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Presentation on Immunization Issues

This presentation addresses programmatic and supply chain issues in the Universal Immunization Programme, recommending interventions to improve coverage and vaccine management. State-specific challenges in Andhra Pradesh, Bihar, and Chattisgarh are discussed, along with expenditure status updates. Suggestions include strengthening beneficiary tracking systems, addressing human resource gaps, and enhancing vaccination training.

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Presentation on Immunization Issues

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  1. Presentation on Immunization Issues Meeting of State Health Secretaries 15-16 Jan 2010 Amit Mohan Prasad Joint Secretary(RCH)

  2. Overview of Universal Immunization Programme • UIP is one of the largest ongoing public health interventions in the country • Centrally sponsored programme targeting approx 2.7 crore infants & 3 crore pregnant women (2009-10) • Vaccines against 6 diseases • Since 2006, two new vaccines have been introduced in select districts & states

  3. Programmatic Issues & Suggested Interventions • COVERAGE • As per the DLHS3 survey, the states of Uttar Pradesh, Bihar, Madhya Pradesh, and Rajasthan have large number of unimmunized children. • The improvement in coverage of these states is critical for further improvement in the coverage of the country. • The states need to establish and strengthen the beneficiary tracking system to reduce the dropout rates. • There are gaps in the reporting of actual number of children vaccinated; reporting system needs to be strengthened. • Inadequate visits to the field by the supervisory staff at block, district and state levels in spite of mobility support. Regular review meeting and monitoring may be done at all levels. • There is a human resource gap at all levels. Frequent transfers of programme managers at State and District level are also hampering improvement in immunization. Vacant positions need to be filled.

  4. Programmatic Issues & Suggested Interventions • COLD CHAIN • Gapsidentified in Cold Chain Assessment done in 2008 • WIC 160, WIF 49 • ILR 25196 & DF 29678 • Procurement started to fill the gaps • ~15000 ILRs & DFs procured (50% supplied); Balance are being procured. • All required quantities of Vaccine carriers(202350), Icepacks(2196800), Cold Boxes(14790) etc. supplied. • 91 WIC & 25 WIF being supplied in 2009-10.

  5. Programmatic Issues & Suggested Interventions • SUPPLY CHAIN MANAGEMENT OF VACCINES • The consumption of vaccines is sometimes less than their projected monthly requirement; • States are refusing to accept the vaccines; • The States/UTs don’t send the monthly balance stock position of UIP vaccines in the first week of every month. • States should make realistic projections based on microplans • The supply chain management in the states need to be strengthened with adequate skilled manpower.

  6. Vaccine Wastage: Issues & Suggestion

  7. Thanks

  8. STATE-WISE ISSUES ON Immunization

  9. Andhra Pradesh • Districts of Srikakulam, Nellore, Adilabad, Vizianagaram, Guntur, Kurnool & Kadappa <60% coverage. • 11/23 districts are showing decline in coverage compared to DLHS2 (2002-04) survey. • The State has refused to accept BCG vaccines during the current financial year. • The state needs to furnish its annual requirement region-wise for 2010-11. • The State needs to start the Immunization training of Health Workers and other field staff. • There had been frequent transfers of programme managers at State & districts. • The state needs to integrate the JE vaccination into routine immunization programme in the endemic districts where campaign has been conducted. Expenditure status as on 30th Sep2009

  10. Andhra Pradesh

  11. Bihar • The State continues to have issues of poor accessibility to immunization services since as per DLHS-3 survey 16.7% have received “No Immunization”, as well as high dropout ratefrom BCG to DPT-3 (33.2%). • The districts needing more focus are Jamui, Kaimur, Kishanganj, Buxar, Sheohar & Paschim Champaran- districts have coverage of even less than 30%. • The State has refused to accept BCG, TT and DPT vaccines during current financial year. • The State has been requested to re-assess its annual requirement of BCG & DPT vaccines as consumption of these vaccines in the current year is less than its projected requirement. • The State had also refused to accept Measles vaccine with expiry in Jan/Feb’10 which was allocated to the States in the month of Oct-Nov'09 even though there was requirement of the vaccine. Contd.. Expenditure status as on 30th Sep2009

  12. Bihar • The refrigerator mechanics at districts not yet appointed. • Bihar needs to strengthen Vaccine Preventable Death (VPDs) surveillance, as the State is not reporting any VPDs, despite of existence of high probability of VPDs like measles. • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate demand for immunization for further improvement in full immunization coverage.

  13. Bihar

  14. Chattisgarh • The State continues to have high dropoutfrom BCG to DPT-3(23.7%), reducing the dropout through better beneficiary tracking is critical for further improvement in coverage. • The state needs to provide special focus in the districts of Korba, Sarguja, Raipur, Jashpur, Raigarhand and Koriya as not only these are with low coverage (<60%) but also shows declining coverage compared DLHS-2(2002-04). • The State also continues to have wide disparity between the reported and evaluated coverage; the DPT3 coverage as per DLHS3 is 72.5% while the reported coverage for the corresponding period (2006-07) is 112.2%. • The State has been requested to furnish monthly balance stock position of UIP vaccines in the first week of every month. • New WIC is lying at Raipur since last three years, Site is identified but not prepared for installation, some renovation is required. UNICEF is ready to provide funds. • The post of State Cold Chain is lying vacant since the inception of the State. Expenditure status as on 30th Sep2009

  15. Chattisgarh

  16. Goa • The state needs to address the issue of the dropout from BCG- DPT3 through better system for tracking of beneficiary for further improvement in coverage. • The State has been requested to furnish monthly balance stock position of UIP vaccines timely in the first week of every month. • The State has conducted training for 99/370 the health workers only so far, the trainings of remaining staff need to be completed by the year end. • The state should strengthen surveillance systems for VPDs and AEFIs Expenditure status as on 30th Sep2009

  17. Goa

  18. Gujarat • It is a matter of grave concern that the proportion of children with ‘No immunization’ has increased in the state from 7.3% in 2002-04(DLHS-2) to 9.4 % in 2007-08 as per the latest DLHS-3 survey. • The Full Immunization coverage of State has also shown a declining trend ; 8/25 shows decline in coverage as per DLHS3 compared to DLHS2. • State refused to accept scheduled consignments of TT & Measles. • The State has been requested to re-assess the annual requirement of UIP vaccines for the year 2010-11, as the current projection of the State is more than GOI estimation. The State has also been requested to project its no. of beneficiaries and the annual requirement of vaccines (region-wise). • The State does not send the monthly balance stock position of UIP vaccines regularly. • The position of state cold chain officer is vacant Expenditure status as on 30th Sep2009

  19. Gujarat

  20. Haryana • The proportion of “No Immunization” in the state has increased from 11.8% in 2002-04 (DLHS-2) to 12.1% in 2007-08 (DLHS-3). • The State continues to have high dropout from BCG to DPT 3 at 18.8% • The districts of Mewat, Faridabad , Panipat and Hissar have coverage less than 55%; Mewat (12.2%) has 5th lowest coverage in the country. • The State does not send the monthly balance stock position of UIP vaccines regularly. • The State needs to expedite and complete the Immunization training of Health Workers as it has trained only 18.3%(665/3633) of health workers. Further the trainings for MOs need to be started. • The position of state cold chain officer is vacant • The State needs to strengthen the surveillance for VPDs as well as AEFIs. Expenditure status as on 30th Sep2009

  21. Haryana

  22. Himachal Pradesh • As per the DLHS3 survey, 5/12 districts are showing decline in coverage compared to DLHS2 survey. • Establish the process of regular review meetings for exclusive review of routine immunization at the block and district level. • Strengthen immunization in urban, industrial and project areas. In view of the diverse and difficult terrain of the state, activities to reach the un-reached and underserved areas are needed. • The State needs to strengthen the VPD surveillance system. Expenditure status as on 30th Sep2009

  23. Himachal Pradesh

  24. Jammu & Kashmir • Districts like Poonch, Doda and Rajouri have coverage of <45%, districts like Baramulla, Kargil and Srinagar showing decline compared to DLHS-2. • The BCG-DPT3 dropout rate is 24.0% in the state. The dropout rate is high in most districts; reducing the dropout is critical for further improvement in coverage. • The State does not send the monthly balance stock position of UIP vaccines regularly, last update provide on 15th Oct’09. • There is also need to improve accessibility of immunization services through revision of microplans especially for the areas with difficult terrain. Expenditure status as on 30th Sep2009

  25. Jammu & Kashmir

  26. Jharkhand • The State continues to have dual problem of poor accessibility to immunization as 12.8% have received “ No Immunization” as per the DLHS3. • The districts of Giridih, Godda, Jamtara, Sahebganj, Deogarh have coverage <40% as per DLHS 3. • The Supplier of t-OPV during this year has been instructed for immediate supply of the vaccine to meet the shortfall. • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate community demand. • There is an urgent need to address these issues through measures like revision of microplans, beneficiary tracking, improved monitoring and supervision etc. for improvement in full immunization coverage. Expenditure status as on 30th Sep2009

  27. Jharkhand

  28. Karnataka • The state should focus in the districts with low coverage as per the DLHS-3 reports like Raichur, Bijapur, Bagalkot, Belgaum and Bellary which have high BCG-DPT-3 dropout rate >20%. • As per the DLHS3 survey 7/27 districts are showing decline in coverage compared to DLHS2 survey. • The state need to take steps to improve beneficiary tracking and generate community demand to reduce the dropout rate for further improvement in coverage. • The State needs to furnish the annual requirement of UIP vaccine (region-wise) for the year 2010-11. • The supplier of t-OPV during this year has been instructed for immediate supply of the vaccine to meet the shortfall. • Karnataka has completed the Immunization training of Health workers however, the training of Medical Officers need to be expedited. Expenditure status as on 30th Sep2009

  29. Karnataka

  30. Kerala • As per DLHS 3 the State continues to have high dropoutfrom BCG to DPT-3 especially in districts of Pallakad, Mallapuram, Khozikhode, which is critical for further improvement in full immunization coverage. • The State has been requested to project its region-wise requirement while projecting the annual requirement of UIP vaccines. • 5.00 lakh doses of t-OPV is being supplied in Jan'10 by the Supplier to meet the shortfall. • Hepatitis B has been introduced under Universal Immunization Programme (UIP) in the state since December 2007 but the coverage need to be improved as the reported coverage for Hep B 3 is low. • The State needs to expedite and complete immunization trainings of the health workers since only 45.0 % (4814/10689) of training has been completed so far. The State also needs to expedite the training of Medical Officers. Expenditure status as on 30th Sep2009

  31. Kerala

  32. Madhya Pradesh • The State continues to have dual problem of poor accessibility to immunization with 9.8% having received “no immunization” as per the DLHS3 as well as high dropoutfrom BCG to DPT 3 at 41.8%. • The disparity between reported and evaluated coverage is huge with reported coverage for the corresponding period (2006-07) DPT3 is 101.9% while as per DLSH3 is 49.6%; this need to be rectified to have a realistic picture. • The coverage has not been apparently commensurate with fiscal progress, reflecting status of operationalization of the PIP. • The State has been requested to project region-wise annual requirement of UIP vaccine for 2010-11. It has also been requested to project realistic figure as the consumption of BCG vaccines is less than its projected requirement. • The State does not send the monthly stock position of UIP vaccines regularly every month. • 10.00 lakh doses of t-OPV is being supplied in the month of Jan'10 by the supplier to meet the shortfall. Contd.. Expenditure status as on 30th Sep2009

  33. Madhya Pradesh • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate community demand for immunization as well besides addressing the supply side issues through better monitoring and supervision. • There is an urgent need to address these issues through measures like revision of microplans, beneficiary tracking, improved monitoring and supervision etc. for improvement in full immunization coverage. • There is high probability of VPDs like measles in view of the poor coverage. The state needs to strengthen the surveillance systems for both the VPDs as well as AEFIs.

  34. Madhya Pradesh

  35. Maharashtra • The State continues to have high dropout at 17.4% from BCG to DPT 3; reducing the dropout through better beneficiary tracking is critical for further improvement in coverage. • 18/35 districts showing decline in coverage as per the DLHS3 compared to DLHS2. • The State should focus on districts like Nandurbar, Dhule, Gdchiroli and Jalgaon as these districts not only have coverage less than 50% as per DLHS-3 (2007-08) but also showing a BCG-DPT3 dropout rate of over 40%. • The State has reduced the requirement of BCG vaccine by 34.00 lakh doses in the current financial year. The State has been requested to project the realistic figure while projecting the annual requirement of UIP vaccines for 2010-11. • The immunization training of Health workers & Medical Officers needs to be expedited. • The integration of JE vaccine into routine immunization should be operationalised in all endemic districts where campaign has been completed. Expenditure status as on 30th Sep2009

  36. Maharashtra

  37. Orissa • The State continues to have high dropout from BCG to DPT 3 at 21.1%; reducing the dropout though beneficiary tracking better supervision, monitoring is critical for further improvement in full immunization coverage. • The state should focus on the districts like Rayagad, Malkangiri, Nabrangapur, Balangir,., as these districts not only have coverage <40% as per the DLHS3 (2007-08) survey, but also showing decline compared to DLHS2 (2002-04). In fact 14/30 districts are showing decline in DLHS3 compared to DLHS2 survey. • The State does not send monthly balance stock position of UIP vaccine regularly. • There is need to optimally utilize the strategies like social mobilization by ASHA, VHND, IEC(RCH) etc., to generate community demand for immunization as well besides addressing the supply side issues through better supply chain management. • There is high probability of VPDs like measles in view of the poor coverage. The state needs to strengthen the surveillance systems for both the VPDs as well as AEFIs. Expenditure status as on 30th Sep2009

  38. Orissa

  39. Punjab • There is high dropout from BCG to DPT 3 at 9.3%. • There is wide inter-district variation in coverage as per the DLHS 3 report; districts like Mansa, Sangrur have coverage <60%, 8/21 districts are showing decline in Full immunization coverage compared to DLHS-2. • There is disparity between the reported and evaluated coverage data with reported coverage exceeding 100%; this needs to be rectified to have a realistic status of the programme. • The State does not send monthly balance stock position of UIP vaccines timely in the first week of every month regularly. • The consumption of t-OPV, DPT and TT vaccines is less than its requirement in the current financial year. • The State needs to expedite Immunization trainings of Health Workers , trainings of Medical Officers and other field staff. Expenditure status as on 30th Sep2009

  40. Punjab

  41. Rajasthan • The State continues to have dual problem of poor accessibility to immunization as 14.3% have recived “No Immunization” as per DLHS3. • The districts of Bharatpur, Alwar, Dhoulpur, Sawai Madhopur and Karauli have coverage less than <30%. • 10/32 districts have dropout rate over 40% as per DLHS3 survey. • There is an urgent need to address these issues through measures like revision of microplans, beneficiary tracking, improved monitoring and supervision etc. for improvement in full immunization coverage. • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate community demand for immunization. • There is high probability of VPDs like measles in view of the poor coverage. The state needs to strengthen the surveillance systems for both the VPDs as well as AEFIs. Contd.. Expenditure status as on 30th Sep2009

  42. Rajasthan • The State of Rajasthan has refused to accept the BCG, TT and DPT vaccine in the current financial year. It seems that the consumption of these vaccines is less than its projected requirement. • The State does not send monthly balance stock position of UIP vaccines timely in the first week of every month regularly. • The State has not yet furnished the annual requirement of UIP vaccines (region-wise) for the year 2010-11. • 6.00 lakh doses of t-OPV is being supplied in Jan'10 by the Supplier to meet the shortfall.

  43. Rajasthan

  44. Tamil Nadu • The state is showing decline in coverage as per the latest DLHS 3 report compared to DLHS-2. Similar decline is observed in almost all districts of the state. • The State continues to have high dropoutfrom BCG to DPT-3 at 9.9% (as per DLHS3). • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate demand for immunization. • The State does not send monthly balance stock position of UIP vaccines regularly; last update by state provided on 1st Nov 2009. • It seems the consumption of DPT is less than its projected requirement during this year. • Human Resource: Positions of Cold chain mechanics need to be filled up. • The state needs to expedite the Immunization training of Health Workers as it has trained only 25% (8000/32000) of health workers, also, the training of Medical Officers need to be expedited. Expenditure status as on 30th Sep2009

  45. Tamil Nadu

  46. Uttar Pradesh • The State continues to have dual problem of poor accessibility to immunization coverage as well as high dropoutfrom BCG to DPT 3 at 46.1%. • The disparity between reported and evaluated coverage is huge with reported coverage (2006-07) for DPT3 is 101.5% while as per DLHS3 it is only 39.7%; this need to be rectified for better monitoring and programme management. • The coverage has not been apparently commensurate with fiscal progress, reflecting status of operationalization of the PIP. • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate demand for immunization. • There is an urgent need to address these issues through measures like revision of microplans, beneficiary tracking, improved monitoring and supervision etc. for improvement in full immunization coverage. • There is high probability of VPDs like measles in view of the poor coverage. The state needs to strengthen the surveillance systems for both the VPDs as well as AEFIs. Contd.. Expenditure status as on 30th Sep2009

  47. Uttar Pradesh • The State does not send monthly balance stock position of UIP vaccines regularly; last status communicated on 1st Nov 2009 . • The State has not furnished the annual requirement of UIP vaccines for 2010-11 despite issuing repeated reminders. • The State has refused to accept the DPT vaccine in the current financial year; consumption is less than its projected requirement. • 10.00 lakh doses of t-OPV is being supplied in the month of Jan'10 to meet the shortfall. • The issues of HR at service delivery as well as programme management levels need to be addressed at the earliest. The vacant positions at District and PHCs need to be filled. • The progress in immunization trainings of the health workers (14912/20099) has stagnated at 74.2 % only for more than a year; the training of remaining health workers need to be completed by the year end. Further the training of Medical Officers needs to be expedited.

  48. Uttar Pradesh

  49. Uttarakhand • The State continues to have problem of poor accessibility to immunization services high dropoutfrom BCG to DPT-3 at 20.4% which is critical for further improvement in full immunization coverage. • The disparity between reported and evaluated coverage is huge, the evaluated coverage reported DPT3 coverage 72.6% is while reported coverage(2006-07) is 145.7%; this need to be rectified for better monitoring and programme management. • The State does not send monthly balance stock position of UIP vaccine regularly; the last update available is as on 1st Nov’2009. • 1.50 lakh doses of Measles vaccine issued from GMSD, Karnal in the month of Nov'09 to meet the shortfall. • The position of state cold chain officer is vacant. • There is need to optimally utilize the strategies under NRHM like ASHA scheme, VHND, IEC(RCH) to generate demand for immunization as well besides addressing the supply side issues through better supply chain management. Expenditure status as on 30th Sep2009

  50. Uttarakhand

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