Intensification of Routine Immunization (IRI) in IndiaCoverage Improvement Plans for 2012-13 SEPIO Swasthya Bhavan GoWB
• August 2011 - High Level Ministerial Meeting(HLMM) on “Intensification of RoutineImmunization”.• September 2011 - All SEAR countries endorsed2012 as the “Year of Intensification of RoutineImmunization”.• GoI has declared 2012-13 as “Year ofIntensification of Routine Immunization”.• Strategy for IRI discussed within Imm. Division ofMinistry, with Partners and also during focusedreview meetings held with priority states.
Proportion of Fully immunized (FI) children CES 2006 CES 2009 FI: 62% FI: 61% • OPV3: 68% • OPV3: 70.4% • DPT3: 68% • DPT3: 71.5% • Measles: 71% • Measles: 74.1% JAMMU & KASHMIR HIMACHAL PRADESH PUNJAB UTTARANCHAL HARYANA ARUNACHAL PR. SIKKIM RAJASTHAN UTTAR PRADESH ASSAM NAGALAND BIHAR MEGHALAYA MANIPUR TRIPURA JHARKHAND GUJARAT MADHYA PRADESH MIZORAM WEST BENGAL India State CHHATTISGARH ORISSA DLHS-2 D&N HAVELI Below 40 MAHARASHTRA 40 to 50 50 to 60 ANDHRA PRADESH 60 to 70 GOA Above 70 KARNATAKA A&N ISLANDS PONDICHERRY TAMIL NADU LAKSHADWEEPKERALA
FI coverage: CES 2009 vs CES 20063020 Assam: +20 % Rajasthan: +6 %10 Maharastra: +6 % Punjab: +8 % Bihar: +11 % UP: +4 0 % AN AP AC AS BI CH CG DN DD DL GO GU HA HP JK JH KA KE LD MP MH MN ME MZ NA OR PD PB RJ SI TN TR UP UA WB Jharkhand: +7 %-10-20-30 WB: - 5 % Haryana: -3 % Delhi: - 14 % MP: - 11 % 12 low performing states improved, However, 17 states declined
System weakness in tracking and following children: Percentage difference between BCG and MCV1 coverage JAMMU & K ASHMIR HIMACHAL PRADESH PUNJAB UTTARANC HAL HARYANA DELHI ARUNACHAL PR. SIKKIM RAJASTHAN UTTA R PRADESH ASSAM NAGALAND BIHAR MEGHALAYA MANIPUR WE ST BENGAL TRIPURA GUJA RAT MADHYA PRADES H JHARKHAND MIZORAM CHHATTISGARH ORISSA D&N HAVELI MAHARASHTRA 0 – 10% ANDHRA PRADESH 10 – 20% GOA KAR NATAKA 20 - 28% A&N ISLANDS PONDICHERRY TAMIL NADU LAKSHA DW EEPKER ALASource: DLHS 3 2007-08
Prioritization:• DTP3 : important indicator• > 90% DPT3 at national level• > 80% at least, at district level• CES-2009(India): – FIC%:61% – DPT3%: 71% – 14 states under national average. – Others(includes WB): Low performing pockets for focused attention.
• Prioritization of districts also based on – % of fully immunized children (as per DLHS-3 survey). • in WB: 6 districts identified for special focus 2yrs back. – Districts with < 50% FI children prioritized for focused interventions to improve coverage. • In WB lowest FIC% of 54% (DLHS-3) was UDP.• Prioritization of blocks in all districts based on risk analysis
Purpose of IRI• To improve immunization coverage in all the districts of the country.• State and district wise realistic targets to improve immunization coverage.
Proposed activities1. National and State level advocacy2. Strengthening communication and social mobilization3. Regular program reviews at all levels4. Development of Coverage Improvement Plans5. Institutional Capacity Building6. Vaccine and logistics management7. Cold chain strengthening and maintenance8. Teeka Express9. Immunization Weeks10. Strengthening RI monitoring and supervision11. Strengthening partnership with all stakeholders12. Institutionalizing AEFI and VPD surveillance13. Operational Research studies planned during 2012-13
National and State level advocacyProposed actions: • 2012-13 as the “Year of Intensification of RI”. • Interdepartmental coordination. • State and District level Task force • State level launch of the Year of IRI.
Strengthening communication and social mobilization• Focus on components and strategies for addressing – left outs, – drop outs and – increasing community participation in immunization.• Social mobilization activities :activate wider networks and groups to include: – ICDS, – Education, – Panchayati Raj Institutions, – Professional bodies, – Women Self Help Group, – NGOs etc.
Regular program reviews at all levelsReview meetings – – to track progress, identify problems and analyze issues and address them. – quarterly at national/state level – and monthly at district and block levels
Development of Coverage Improvement Plans • States and districts - to conduct risk analysis to identify and prioritize high risk blocks, - gap analysis to identify bottlenecks in HRA,- review and update the micro-plans of these areas and - strengthen monitoring of session sites and community.
• Institutional Capacity Building : Vacancy etc• Vaccine and logistics/CC management EVM guideline & post EVM follow up • Planning and strengthening AVD Linkage with rational micro-plan• Strengthening partnership with all stakeholders ICDS, PRI, Urban local bodies, NGO/SHG, Education dept. Unicef, WHO-NPSP, Professional bodies etc.
Strengthening RI monitoring and supervision• All levels• Use standard monitoring formats.• Immediate feedback & record in Inspection book.• Compilation, convergence and Analysis of Data- from RI monitoring,- HMIS,- surveillance and- coverage surveys
Institutionalizing AEFI and VPD surveillance• Present AEFI/VPD reporting status poor.• District AEFI committee to be operational.• Capacity building of AEFI committee members will be undertaken.• DMCHO should be the nodal person.• Timely report of minor & serious AEFI including FIR, PIR & DIR .• DMCHO would be held responsible personally for AEFI/VPD surveillance
Operational Research studies planned during 2012-131. Evaluation of MO training in immunization;2. Cold chain assessments;3. Studies on vaccine freezing and4. Injection safety studies