This document provides information on Intensified Mission Indradhanush 4.0 (IMI 4.0), India's immunization drive. It discusses immunization coverage trends from NFHS surveys from 2005-2021. It shows that full immunization coverage in India has increased from 43.5% to 76.4% over this period. However, 6 states saw decreases in coverage from NFHS-4 to NFHS-5. The document outlines programmatic challenges during COVID-19 like disrupted outreach and decreased uptake. It provides details of the IMI 4.0 plan like its timeline in 3 phases, target populations, focus areas, and accountability framework at national, state and district levels. Microplanning, communication and

1. IMI- 4.0 1
Intensified Mission Indradhanush
(IMI 4.0)

2. Immunization Coverage (FIC – NFHS 3, NFHS 4 & NFHS 5)
≥ 80%
70% to 80%
60% to 70%
50% to 60%
< 50%
India: 43.5% ranging
from 21% to 81%,
NFHS-3, 2005-06
India: 62% ranging
from 36% to 91%,
NFHS-4, 2015-16
India: 76.4% ranging
from 58% to 95%,
NFHS-5, 2019-21
Six States/UTs shows decrease in FIC (%) in NFHS-5 compared to NFHS-4
Punjab (12.9%), Puducherry (9.4%), Goa (6.5%), Kerala (4.3%), Lakshadweep (2.9%) Sikkim (2.4%).
NA

3. 18.8
20.6
24.8
30.2
25.5
20.6
19.8
19.6
16.5
17.6
19.3
23.2
17.3
17.4
19.9
19.1
19.4
24.1
20.5
16.9
17.8
18.2
3.2
3.7
6.0
11.3
6.1
3.7
3.9
2.9
2.5
2.8
3.2
5.4
4.5
2.8
3.4
4.1
3.5
4.6
3.9
3.2
2.8
3.1
1
2-3
4-5
6+
NO SCHOOLING
<5 YEARS COMPLETE
5-7 YEARS COMPLETE
8-9 YEARS COMPLETE
10-11 YEARS COMPLETE
12 OR MORE YEARS…
HINDU
MUSLIM
CHRISTIAN
SIKH
SCHEDULED CASTE
SCHEDULED TRIBE
OTHER BACKWARD CLASS
LOWEST
SECOND
MIDDLE
FOURTH
HIGHEST
BIRTH
ORDER
MOTHER'S
SCHOOLING
RELIGION
CASTE
WEALTH
QUINTILE
Fully vaccinated (all basic vaccinations) Partial Vaccination No vaccination
Data source: NFHS-5
Address the Partially vaccinated & Unvaccinated

4. M i g r a n t P o p u l a t i o n s
R a p i d U r b a n i z a t i o n
Programmatic Challenges
A c c e s s i b i l i t y
A c c e p t a n c e
S l o w P r o g r e s s E q u i t y I s s u e s

5. Programmatic Challenges- COVID-19
 Due to COVID-19 containment many outreach
sessions not being held, resulting in a fall in
immunization coverages.
 Since Anganwadi centres & schools are closed RI
sessions are being organized at alternate session sites
affecting the uptake of services.
 Overlap of work due to engagement of ANM and
frontline workers in COVID containment and COVID
vaccination
 Large scale movement of migrant population
 Hesitancy among caregivers to take their children to
healthcare facilities due to fear of exposure to COVID-
19.

6. Drop in Immunization Coverage
• Globally 2.3 crore children <1 year
old left unvaccinated even with
basic vaccines
• India ranks first with most
un/partially vaccinated children
IMI- 4.0 6

7. Immunization strengthening during COVID-19 pandemic
• Health Services including Immunization deemed as essential
services – MHA order issued
• Guidelines for delivering Immunization services during
COVID-19 outbreak disseminated by MoHFW
• Routine Immunization
• Polio SIAs
• Surveillance for Vaccine Preventable Diseases
• Reviews held with States/ UTs to discuss challenges being
faced during the pandemic and the necessary measures
taken to ensure immunization services

8. 3,005,886 3,039,814 3,125,048
3,215,231
2,229,731
2,977,789
3,183,062 3,211,625
2,869,455
3,058,072
2,595,247
0
1000000
2000000
3000000
4000000
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3
2019-20 2020-21 2021-22
*Data Source: HMIS
Impact of COVID-19 on Immunization Coverage, India- No. of sessions

9. 93
88
97 96
73.2
95.1 95.1
90.0
79.4
97.3
80.3
0
20
40
60
80
100
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
Full Immunization Coverage
2019-20 2020-21 2021-22
Impact of COVID-19 on Immunization Coverage, India- FIC(%)
Percent
*Data Source: HMIS

10. IMI- 4.0 10
Rural & Urban Variation
58
39
44
64
61 62
75.5 76.8 76.4
Urban Rural Total
Full Immunization Coverage(%): Urban vs Rural
NFHS - 3 NFHS - 4 NFHS - 5

11. Districts Selected for IMI- 4.0
IMI- 4.0 11
No. Of Districts State/s
1 A&N Islands , Chhattisgarh, Daman & Diu, J&K, Mizoram
2 Haryana, Meghalaya, Pondicherry, Sikkim, Tripura, Goa
3 Uttarakhand
4 Punjab
5 Jharkhand, Madhya Pradesh,
7 Delhi
8 West Bengal
9 Karnataka, Kerala
10 Maharashtra, Odisha
12 Nagaland, Tamil Nadu
13 Andhra Pradesh
14 Arunachal Pradesh
15 Manipur
19 Rajasthan
27 Assam
29 Telangana
33 Gujarat
38 Bihar
75 Uttar Pradesh
IMI 4.0 districts – 374 of 736

12. Timeline – 3 Phases in 3 Months
• In view of the involvement in Covid vaccination and Covid surge the earlier guidance is
relaxed
• Unlike in the past, each round will be conducted for seven days, including RI days,
Sundays, and public holidays
• Timings: Flexible timing; as agreed with community
IMI- 4.0 12
Round Date (2022)
1 7th February onwards
2 7th March onwards
3 4th April onwards

13. Target Population
• The target beneficiaries include,
• Un/Partially vaccinated children less than 2 years (0 to 23 Months)
• Unvaccinated or partially vaccinated pregnant women
• Pregnant women target includes all those who are currently pregnant on the day of
headcount survey and due for vaccination either with primary or booster dose for Td.
• The target children include all those born in or after February 2020 and due for one
or more vaccines
IMI- 4.0 13

14. Focus area
IMI- 4.0 14
• Areas with disrupted RI services due to COVID-19 pandemic
• High-risk areas: Migratory population, Nomadic sites, Brick Kilns Construction Sites Others
• New-born who was delivered at home.
• Villages/areas with Vacant sub centers, two or more consecutive missed routine immunization sessions.
• Hard to reach and areas with vaccine hesitancy
• Urban areas specially slums,
• Areas with outbreak of Measles, and other VPDs,
• Areas like orphanage, prisons, red-light areas, riverine areas, migration for agriculture etc.
• Tribal areas
• Other difficult areas: Areas hit by natural calamities (e.g., flood). The areas under social/political/or other
conflicts need additional administrative support.

15. IMI session planning
• Outreach and mobile sessions
• Criteria for selection of session site:
o Closer to the community
o Easily accessible and information reachable to community in advance
o Acceptable by the community
o Highly visible to people
o Suitable for Covid situation
IMI- 4.0 15
All efforts need to be made to ensure inclusion of all settlements including urban,
periurbal, rural and and temporary population at fringes of the village

16. Microplanning
Target of at least
90% FIC
Identification of beneficiaries missed
during COVID-19 pandemic
Key strategies and activities
During campaign: Intensive
monitoring and supervision
Communication
Planning
Governance and Multi-
sectoral collaboration
System
Strengthening
Follow COVID appropriate
behaviors at sessions

17. Accountability Framework
• MoHFW for overall guidance and review
• Training/Orientation of state health officials
• Communication strategy, prototype of IEC
materials
National
• State Steering Committee
• State Task Force for Immunization
• State review committee
• State level training of all district level master
trainers
State
• District/ City Task Force for Immunization (DTFI/CTFI)
• District Review Committee
• District health official as nodal officer for each
block/Urban units
• Distribution of funds, vaccines, IEC materials Logistics
to blocks/Urban units
District
/
City
• Block task force (BTF) headed by BDO
• Block review committee to review progress and ensure
timeliness
• Timely distribution of funds, IEC materials, logistics
and training of HW
• Micro planning with adequate HR allocation
Block
IMI- 4.0 17

18. State Level
• State Steering Committee meeting: once for inter-departmental coordination
• Meeting of State Task Force for Immunization: before and immediately after both
rounds
• State Workshop: Build capacity of key officials from IMI districts, preferably through
virtual platforms (One day)
• Media Sensitization Meeting (Half day)
• Review of districts for preparedness: Principal Secretary/ MD-NHM to review
preparedness of IMI districts before each round (Half day)

19. WOMEN & CHILD
DEVELOPMENT
EDUCATION
Supporting departments
HOUSING & URBAN
AFFAIRS
YOUTH AFFAIRS
AND SPORTS
INFORMATION &
BROADCASTING
PANCHAYATI RAJ
TRIBAL AFFAIRS

20. District Level
Task Force Participants Function Frequency
District Task force for
Immunization (DTFI)
Chairperson: District
magistrate / collector
Member secretary:
District
Immunization Officer
Responsibility: CS / Chief Medical Officer Reviews:
 sensitize the stake holders, plan,
review the progress, strengthen
interdepartmental coordination,
identify the bottle necks, and
resolve the issues
 Review the preparedness,
performance in between rounds
At least twice
before IMI 2022
and once
between rounds
District Task force for
Urban Immunization -
DTFU (I)
Chairperson: District
magistrate / collector
Member secretary:
District Medical and
Health Officer/CMO
Municipal Commissioner, DIO, District
coordinator/nodal officer NUHM,
Medical superintendent from DH,
District Development Officer, District
Education Officer, District Project Officer
ICDS, District Public Relation Officer,
Municipal Health Officer
Critically review the Immunization
progress, identify gaps, and decide
strategic actions to improve RI
coverage.
At least twice
before IMI 2022
and once
between rounds.

21. District Level
Group/ Workshop Participants Function Frequency
District review
committee Headed by
CMO/CS
Members include nodal officers,
district officials of key departments,
representatives of district level
partners, and CSOs.
 Review micro plan,
 Develop communication strategy,
 Ensures timely reporting formats,
 Monitor vaccine and logistics supply chain and cold
chain management.
 Availability and distribution of funds and logistics
District workshop Training of medical officers:
Participants:
 Two per block / urban planning unit (MOIC and one MO)
 District Program Manager (NHM), district IEC consultant, district ASHA coordinator, district
cold chain handler, district data manager, district M&E coordinator (NHM), district accounts
manager (NHM)
One day
Training of Program / Accounts managers
 Block program and accounts managers
 DIO, District Program Manager, Master trainer (MO/District training officer), partner
agencies
One Hour
Training of Data Handlers Half a day
Training of cold chain handlers Half a day
Media sensitization workshop: to sensitize media person, media coverage, demand generation,
and to resolve their queries.
Half a day

22. Block/ City Level
• Identification of Supervisors: in blocks/ planning units
• Meeting of Block/ Urban Task Force for Immunization: one each before, during and
immediately after each round
• Training of health workers: Build capacity of ANMs, LHVs and Health Supervisors
(One day for each session)
• Orientation of Mobilizers: ASHAs and AWWs (Half day for each workshop)
• Development of microplans including Communication plan
• Monitoring of Communication activities
• Daily Evening Review Meeting: During implementation phase

23. Village/ Session Site Level
• Head Count Survey and preparation of due-lists
• Appropriate session site/s identification by ANM/ASHA
• Display of IEC material at strategic sites
• Meeting with Panchayat representative for involvement and support in social
mobilization - utilize meetings for Gram Swaraj Abhiyan
• Immunization session/s to be conducted on pre-defined dates
• Mobilization of beneficiaries to session sites by NYK, NSS, NCC, local volunteers and
PRIs

24. Microplanning
IMI 4.0 sessions are planned across seven days including RI
days/ COVID vaccination days
Focus on containment zones where some sessions were not
held, pockets of migrants who may have migrated during
lockdown
Flexible session timings, if required, specially in urban slums
Deployment of mobile teams, if required, to cover sparsely
populated settlements
Ensure that target is updated prior to the sessions and the
same is uploaded on the reporting portal for IMI 3.0

25. • Step-1: Identification of influencers: Identify the influencers in the catchment area. Influencers can be
gram Pradhan, community or religious leaders, teachers, NGO members, or ward members, counsellors etc.
• Step-2: Identify best venue, time, date/day: To be decided in consensus with the influencer.
• Step 3: Due listing of beneficiaries: The due list of beneficiaries is to be informed to the leaders of the
community (elderly, religious leaders, gram Pradhan etc.). The leaders of the community may be encouraged
to certify that all the children and pregnant women due for any vaccination have been captured in the due
list.
• Step-4: Update micro plans to conduct sessions as per community needs
• Step-5: Engage community leadership for mobilization
IMI- 4.0
New Activity Proposed
‘Vaccination on Demand’ in urban areas

26. • Display communication materials on COVID appropriate behaviors
• Availability of handwashing/ sanitization station for beneficiaries/
caregivers
• Vaccination team to wear 3 layer surgical mask
• Screen beneficiaries for flu-like symptoms
• Avoid crowding, ensure physical distancing of “2 gaz”
• Sanitize hands after vaccinating every beneficiary
• Provide messages to caregivers/ beneficiaries
• Disinfect seating space and equipment after completion of session
Infection Prevention & Control at Session Site
Staff to be trained on screening beneficiaries and
parents for Flu like symptoms

27. THANKS