1
June 2011
Health Network meeting
13th December 2011
Intensification of
Routine Immunization
(IRI) in India:
An Update an...
Presentation outline
• Status and performance of RI
• Efforts to strengthen RI
• Continued challenges in reaching the unre...
Routine immunization
performance
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
UTTAR PRADESH
KARNATAKA
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAM...
FI coverage: CES 2009 vs CES 2006
-30
-20
-10
0
10
20
30
AN AP AC AS BI CH CG DN DD DL GO GU HA HP JK JH KA KE LD MP MH MN...
Where are the missed
children?
(Equity in Immunization)
Data not available
0-1 %
1-4 %
8 %
10 %
13 %
35 %
5 %
Where are the unvaccinated?
Children not vaccinated with DPT3
Source...
Where are the unvaccinated?
District-level percentage of fully immunized children
FI (DLHS-2)
Below 30
30 to 50
50 to 70
7...
63
50
63
53
46
73
36
Urban Rural Others Scheduled
Castes
Scheduled
Tribes
Richest
Qunitle
Poorest
Quintile
37
Percentage o...
Continued Challenges
Key Programmatic challenges
• Shortage of trained human resources at all levels
• Coordination and planning:
– Weak inter-...
R AJAS TH AN
OR ISS A
GU JA R AT
M AH A R AS H TR A
M AD H YA PR A D ES H
BIH AR
KAR N ATAK A
U TTA R PR A D ES H
AN D H R...
Improved access but declining utilization
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Full Immunization Partial Immunizati...
Analysis of gaps
• Low Access :
– Immunization session sites are not included in
microplan
– Session not attended by ANM –...
Reasons for being partially immunized:
June 2010 – May 2011
*WB data for May & June, ’11 only
33%
41% 37% 37%
8%
5% 9% 5%
...
Efforts to strengthen RI
Efforts to strengthen RI
1. Policy level initiatives
2. Expanding RI micro planning and monitoring
3. Capacity building
4....
1. Policy level initiatives
• New draft Multiyear Plan (cMYP) developed 2010-17
• Decentralized and flexible funding as pe...
National Vaccine Policy
• Made by Consultative
process
• Core committee incl.
experts, NTAGI
members, UNICEF and
WHO
• Gui...
Improving RI microplan
• State initiative supported
by partners
• RI micro-plans revised
using more frequently
updated pol...
Harmonization of Polio SIA & RI Microplan
District: Bulandshahr, Uttar Pradesh
Every polio SIA team carries this plan
and ...
Improving and expanding RI monitoring
• In 2011, more than 9,000 session sites and 90,000
children monitored per month in ...
47
57
35
51
20
25
30
35
40
45
50
55
60
65
70
Jun'10 Jul Aug Sep Oct Nov Dec Jan'11 Feb Mar Apr May
percentage(%)
UP State ...
% RI sessions not held: UP & HR blocks
June’10 to May‘11
UP districts – cumulative
State Average: 8.5%
Sessions not held:
...
By ICDS
UP districts - cumulative
State Average = 34.2%
ICDS found present: 24,249 out of 64,653
By ASHA
< 20%
20% to 40%
...
Training & Capacity
Building
• Health Workers:
– Re- started in year 2007, majority of HW got 2 days
training exclusively ...
Action Plan to improve RI
coverage with Equity
( Year of intensification 2012)
Detailed guidelines under development
Prioritization of the states
Category DPT3 coverage Names of the states Remarks
Poor performing
states
DPT3 coverage
less ...
Grouping of the states for IRI in India-2012
North-East states
Poor performing states
Good & medium performing states
Note...
Identification and prioritization
low coverage areas
Strategy
• Risk analysis using block as unit
• key basic parameters f...
Special strategies (1/3)
• Development of action plan with clear timelines.
• Suggested components to include but is not
l...
Special strategies (2/3)
• Communication strategy and operational plan to
be rolled out in Q1, 2012
– Awareness about sess...
Special strategies (3/3)
• Teeka Express
– Strengthening AVD
– to provide a branded vaccine
delivery van to cold chain poi...
To conclude..
• India accounts for highest
number of un- immunized
children in the world
• Disparity exists among rich/
po...
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Immunization Intensification -network mtg 13 dec 2011

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Immunization Intensification -network mtg 13 dec 2011

  1. 1. 1 June 2011 Health Network meeting 13th December 2011 Intensification of Routine Immunization (IRI) in India: An Update and action plan for reaching the unreached in Year 2012
  2. 2. Presentation outline • Status and performance of RI • Efforts to strengthen RI • Continued challenges in reaching the unreached • Action plan for Intensification of RI (IRI) 2012 • Conclusion
  3. 3. Routine immunization performance
  4. 4. RAJASTHAN ORISSA GUJARAT MAHARASHTRA MADHYA PRADESH BIHAR UTTAR PRADESH KARNATAKA ANDHRA PRADESH JAMMU & KASHMIR ASSAM TAMIL NADU CHHATTISGARH PUNJAB JHARKHAND WEST BENGAL ARUNACHAL PR. HARYANA KERALA UTTARANCHAL HIMACHAL PRADESH MANIPUR MIZORAM MEGHALAYA NAGALAND TRIPURA SIKKIM GOA A&N ISLANDS D&N HAVELI PONDICHERRY LAKSHADWEEP FI: 61% • OPV3: 70.4% • DPT3: 71.5% • Measles: 74.1% Proportion of Fully immunized (FI) children DLHS-2 Below 40 40 to 50 50 to 60 60 to 70 Above 70 India State FI: 62% • OPV3: 68% • DPT3: 68% • Measles: 71% CES 2006 CES 2009
  5. 5. FI coverage: CES 2009 vs CES 2006 -30 -20 -10 0 10 20 30 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 Delhi: - 14 % Haryana: -3 % Punjab: +8 % Rajasthan: +6 % Bihar: +11 % UP: +4 % MP: - 11 % 12 low performing states improved However, 17 states declined Jharkhand: +7 % Maharastra: +6 % WB: - 5 % Assam: +20 %
  6. 6. Where are the missed children? (Equity in Immunization)
  7. 7. Data not available 0-1 % 1-4 % 8 % 10 % 13 % 35 % 5 % Where are the unvaccinated? Children not vaccinated with DPT3 Source: DLHS 2007-08; children surveyed were between 12-23 months 72% in 5 states
  8. 8. Where are the unvaccinated? District-level percentage of fully immunized children FI (DLHS-2) Below 30 30 to 50 50 to 70 70 to 90 Above 90 Data not available FI (DLHS-2) Below 30 30 to 50 50 to 70 70 to 90 Above 90 Data not available Wide intra-state variations Source: DLHS 2007-08; children surveyed were between 12-23 months
  9. 9. 63 50 63 53 46 73 36 Urban Rural Others Scheduled Castes Scheduled Tribes Richest Qunitle Poorest Quintile 37 Percentage of children age 12-23 fully immunized District Level Household Survey 2007-2008 Immunization coverage varies significantly among different population categories
  10. 10. Continued Challenges
  11. 11. Key Programmatic challenges • Shortage of trained human resources at all levels • Coordination and planning: – Weak inter-sectoral coordination among Health, ICDS and other ministerial departments (eg education) – Lack of quality RI micro-plans and PIPs in many districts, states • Data reporting and use: – Divergent coverage estimates – survey assessed and reported – Tracking children • IEC – Communication for behavior change: – Inadequate social mobilization and demand generation for immunization
  12. 12. R AJAS TH AN OR ISS A GU JA R AT M AH A R AS H TR A M AD H YA PR A D ES H BIH AR KAR N ATAK A U TTA R PR A D ES H AN D H R A P R AD E SH JA M M U & K AS H M IR ASS AM TA M IL N AD U C H H ATTISG AR H PU N JA B JH A R K H AN D W E ST BE N G AL AR U N A C H AL P R . H AR YA N A KER ALA U TTA R AN C H AL H IM A C H AL PR A D ES H M AN IPU R M IZO R AM M EG H AL AYA N AG AL AN D TR IP U R A SIKK IM GO A A&N IS LAN D S D ELH I D &N H AV EL I PO N D IC H E R R Y LAK SH A D W EE P 0 – 10% 10 – 20% 20 - 28% Source: DLHS 3 2007-08 System weakness in tracking and following children: Percentage difference between BCG and MCV1 coverage
  13. 13. Improved access but declining utilization 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Full Immunization Partial Immunization No Immunization Source: DLHS-2 and DLHS-3
  14. 14. 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
  15. 15. Reasons for being partially immunized: June 2010 – May 2011 *WB data for May & June, ’11 only 33% 41% 37% 37% 8% 5% 9% 5% 23% 23% 11% 26% 18% 16% 22% 16% 18% 16% 22% 16% 0% 20% 40% 60% 80% 100% Bihar UP Jharkhand WB Awareness & Inform ation gap Operational gap AEFI apprehension Other reasons Data not available
  16. 16. Efforts to strengthen RI
  17. 17. Efforts to strengthen RI 1. Policy level initiatives 2. Expanding RI micro planning and monitoring 3. Capacity building 4. Cold chain and vaccine mgt. strengthening
  18. 18. 1. Policy level initiatives • New draft Multiyear Plan (cMYP) developed 2010-17 • Decentralized and flexible funding as per state Project Implementation Plans (PIP) under NRHM – District/block specific plans for hard to reach areas (inaccessible, tribal and urban) are reflected in PIPs – Funds for Addl. Vaccinators, alternate vaccine delivery, ASHA • Indian Public Health Standards (IPHS) – revised • Human resource assessment at national and state level for UIP ( IIM Ahmedabad 2010) • Developed National Vaccine Policy in 2011
  19. 19. National Vaccine Policy • Made by Consultative process • Core committee incl. experts, NTAGI members, UNICEF and WHO • Guided by principle of vaccine security • Newer vaccine introduction kept in mind
  20. 20. Improving RI microplan • State initiative supported by partners • RI micro-plans revised using more frequently updated polio micro - plans • Exercise lead to increase in number of outreach sessions planned 19,978 9,797 21,104 12,596 0 2500 5000 7500 10000 12500 15000 17500 20000 22500 UP (12 districts) BIHAR(4 districts) Sessions planned prior to microplan exercise Sessions planned after microplan exercise 1,126 added sessions 2,799 added sessions
  21. 21. Harmonization of Polio SIA & RI Microplan District: Bulandshahr, Uttar Pradesh Every polio SIA team carries this plan and must inform parents of when and where RI sessions are held SIA component RI component Village visited by SIA team
  22. 22. 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 RI monitoring: June 2010 – May 2011 State Sessions monitored Children surveyed 0 to 11 months 12 to 23 months Bihar 36,362 200,015 87,474 Jharkhand 5,158 24,303 12,998 UP 83,890 500,719 170,100 TOTAL 125,410 725,037 270,572
  23. 23. 47 57 35 51 20 25 30 35 40 45 50 55 60 65 70 Jun'10 Jul Aug Sep Oct Nov Dec Jan'11 Feb Mar Apr May percentage(%) UP State HR blocks Full immunization coverage: RI monitoring UP & HR Blocks, June’10 – May’11 Visited 1 Up.shp BCG_0M 0 - 40 40.1 - 60 60.1 - 80 80.1 - 100 Visited 1 Up.shp BCG_0M 0 - 40 40.1 - 60 60.1 - 80 80.1 - 100 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 KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH BAD BJN PIL SHA BRL MZN AGR SHP ALG BLS MRD MTR MAI ETA MRT JPN FER FKB RMP ETW KAN GZA HTR BGT GBN
  24. 24. % RI sessions not held: UP & HR blocks June’10 to May‘11 UP districts – cumulative State Average: 8.5% Sessions not held: 6,613 out of 70,851 > 20% 15% to 20% 10% to 15% < 10% % Sessions not held HR Blocks State Average: 8.6% Sessions not Held: 1,196 out of 13,856 SHP PIL RMP FKB SHA ETA KAN ALG MTR JPN BRL AGR BAD HTR GBN BJN MZN BLS ETW MAI MRD MRTBGT GZA FER SHP PIL RMP FKB SHA ETA KAN ALG MTR JPN BRL AGR BAD HTR GBN BJN MZN BLS ETW MAI MRD MRTBGT GZA FER KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH
  25. 25. By ICDS UP districts - cumulative State Average = 34.2% ICDS found present: 24,249 out of 64,653 By ASHA < 20% 20% to 40% 40% to 60% > 60% Mobilization of beneficiaries at monitored RI session sites, U.P. April ’10-March ‘11 KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH <Empty Picture><Empty Picture><Empty Picture>UP districts - cumulative State Average = 63.5% ASHA found present: 44,981 out of 64,653 KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH KRI SBD STP LLP HDO JAL JNS AHB BJN BAD BRC PIL SHA MZP BRL FTP BNA JNP UNN AZG MZN AGR ALG SHP BBK HMP BLS GND PTG KSN MRD BRP RBL FAI GZP BAL GRP BST KPN CKT MTR MAI KPD SULCSN MHB ETA SDN MRT LNO DOR JPN FKB CND FER ABN RMP MHG ETW KNA KAN AUR GZA HTR KSM SRW MAU SKN VRN BGT GBN BDH
  26. 26. Training & Capacity Building • Health Workers: – Re- started in year 2007, majority of HW got 2 days training exclusively on immunization – Evaluation of HW training done in year 2009-10 – New Training material developed, refresher training started this year (Feb 2011) • Medical Officers: – Ongoing in most states – 60,000 Medical Officers to be trained – Approx. 60% have been trained by now
  27. 27. Action Plan to improve RI coverage with Equity ( Year of intensification 2012) Detailed guidelines under development
  28. 28. Prioritization of the states Category DPT3 coverage Names of the states Remarks Poor performing states DPT3 coverage less than national average (NE states excluded) MP, UP, Bihar, Rajasthan, Jharkhand, Orissa, Gujarat, and Chhattisgarh Good and medium performing states DPT3 coverage more than national average (NE states excluded) Rest of the states North Eastern states Not considered Assam, Sikkim, Arunachal Pradesh, Manipur, Mizoram, Nagaland, Tripura, Meghalaya Difficult to access, geographical terrain, during a large part of the year
  29. 29. Grouping of the states for IRI in India-2012 North-East states Poor performing states Good & medium performing states Note: These states have been categorized, based upon DPT3 coverage in India, as per CES-2009
  30. 30. Identification and prioritization low coverage areas Strategy • Risk analysis using block as unit • key basic parameters for risk analysis are – Immunization coverage, drop-out, – outbreaks of measles or other VPDs, – session monitoring data, – accessibility, and availability of services, – human resource availability – high risk population data collected for Polio under the RRT (EPRP)
  31. 31. Special strategies (1/3) • Development of action plan with clear timelines. • Suggested components to include but is not limited to – Up-dation of micro-plan – Reallocation of human resource – Trainings – Intensive IEC activities – Catch up vaccination (Immunization weeks) b/w Jan- April 2012 to raise the profile of Imm. Program and to reach the unreached
  32. 32. Special strategies (2/3) • Communication strategy and operational plan to be rolled out in Q1, 2012 – Awareness about session site (visibility) – Branding of immunization – Advocacy with media and partners • HR strengthening – strengthening in management structure, Technical support unit (TSU) be set up at national/ state level in accordance with HR assessment report – Filling up vacancies at all levels including ASHA and AWW – Detailed guideline under development
  33. 33. Special strategies (3/3) • Teeka Express – Strengthening AVD – to provide a branded vaccine delivery van to cold chain point for the delivery of vaccine to the session site and return back – In underserved populations, tribal, hard to reach areas, LWE areas, urban and peri-urban areas • Improved supervision (addl. Funding under PIP) • Cold chain & VM
  34. 34. To conclude.. • India accounts for highest number of un- immunized children in the world • Disparity exists among rich/ poor, rural/ urban and social groups • Year of intensification 2012 has provided an opportunity to accelerate efforts to reach the unreached.
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