • RIMS to be universally used for RI data uploading and analysis for local action

  31. Thank you

  32. Additional slides

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