24 th Meeting of India Expert Advisory Group on Polio New Delhi 15-16 March 2012

1. Emergency Preparedness and Response Planning – risk analysis, actions taken in HR areas & preparedness status for mop ups : West Bengal 24th Meeting of India Expert Advisory Group on Polio New Delhi 15-16 March 2012 Dr Rashmi Kamal,IAS Addl State Mission Director, NRHM & Jt Secy to Govt of West Bengal

2. Outline of the presentation • Risk assessment • Sustaining high population immunity in HRAs • SIAs • Routine Immunization • Status of AFP Surveillance • Preparedness for responding to importations

3. Risk assessment

4. Risk assessment in West Bengal WPV cases HR districts Location of wild polio cases (2002 to 2011) HR districts

5. Sub district risk assessment (based on past epidemiology & performance) Howrah HR Gram Panchayats/ wards identified in each district 9 districts 36 blocks/ urban areas

6. Identification of High Risk Areas, WB = 10 Migrant site = 10 HR site High risk areas in settled population Migrant sites ~ 5,200 Migrant sites ~ 10,122 HR areas in settled population

7. Progress on Emergency Preparedness & Response Plan • EPRG constituted – Two EPRG meetings held since December to assess progress • RRT members selected and trained • High Risk districts allocated to RRT members • EPRP prepared and implemented Dr Soumitra Roy Dr Kalyan Mukherjee Dr J K Mehta Dr Amabasu Das Dr Dipankar Maji Dr S S Basu Dr Prasanta Biswas Dr Pramit Ghosh

8. Sustaining high population immunity in HRAs • SIAs • Routine Immunization

9. Urban area task force meeting in progress at Maheshtala District Magistrate Howrah monitoring activity Intensive Government Oversight • Regular video conferences by Principal Secretary for polio SIAs with DMs /Mayors & Chair persons of urban bodies and Health / ICDS officials • Senior state officials assigned to HR districts for monitoring • District, sub divisional and block task forces to review preparedness & supervise operations • Daily evening review meetings at districts & block PHCs

10. Intensification of underserved strategy Polio advocacy at Urs • Endorsement from religious institutions • Compilation of appeals for teams working in HRAs • Announcement from mosques • Advocacy in religious gatherings • Inauguration by religious leaders • Sensitization of Hajis before and after return from Haj pilgrimage • Rally by Madarsa students Sensitization of Hajis Rally by madarsa students

11. Health camps : Murshidabad Clinic booths: Howrah Impact of health camps : Khargram Sick children vaccinated at clinic booths 123 clinic booths Special initiatives to reduce missed children in HR districts of West Bengal Remaining houses with reluctance to vaccination

12. Partner supported Social Mobilization / Advocacy • 1600 Field volunteers and supervisors from 23 NGOs deployed by Unicef in 6 HR district • Social Mapping is being done in HR areas for planning appropriate area specific intervention • Sensitization meetings with all PRI members and urban councilors • 24 Pgs South • Howrah • SIA inauguration and advocacy by Cricketers • Kolkata Knight Riders • West Indies team

13. Special immunization plans for Congregations • Ganga sagar Mela • Urs in different Mazars • Eid congregations • Other religious festivals Vaccination at Ganga sagar mela Vaccination at Urs ~ 20,000 children vaccinated at various congregations in 2012

14. Social mobilization to overcome refusals Number of houses with reluctance to vaccination: 2011 vs 2012 North Bengal districts South Bengal districts

15. Vaccination of children in transit > 500,000 children vaccinated in transit during each campaign in the state Children vaccinated at transit points: 2011 vs 2012

16. Trend in remaining X houses – Kolkata & Murshidabad Other special initiatives to improve coverage • Targeted X-P conversion : Doctors from Medical colleges visit reluctant families (X houses) with medicines immediately after the round. • Distribution of Motivational items from booths • ICDS feeding on booth day Medical college doctors visiting an X house Outcome : Reduction in remaining X houses ICDS feeding on booth day

17. Northern districts, West Bengal Percent unvaccinated children End-of-round survey Percent 6,890 8,924 6,461 7,996 N= 1,371 4,490 2,996 4,020 3,515 6,556 7,574 7,686 7,065 10,320 6,651 Southern districts, West Bengal Percent 12,602 11,343 11,816 10,919 17,450 7,525 6,665 8,193 11,933 11,027 11,787 N=

18. Strengthening Routine immunization • Merger with SIA microplans in process • Identification of new RI/VHND sites through SIA microplan • Incorporating RI session plan in SIA microplan • Identification of newborns during SIA and their inclusion in RI • Training of MOs and Cold chain handlers • Quarterly review of RI performance at state level

19. RI sessions planned vs held – West Bengal May 2011 – January 2012 Reason for session not held (N=57) State N = 1,582 Source: Session RI Monitoring data (May 2011-January 2012)

20. Immunization status of monitored children, West Bengal, May 2011 - January 2012 Reasons for children not being fully immunized Not aware of need Fear of AEFI Unaware of session site N= 1,629 Beneficiary not available Programmatic Reason Other Reasons State N (children 12 to 23 months of age)= 6,223

21. Status of AFP Surveillance

22. AFP Surveillance is sensitive enough to pick any transmission in the state Status of AFP Surveillance - 2011 Non-polio AFP rate Stool collection rate 87% 7.18 * data as on 3 March 2012

23. Preparedness for responding to importations

24. Preparedness for responding to importation Prepared to hold first mop up within 7 days of detection of transmission, as demonstrated in the past. Mop up conducted Vaccine & other logistics reach blocks • National level partners meeting • Media plan operationalized • Vaccine arrived in district • State & District Task Force Meetings • 14 additional SMOs arrive in districts • IEC plan developed • Marker pens & other logistics procured • Field Investigation (NCDC/NPSP/UNICEF) • National Technical Group Meeting • Decision on mop up Chief Minister & Chief Secretary WB informed by GoI WPV notified Day 0 Day 1 Day 2 Day 3 Day 4 Day 6 Day5 7 Feb 2011 13 Feb 2011

25. Preparedness for responding to importation Logistics plan Running rate contract exists for marker pens – supplies expected to districts within 7 days of placing order Printing of formats have been decentralized to districts – may be done in 5 days Vaccine distribution to block PHCs (including hard to reach areas) within 4 days of receipt at state Communication plan Running rate contract exists for printing of banners/posters and delivery to districts UNICEF is ready with the prototype IEC materials, will be updated in minimum time

26. Preparedness for responding to importation Cold chain Adequate vaccine carriers available in High risk blocks and urban areas Repair of cold chain equipments has been decentralized to district level to minimize delay Microplanning Microplans of all high priority planning units are reviewed and rationalized before each round Manpower & training Training of all high priority teams will be conducted within 6 days of notification

27. Preparedness for responding to importation EPRG & RRT EPRG is meeting from time to time to assess ongoing activities for increasing / sustaining population immunity and maintaining sensitive AFP surveillance can be activated within 24 hours District, Sub division and Block / Urban area task force will meet as soon as campaign is decided.

28. Highest level of political commitment to keep West Bengal polio free Thank You