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RI P Halder may 11

RI P Halder may 11






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  • As per fact sheet, same colors
  • Number of sessions is different than previous slide. Up – 17742 Bi-8,500 755
  • Example of Bihar -

RI P Halder may 11 RI P Halder may 11 Presentation Transcript

  • Routine Immunization current status & low coverage areas identification Strategy & way forward SEPIO meeting 18-20 May 2011 Dr Pradeep Haldar, MoHFW, GoI
  • Presentation Outline
    • Routine immunization Current Status
    • Evidence from the field
    • Low RI coverage area - Identification
    • Way forward
  • Routine Immunization in India Proportion of Fully immunized children (12 – 23 months) CES 2009: FI 61 % Source: http://www.mohfw.nic.in
  • Challenges: Access & Utilisation Source: DLHS-3 Data
  • Improved access but declining utilisation Source: DLHS-2 and DLHS-3
  • Assessing utilisation and access of services DLHS 2 versus DLHS 3 Full Immunization Improved Utilisation Improvement Decline Access Improvement Andhra Pr, Assam, Goa, HP, Karnataka, Kerala, Lakshadweep, Mizoram, Orissa, Punjab, Uttarakhand, WB Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh, D&D, Jharkhand Decline A & N Islands, Chandigarh, Delhi, Gujarat, Haryana, J&K, Manipur, Meghalaya, Tripura
  • Analysis of gaps
    • Low Access :
      • Immunization session sites are not included in microplan
      • Session not attended by ANM – leave, post vacant, not going to the site
    • Poor utilisation:
      • Irregular sessions, variable quality of services
      • Non-availability of vaccine/logistics
      • Poor messaging and communication
      • Low community confidence in services
  • DLHS-2 v/s DLHS 3 Full Immunization Declined Utilization Improvement Decline Access Improvement Tamil Nadu Decline D& NH, Poducherry, Maharashtra,
  • BCG (HIMS 10-11 Vs CES-09)
  • BCG (HIMS 10-11 Vs CES-09)
  • DPT (HIMS 10-11 Vs CES-09)
  • DPT (HIMS 10-11 Vs CES-09)
  • Measles (HIMS 10-11 Vs CES-09)
  • Measles (HIMS 10-11 Vs CES-09)
  • Vaccine Supply Vs HIMS 10-11
  • Vaccine Supply Vs HIMS 10-11 Cont
  • Findings from RI Monitoring
  • % RI session held – UP, Bihar and Jharkhand (Year - 2010) n=number of sessions monitored 15 to 25% sessions not held / not held as per microplan Due to absence of ANM and/or vaccine, logistics
  • Availability of vaccine & diluent at RI sessions January – December 2010 n=number of RI session found conducted
  • % availability of all Vaccines on sessions sites (Year – 2010 & 1 st Quarter 2011) JBSA – Jachha Bachha Suraksha Abhiyan -UP JBSA started form August’10 UP districts Cumulative Jan’11 – Mar’11: State Average- 83% Sessions held- 17,573 Data not available <= 40% 40% to 60% 60% to 80% >= 80% Not monitored UP districts Cumulative Jan’10 - Dec’10 : 80% Sessions held- 59,811 AEFI of Mohanlal Ganj (Lucknow)
  • Availability of all UIP vaccines and diluent at RI sessions, Bihar - 2010 Year 2010: Total 30,604 RI sessions monitored
  • % Sessions where all RI vaccines and AD syringes were available, Jan-Dec 2010, Jharkhand State average 2010: 69.8% Source: RI session monitoring data N = 5692 RI session found held
  • Full immunization status and BCG-measles drop out rates, 2010 – Uttar Pradesh FIC (Fully immunized coverage) BCG-measles drop out rate n= 1,76,634 children 12 to 23 month of age
  • Full immunization status and BCG-measles drop out rates, Bihar, Jan-Mar 2011 FIC (Fully immunized coverage) BCG-measles drop out rate n = 20,872 children 12 to 23 month of age
  • Jharkhand: Monitoring community coverage gaps: % Fully immunized children, children 12-23 months By district, Year 2010 State average : 76.1% Source: RI h-t-h monitoring data N = 12485 Children 12-23 month Percent fully immunized
  • Improving access and utilisation of RI: Lessons from pulse polio activities (1)
    • Social mobilization in Polio to increase utilisation;
      • Messages tailored for specific audience
      • Use of local resources (community members, local leaders, and influential people)
      • Religious sites and gatherings for message delivery
    • Strengthen linkages with pulse polio teams activities:
      • Polio microplans to include RI session site information (where, when and by whom)
      • Teams provide RI card to families during the house-to-house visits and share information on RI sessions
  • Improving access and utilisation of RI: Lessons from pulse polio activities (2)
    • Strong inter-sectoral coordination (health, education and ICDS):
      • Pooling of human resources, venue, vehicles and leadership prior and during rounds
      • ANM and ASHA (Health), AWW (of ICDS), School teachers (education) works together.
      • Evening briefings attended by MOI/Cs, CDPOs, BEO and community members for better planning
    • Replicating and extending coordination in support of RI:
      • RI monitoring feedback during coordination meetings
      • Preparing joint strategies to strengthen RI at different levels
  • Low coverage area Identification
    • populations known to have a disproportionate share of the disease burden;
    • un-immunized or under-immunized children in urban and peri-urban areas;
    • populations in places where sanitation is poor;
    • populations inhabiting difficult or mountainous terrain, marshy areas, islands
    • refugees, internally displaced persons, migrant workers and other transient populations;
    • politically and or socially marginalized populations or minority groups;
    • religious groups that oppose vaccination.
    • Communities at international borders and Intra-State administrative borders.
  • Identification and prioritization low coverage areas
    • URBAN Strategy
    • Rural Strategy
      • First priority to the villages/habitations which are never (rarely) reached
      • Then the villages / habitations in which immunization was planned but not held during previous 3-4 months.
      • Villages where RI is normally done but coverage is low
      • Convergence of Microplan – for uncovered areas
  • Way forward
    • Experience from Polio SIAs to be used for RI improvement
      • Improved access and utilization
      • Updating micro-plans
      • Social mobilization
    • Expand RI monitoring to other states and locations
  • Thank you