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MISSION INDRADHANUSH.pptx
- 2. What is Mission Indradhanush? • Initiative of Ministry of Health and Family Welfare, Government of India • Immunization of all children below 2 years of age and pregnant women against vaccine preventable diseases.
- 3. Why the mission is INDRADHANUSH ? Seven colours of rainbow = Immunity against seven vaccine preventable childhood diseases Diphtheria Tetanus Pertusis (Wooping cough) Tuberculosis Polio Measles Hepatitis B
- 4. 5 more diseases Rubella H- Influenza type B Japanese Encephalitis Rotavirus Pneumonia
- 5. Rationale for Mission Indradhanush Immunization programme (Expanded programme of Immunization) Universal Immunization programme 1978 1985
- 6. Evaluation surveys NFHS I NFHS II NFHS III CES (1992-93) (1998-99) (2005-06) (2009) 35.4 % 42% 43.5% 61% Full Immunization Coverage - 12-23 months
- 7. Rationale for Mission Indradhanush • UIP, Despite being operational for more than 30 years, only 65.3% of 12-23 months old children are fully immunized. • National-level measles coverage in India was 79% • More than 70 lakh (7 million) children in the country did not receive all vaccines that are available under the UIP • Drop-out rates for DPT 2 to 3 and OPV 2 to 3 were 11.1% and 11.9%, respectively. (Reference: Integrated Child health and Immunization Survey (ICHIS-2016), (Rapid Survey On Children , 2013-14)
- 8. UIP- Programmatic Challenges Accessibility Acceptance Slow Progress Equity Issues Rapid Urbanization Migrant Populations
- 9. To strengthen and reenergize the programme 25th December 2014 Jagat Prakash Nadda
- 10. Aims and Objectives • To fully immunize more than 90% of newborns by 2020 through special drives to reach all children who are partially vaccinated or unvaccinated. • UIP Provide free vaccines against 12 life threatening diseases 26 million children annually. • Also focuses on strengthening health systems for addressing equity issues in access to immunization.
- 11. Implementation • Focused and systematic immunization drive which was through a “catch-up” campaign mode • All the children who have been left out or missed out • Pregnant women are administered the tetanus vaccine • ORS packets and zinc tablets are distributed for use in the event of severe diarrhoea or dehydration • Vitamin A doses are administered to boost child immunity.
- 12. Areas Under Focus… • Areas with low RI coverage (pockets with Measles/vaccine preventable disease outbreaks). • Areas with vacant sub-centers: No ANM posted for more than three months. • Areas with missed Routine Immunization sessions : Eg: ANMs on long leave • Small villages and hamlets, clubbed with another village for RI sessions and not having independent RI sessions.
- 13. Areas Under Focus Areas which are at high risk for polio • Urban slums with migration • Nomads • Brick kilns • Construction sites • Other migrants (fisherman villages, riverine areas with shifting populations etc.) • Underserved and hard to reach populations (forested and tribal populations etc.)
- 14. Journey of Mission Indradhanush • The country was categorized into high, medium and low focus districts • A total of 528 districts covered during the various 4 phases of Mission Indradhanush from 2015- 2017 PHASE I PHASE II PHASE III PHASE IV • April- July 2015 • 201 districts • October 2015- January 2016 • 352 districts • 73 districts repeated from Phase-1 • 279 districts • April – July 2016 • 4 intensified immunization rounds • 216 districts • 199 districts repeated from Phase-1/2 • Feb- May 2017 in NE states , 68 districts, 60 districts repeated from Phase-1, 2 & 3 • April to July 2017 in 19 other states: 186 districts, 163 districts repeated from phase1/2/3
- 15. Phase I Phase III
- 16. 75.75 146.05 208.13 254.78 314.27 319.24 334.5 339.44 376.36 385.9 20.95 37.78 55.61 68.79 80.65 81.78 86.07 87.2 94.59 96.83 MI-1 (2015) MI-2 (2015-16) MI-3 (2016) MI-4 (2017) IMI (2017-18) MI-GSA (2018) MI-EGSA (2018) PH-6 (2018) IMI-2.0 (2019-20) IMI-3.0 (2021) Mission Indradhanush- Results from across all phases(Annual report – 2021-22) No. of children Immunized(Lakhs) No.of pregnant women immunized(Lakhs) Reference: Annual report 2021-22, Table No;4.7, Page No;92, Mission Indradhanush (All Phases) Coverage Report (As on March, 2021)
- 17. Strategy for Mission Indradhanush 4 Basic elements, Meticulous planning of campaigns/sessions at all levels Effective communication and social mobilization efforts Intensive training of the health officials and frontline workers Establish accountability framework through task forces
- 18. Period and programme approach • Four phases, each consisting of four monthly rounds, with each round lasting for 1 week • Did not include the routine immunization days planned in that week • Improved microplanning, monitoring, social mobilization and strengthened vaccination systems (especially in areas with inadequate staff numbers)
- 19. Mission Indradhanush sessions in district • Reach out all identified areas which have no/infrequent routine immunization sessions • Deploying of ANMs • Coordination between District immunization officer, urban nodal officer with block medical officers Planning process Prepare roster Implementation
- 20. • Head count survey House to house visits Conducted by ASHA/AWW/mobilizer Utilized for preparation of name‐based due lists for tracking and mobilization of beneficiaries Due lists for subsequent Mission Indradhanush rounds were updated Mission Indradhanush sessions in district
- 22. Components of Mission Indradhanush Components Operational planning Fixed and Out reach sessions Mobile sessions Communication planning 1. National Communication plan 2. State communication plan 3. District communication plan 4. Block communication plan 5. Community –level communication plan 6. Role of local influenzer
- 23. Fixed and outreach sessions • Sites for vaccination • Availability of human resources • Timings: 9:00 am to 4:00 pm. • Team: One vaccinator and two mobilizers
- 24. Mobile sessions • Peri‐urban areas • Scattered slums • Brick kilns • Construction sites etc.
- 25. Communication planning A need‐based communication and social mobilization activities were planned to achieve the following objectives: • Demand generation through increased visibility • Advocacy through media • Professional bodies and political leadership
- 26. Communication planning • Capacity building of immunization workforce on communication • Social mobilization through interpersonal communication, school and youth networks and corporates • Concurrent monitoring of communication interventions
- 27. Results • Full Immunization coverage of Children aged 12-23months NFHS I NFHS II NFHS III CES NFHS IV (1992-93) (1998-99) (2005-06) (2009) (2015-16) 35.4 % 42% 43.5% 61% 62%
- 28. Results NFHS4 (2015-16) Figure shows the coverage for each of the basic vaccinations among children age 12-23 months
- 29. Coverage with All Basic vaccinations by State/ UT
- 30. • Data from five states (Bihar, Madhya Pradesh, Rajasthan, Telangana and Uttar Pradesh), included in both rounds of INCHIS, was used to assess the impact of MI. 62.9 54.7 67.9 48 90.7 86.5 70.6 74 51 90.4 0 10 20 30 40 50 60 70 80 90 100 Bihar Rajasthan Madhyapradesh Uttar pradesh telangana Full Immunization coverage in 1st 2 phases of Mission indradhanush INCHIS-1 INCHIS-2 Results
- 31. As per the National Family Health Survey-4 (NFHS 4) trends increase in full immunization in urban areas has been 6% (57.6 to 63.9) as compared to NFHS-3, whereas the same is 22% (38.6 to 61.3) in rural areas 57.6 38.6 63.9 61.3 0 10 20 30 40 50 60 70 Urban Rural Full Immunization Coverage NFHS 3 NFHS 4 Results
- 32. Conclusion In spite of repeated phases of Mission Indradhanush • Full Immunization coverage in selected districts/ cities showed slow progress • Sluggish increase in urban areas as compared to rural areas There was a need of acceleration of full Immunization coverage
- 33. PRAGATI platform: Need of supplemental aggressive action plan Left outs And Drop outs December 2018
- 35. References • Mission Indradhanush, Operational guidelines 2016; MoHFW • Intensified Mission Indradhanush, operational guidelines, MoHFW • National Family health survey( NFHS) 3 & 4 • Integrated Child Health and Immunization Survey (ICHIS) Report 1 & 2, 2016 • Gurnani V, Haldar P, Aggarwal MK, Das MK, Chauhan A, Murray J, Arora NK, Jhalani M, Sudan P. Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy. Bmj. 2018 Dec 7;363. • Rapid Survey On Children (RSOC) 2013-14 National Report, UNISEF • Annual Report 2021-22, Department of health and family welfare, MoHFW ,GOI • Website : mohfw.nic.in • Website: https://nhm.gov.in
Editor's Notes
- This programme provides vaccination against 7 vaccine preventable diseases present which were common among children under 5 years of age which include
- Annual Report: 1992-Part of Child survival and Safe Motherhood Programme 1997- came under National Reproductive and Child Health Programme 2005-UIP is an integral part of National Rural Health Mission
- CES: Coverage Evaluation Survey RSOC: Rapid Survey of children Full Immunization Coverage (FIC) defined as receipt of one dose of BCG, three doses of OPV and DPT/Pentavalent, and one dose of measles vaccine. There was only 1% increase in vaccination coverage every year from 2009-2013
- UIP resulted in steady fall of infant Mortality rate from 80/1000 live births in 1991 to 37/ 1000 live births in 2015 High burden of morbidity and mortality from vaccine preventable diseases (VPDs).
- Equity issues faced by children accessing the public health system through a variety of supply and demand side interventions
- Union minister of health and family welfare launched Mission Indradhanush in 2014. The Minister launched the Mission on Good Governance Day to mark the birth anniversary of Bharat Ratna Shri Madan Mohan Malaviya and birthday of Bharat Ratna Shri Atal Bihari Vajpayee.
- Catch-up campaign-refers to the action of vaccinating an individual who, for whatever reason is missing or has not received doses of vaccines for which they are eligible, per the national immunization schedule It also includes children under 5 years of age to ensure the booster dose coverage.
- Nomad: a member of a people having no permanent home but moving from place to place usually in search of food or to graze livestock.
- Phase I: 50% of all are unvaccinated or partially vaccinated children. 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and nearly 25% of the unvaccinated or partially vaccinated children of India are in these 82 districts of 4 states.Phase III: These 216 districts have been identified on the basis of estimates where full immunization coverage is less than 60 per cent and have high dropout rates. Phase IV: North-eastern states of Assam, Arunachal Pradesh, Mizoram, Tripura, Manipur, Meghalaya, Nagaland and also Sikkim
- PHASE I More than 75 lakh children were vaccinated 20 lakh children were fully vaccinated More than 20 lakh pregnant women received tetanus toxoid vaccine. PHASE I& II Across 21.3 lakh sessions held through the country in high and mid-priority districts 1.48 crore children and 38 lakh pregnant women additionally immunized. 39 lakh children and more than 20 lakh pregnant women have been additionally fully immunized PHASE 1,2, 3 28.7 lakh immunization sessions were conducted Covers 2.1 crore children 55 lakh were fully immunized. 55.9 lakh pregnant women were given the tetanus toxoid vaccine Annual report 2021-22, Table No;4.7, Page No;92, Mission Indradhanush (All Phases) Coverage Report (As on March, 2021) GSA-Gram Swaraj Abhiyan, EGSA- Extended Gram Swaraj Abhiyan The first two phases of Mission Indradhanush contributed to an increase in Full Immunization Coverage by 6.7%, as evidenced by Integrated Child Health and Immunization Survey (INCHIS).
- Mission Indradhanush will be a national immunization drive for ensuring high coverage throughout the country with special attention to districts with low immunization coverage. Ensure availability of sufficient vaccinators and all vaccines during routine immunization sessions. Develop special plans to reach the unreached children in high risk settlements such as urban slums, construction sites, brick kilns, nomadic sites and hard-to-reach areas. 2) Generate awareness and demand for immunization services through mass media, mid media, interpersonal communication (IPC), school and youth networks and corporates. 3)in routine immunization activities for quality immunization services. 4) strengthen the district task forces for immunization in all districts of India and monitor the concurrent sessions and Enhance involvement and accountability/ownership of the district administrative and health machinery.
- 1) Implementation according to a roster prepared following the planning process. This includes planning meetings at district and block levels, and oversight provided by district task force for immunization (DTFI) 3)ANMs working in rural areas should be deployed to low performing/coverage areas or vacant sub centers in identified urban areas from rural areas in their own subcentres. 2) the DIO and urban nodal officer should coordinate with block medical officers to pull out the required number of ANMs from adjoining blocks to conduct the desired number of Mission Indradhanush sessions to cover the unreached/vulnerable population groups with limited human resources availability in urban areas
- 1)House to house visits before the first round of Mission Indradhanush, 2) Conducted by ASHA/AWW/mobilizer for estimation of beneficiaries in the catchment area 3) (Targeted beneficiaries will be pregnant women and children up to 2 years of age; however, children up to 5 years need to be focussed upon to improve booster dose coverage).
- 2) ANMs, Other health staff trained for administering injection, retired health workers and staff available from other government agencies such as Medical colleges, ANM/nurse training school, Employee’s State Insurance Corporation, Central Government Health Scheme, Armed Forces, Railways, District Urban Development Agency (DUDA)/State Urban Development Agency (SUDA) and community based organizations 4) An additional vaccinator will be included in the team if the estimated injection load is more than 60–70
- Mobile sessions planned at places where routine immunization coverage is weak and the small number of beneficiaries does not warrant an independent session. For these sessions, alternate means such as mobile vans were planned.
- CES: Coverage Evaluation Survey RSOC- Rapid survey on children The percentage of children age 12-23 months who have received all basic vaccinations increased from 44 percent in 2005-06 to 62 percent in 2015-16 (Figure 9.2).
- NFHS4 (2015-16) Figure shows the coverage for each of the basic vaccinations among children age 12-23 months. Coverage was highest for the BCG vaccine (92%) and lowest for the third dose of polio vaccine (73%). Although more children received the first doses of the DPT and polio vaccines than the second or third doses, the dropout rates are higher for polio than for DPT (Table 9.4). Ninety percent of children age 12-23 months received the first DPT dose and 78 percent received the last dose. These percentages were 91 percent and 73 percent for the polio vaccine. Six percent of children age 12-23 months received no vaccinations. Sixty-three percent of children received three doses of hepatitis B vaccine.
- Coverage of all basic vaccinations varies considerably by state and union territory. The coverage is highest in Puducherry, Punjab, Lakshadweep, and Goa (88-91%) and lowest in Nagaland (35%) and Arunachal Pradesh (38%) NE states: Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura
- INCHIS: Integrated Child Health and Immunization Survey Data from five states (Bihar, Madhya Pradesh, Rajasthan, Telangana and Uttar Pradesh), included in both rounds of INCHIS, was used to assess the impact of MI. Among these states, significant increase in FIC was observed in three states, namely Bihar, Madhya Pradesh and Rajasthan, at endline (INCHIS-2) relative to baseline (INCHIS-1). The percentage of children aged 12- 23 months who were fully immunized increased from 62.9% to 86.5% in Bihar (24% increase), from 54.7 % to 70.6 % in Rajasthan (16% increase) and from 67.9% to 74% in Madhya Pradesh (6% increase). The increase in FIC in Bihar and Rajasthan is statistically significant, whereas in MP it is not. In contrast to the high FIC attainments in Bihar, Rajasthan and Madhya Pradesh, the full immunization coverage increased only marginally from 48.0% to 51.0% in Uttar Pradesh. With already high levels of immunization coverage in Telangana, the full immunization coverage in the state remained almost at the same level between INCHIS-1 (90.7%) and INCHIS-2 (90.4%).
- INCHIS: Integrated Child Health and Immunization Survey Between 2005- 06 and 2015-16, this percentage increased more in rural areas 22% (from 39% to 61%) than in urban areas 6 % (from 58% to 64%). As per report of Integrated Child Health and Immunization Survey (INCHIS), the first two phases of Mission Indradhanush have led to an increase of 6.7% in full immunization coverage in one year This increase was more in rural areas (7.9%) as compared to urban areas (3.1%).
- It was realised that though the pace on full immunization coverage has been icreased with Mission Indradhanush, progress is not uniform in all districts and certain areas like urban slums not getting the required focus. Hon’ble Prime Minister through PRAGATI platform, emphasized the need of a supplemental aggressive action plan to cover all left outs and drop outs in select districts and urban cities with low routine immunization coverage in a specific time-frame
- Pro-active Government And Timely Implementation Hon’ble Prime Minister through PRAGATI platform, emphasized the need of a supplemental aggressive action plan to cover all left outs and drop outs in selected districts and urban cities with low routine immunization coverage in a specific time-frame ie. by 2018