Review cum Workshop on Immunization Programme  18 th-  20 th  May’2011,  New Delhi Jharkhand Dr. Ajit Kr. Prasad
Current Scenario Coverage Annual Target Coverage – DLHS 3 Quantum  Infants (A) Pregnant Women  (B) Fully Immunized  (C) BC...
Fully Immunized Children Jharkhand = 54.1 % Source: DLHS 3 data < 30%(2) 30% to 40%(3) 40% to 50% (5) > 50% (14) D u m k a...
Categorization of districts according to FI coverage  (DLHS 3) Less than 30% 30% - 50% 50% - 70% More than 70% <ul><li>Gir...
Drop out Rate Source: DLHS 3 data >20%(3) 20% to 30%(9) 10% to 20% (10) <10% (1) D u m k a J a m t a r a D e o g h a r G i...
Categorization of districts according to Drop-outs , BCG-DPT3 (DLHS 3) Less than 10% 10% - 20% 20% - 30% More than 30% <ul...
Microplanning  Cold Chain Equipment Total Needed Total Available Functional ILR Small 281 270 DF  small 332 320 ILR Large ...
Health Worker - Training MO - Training Training Load Trainings Completed No. of Health Workers No. of Batched Planned No. ...
AEFI No. of Districts with AEFI Committees No of Serious AEFI Reported No. of AEFI Deaths Reported No. of Serious AEFI Inv...
Access analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-DPT3, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) Bokaro, Garhw...
Utilization analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-Measles, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) Bokar...
Demand Generation Activities <ul><li>Involvement of newly formed PRI members in monitoring & demand generation </li></ul><...
Status : Alternate Vaccine Delivery 2009-10 2010-11 Sessions Planned (Nos) 374637 361207 Held (Nos) 344476 338756 % age He...
Status : Alternate Vaccinators & Mobilizers 2009-10 2010-11 Sessions planned using Alternate Vaccinators Planned (Nos) 374...
Status :Computer Assistants Computer Assistants 2009-10 2010-11 Required in State (No) 25 25 Hired (No) 23 25 % CA s in pl...
Waste Disposal Pits Waste Disposal Pits 2009 2010 Required in State (No) 221 221 Pits Built (No) 221 221 % age pits in pla...
Status of RI supervision  State & District level   <ul><li>Existing Supervisory Mechanism in state- District has been allo...
Status of RI Review Meeting <ul><li>At State Level: </li></ul><ul><ul><li>Key participants: State govt officials, DIOs and...
Outcome/ Impact of Supervisory visits <ul><li>Supervisor can guide the staffs to provide better quality services with avai...
Key issues regarding vaccine stocks State Level  Name of Item Opening balance ( In Lakh Doses) Receiving  ( In Lakh Doses)...
Key issues regarding vaccine stocks Details of Stock Out & Stock in (10-11)   Stock Out Stock In Remarks Measles (RI) 15-S...
Status and Issues in MCTS <ul><li>Full-fledged Online Entry Started in Ramgarh </li></ul><ul><li>Hazaribag, Giridih, Garhw...
Measles Catch-up Campaign Coverage Sr No Name of District Target Population Vaccinated % Coverage 9 m to < 5 y 5 y to  < 1...
Lesson Learned <ul><li>Fixation of dates well in advance is utmost importance for effective programme implementation. </li...
Lesson Learned <ul><li>Inclusion of more private practitioners for AEFI treatment will be beneficial for the programme and...
<ul><li>RI Related IEC Status </li></ul><ul><li>Any state level communication strategy for routine immunization - YES </li...
 
New State initiatives for improving coverage & quality <ul><li>New tally sheet cum due list in sustainable booklet format ...
Key issues and possible solution Issues Solution Estimation of beneficiaries not done properly <ul><li>More emphasis on es...
Immunization Budget Status *State resources/funds also used for RI, IEC & training on Surveillance of VPD’s. Consolidated ...
Component wise expenditure 2010-11 Consolidated year status Alt. Vaccine delivery Alt. Vaccinators Hired Social Mobilizers...
Component wise expenditure 2010-11 Other heads under which funds utilized   Supervisory Visits (funds for State level) Sup...
What works!! <ul><li>2 best performing district as per HMIS report are Pakur & Jamtara </li></ul><ul><li>Intense monitorin...
What doesn’t work!! <ul><li>2 least performing district as per HMIS report are Ramgarh & Khunti </li></ul><ul><li>Issues: ...
Bottlenecks/Hurdles System Components  Main Problems Causes  Solutions  Service Delivery <ul><li>Many post of ANMs are sti...
Bottlenecks/Hurdles System Components  Main Problems Causes  Solutions Surveillance and Monitoring – including AEFI, VPD <...
Achievements in 2010-11 <ul><li>Supportive supervision done in 5 districts of Santhal Pargana division  </li></ul><ul><li>...
Challenges for next year <ul><li>Full implementation of MCH tracking system </li></ul><ul><li>Increasing sample size of mo...
Way forward <ul><li>Complete the health worker trainings as per GOI guidelines </li></ul><ul><li>Supportive supervision in...
Suggestions <ul><li>Inclusion of RI monitoring session in Medical officers trainings </li></ul><ul><li>Inclusion of some q...
Support Required Support Required / Expectations Agency <ul><li>Timely supply of vaccines </li></ul><ul><li>Allocation of ...
Vision…Where do we want to reach? System Component Indicator* Target by 2012 Service Delivery % Fully Immunized Children (...
<ul><li>Thank you </li></ul>
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Jharkhand RI 2011

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Jharkhand RI 2011

  1. 1. Review cum Workshop on Immunization Programme 18 th- 20 th May’2011, New Delhi Jharkhand Dr. Ajit Kr. Prasad
  2. 2. Current Scenario Coverage Annual Target Coverage – DLHS 3 Quantum Infants (A) Pregnant Women (B) Fully Immunized (C) BCG-DPT3 Dropout rate (D) Number of Children Not Fully Immunized [100-(C)] x (A)/100 Number of BCG-DPT3 Dropout Children (D) x (A)/100 815021 939751 54.1 % 22.4 % 37 4094 182564
  3. 3. Fully Immunized Children Jharkhand = 54.1 % Source: DLHS 3 data < 30%(2) 30% to 40%(3) 40% to 50% (5) > 50% (14) D u m k a J a m t a r a D e o g h a r G i r i d i h K o d e r m a G o d d a S a h i b g a n j P a k u r D h a n b a d S i n g h b h u m E a s t G a r h w a P a l a m u C h a t r a L a t e h a r L o h a r d a g a G u m l a S i m d e g a S a r a i k e l l a S i n g h b h u m W e s t B o k a r o K h u n t i R a n c h i H a z a r i b a g h R a m g a
  4. 4. Categorization of districts according to FI coverage (DLHS 3) Less than 30% 30% - 50% 50% - 70% More than 70% <ul><li>Giridih – (21.6) </li></ul><ul><li>Godda – (28.4 </li></ul><ul><li>Sahibganj (33.6) </li></ul><ul><li>Deoghar (35.7) </li></ul><ul><li>Jamtara (38.6) </li></ul><ul><li>Pakur (41.9) </li></ul><ul><li>Chatra (45.4) </li></ul><ul><li>Koderma (46.9) </li></ul><ul><li>Dhanbad (47.5) </li></ul><ul><li>Dumka (52.9) </li></ul><ul><li>Palamu (53.4) </li></ul><ul><li>Bokaro (56.4) </li></ul><ul><li>W. Singhbhum (59.1) </li></ul><ul><li>Simdega (61.2) </li></ul><ul><li>Garhwa (66.6) </li></ul><ul><li>Gumla (68.6) </li></ul><ul><li>Hazaribagh (Ramgarh) (68.9) </li></ul><ul><li>Saraikella (69.3) </li></ul><ul><li>Lathehar (72.7) </li></ul><ul><li>Ranchi (Khunti) (74.3) </li></ul><ul><li>Lohardaga (81.2) </li></ul><ul><li>E. Singhbhum (81.5) </li></ul>
  5. 5. Drop out Rate Source: DLHS 3 data >20%(3) 20% to 30%(9) 10% to 20% (10) <10% (1) D u m k a J a m t a r a D e o g h a r G i r i d i h K o d e r m a G o d d a S a h i b g a n j P a k u r D h a n b a d S i n g h b h u m E a s t G a r h w a P a l a m u C h a t r a L a t e h a r L o h a r d a g a G u m l a S i m d e g a S a r a i k e l l a S i n g h b h u m W e s t B o k a r o K h u n t i R a n c h i H a z a r i b a g h R a m g a
  6. 6. Categorization of districts according to Drop-outs , BCG-DPT3 (DLHS 3) Less than 10% 10% - 20% 20% - 30% More than 30% <ul><li>Saraikella (8.9) </li></ul><ul><li>E. Singhbhum (11.3) </li></ul><ul><li>Ranchi (Ramgarh) (14.1) </li></ul><ul><li>Jamtara (14.5) </li></ul><ul><li>Latehar (14.8) </li></ul><ul><li>Hazaribagh (Ramgarh) (14.9) </li></ul><ul><li>Gumla (15.7) </li></ul><ul><li>Bokaro (16) </li></ul><ul><li>Lohardaga (16.1) </li></ul><ul><li>Garhwa (16.2) </li></ul><ul><li>W. Singhbhum (20.7) </li></ul><ul><li>Deoghar (21.3) </li></ul><ul><li>Simdega (21.5) </li></ul><ul><li>Dumka (23.2) </li></ul><ul><li>Dhanbad (24.1) </li></ul><ul><li>Koderma (25.3) </li></ul><ul><li>Giridih (25.4) </li></ul><ul><li>Chatra (25.9) </li></ul><ul><li>Palamu (28.5) </li></ul><ul><li>Godda(31.3) </li></ul><ul><li>Sahibganj (32.8) </li></ul><ul><li>Pakur (36.3) </li></ul>
  7. 7. Microplanning Cold Chain Equipment Total Needed Total Available Functional ILR Small 281 270 DF small 332 320 ILR Large 579 210 195 DF Large 298 267 259 WIC 5 5 5 WIF 02 2 2 Cold Box (L) 5000 859 859 Cold Box (S) 5000 906 906 Vaccine Carrier 933900 29769 29769 No. of Districts with micro plans revised in 2011 Percent Planned sessions held Number of Sessions Alternate Vaccinators hired (last FY) 24/24 89 34863
  8. 8. Health Worker - Training MO - Training Training Load Trainings Completed No. of Health Workers No. of Batched Planned No. of HWs Trained % HWs Trained 63647 279 27398 43% Training Load Trainings Completed No. of MO No. of Batched Planned No. of Batches Completed No. of MO Trained % MO Trained 1917 79 42 635 33
  9. 9. AEFI No. of Districts with AEFI Committees No of Serious AEFI Reported No. of AEFI Deaths Reported No. of Serious AEFI Investigated 24 10 (4 during Measles SIA round) 5 10
  10. 10. Access analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-DPT3, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) Bokaro, Garhwa, Gumla, Hazaribagh, Latehar, Lohardaga, Ranchi, Khunti, Saraikella, East Singhbhum, Ramgarh (11) Chatra, Deoghar, Dhanbad, Dumka, Koderma, Pakur, Palamu, Sahibganj, Simdega, West Singhbhum (10) Low (< 70%) Jamtara (1) Giridih, godda (2)
  11. 11. Utilization analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-Measles, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) Bokaro, Garhwa, Gumla, Hazaribagh, Latehar, Lohardaga, Ranchi, Khunti, Saraikella, East Singhbhum, Ramgarh, Chatra, Deoghar, Dhanbad, Dumka, Pakur, Palamu, Sahibganj, Simdega, West Singhbhum (20) Koderma Low (< 70%) Jamtara, Giridih, godda (3) Nil
  12. 12. Demand Generation Activities <ul><li>Involvement of newly formed PRI members in monitoring & demand generation </li></ul><ul><li>Implementation of new MCH card </li></ul><ul><li>IEC plan </li></ul><ul><ul><ul><li>A communication strategy of RI is in place </li></ul></ul></ul><ul><ul><ul><li>Folk, Print and other electronic mass media are used </li></ul></ul></ul><ul><ul><ul><li>IPC – awareness generation through home visit and counseling </li></ul></ul></ul><ul><ul><ul><li>IEC printed by Government and other agencies in consultation with Government </li></ul></ul></ul><ul><ul><ul><li>Hoardings, Wall writing, posters and banners on different issues for all service delivery point and outreach too </li></ul></ul></ul><ul><ul><ul><li>Display of IEC on session site is must and reviewed followed by feedback </li></ul></ul></ul>
  13. 13. Status : Alternate Vaccine Delivery 2009-10 2010-11 Sessions Planned (Nos) 374637 361207 Held (Nos) 344476 338756 % age Held 92 94 Alternate Vaccine Delivery (AVD) No of sessions planned with AVD 374637 361207 No of sessions held with AVD 295689 169596 % Sessions held with AVD 78.93% 46.95%
  14. 14. Status : Alternate Vaccinators & Mobilizers 2009-10 2010-11 Sessions planned using Alternate Vaccinators Planned (Nos) 374637 7200 Held (Nos) 344476 4546 % age Held 92 63.13 Mobilizers (Paid mobilizers like ASHAs/ Link workers/ Others) No of sessions planned with soc mobilizers 374637 361207 No of sessions held with mobilizers 233234 116401 % Sessions held with mobilizers 62.3 32.22
  15. 15. Status :Computer Assistants Computer Assistants 2009-10 2010-11 Required in State (No) 25 25 Hired (No) 23 25 % CA s in place 92 100
  16. 16. Waste Disposal Pits Waste Disposal Pits 2009 2010 Required in State (No) 221 221 Pits Built (No) 221 221 % age pits in place 100 100
  17. 17. Status of RI supervision State & District level <ul><li>Existing Supervisory Mechanism in state- District has been allotted to State level officers for supervision </li></ul><ul><li>Field level: Every MO has to visit it session site per month and MOIC has to visit 4 session site per month </li></ul><ul><li>District level: DIO has to visit it 8 session site per month </li></ul><ul><li>Steps to improve – Regular review by Deputy Commissioners/CS at district level. </li></ul>2009-10 2010-11 Number of Visits made by State officials 48 48 Number of Visits made by district officials - 877
  18. 18. Status of RI Review Meeting <ul><li>At State Level: </li></ul><ul><ul><li>Key participants: State govt officials, DIOs and all partners </li></ul></ul><ul><ul><li>Key issues discussed: Monitoring data, fund utilization, policy decisions and guidelines </li></ul></ul><ul><ul><li>Key Recommendations of meetings: Increasing the sample size of monitoring, monitoring of the MCH tracking registers, use of new due list. </li></ul></ul>2009-10 2010-11 No of Review meetings held at State Level 3 7 District Level - 240 Block level - 5770
  19. 19. Outcome/ Impact of Supervisory visits <ul><li>Supervisor can guide the staffs to provide better quality services with available human resource and logistics. </li></ul><ul><li>Supervisors can give the hands of training for making of good quality micro plans, injection technique and waste management </li></ul><ul><li>Grass root level workers generally get information regarding new guidelines related to Routine Immunization </li></ul><ul><li>Regular Visits helps Districts to identify weak blocks and weak sub centers </li></ul><ul><li>Monitoring of helps planning unit for identification of left out area and areas with low immunization coverage </li></ul>
  20. 20. Key issues regarding vaccine stocks State Level Name of Item Opening balance ( In Lakh Doses) Receiving ( In Lakh Doses) Distribution ( In Lakh Doses) Closing Balance ( In Lakh Doses) BCG 14.7 26.2 33.7 7.2 TOPV 3 62 54.4 10.6 DPT 12.5 36.36 44.61 4.25 Measles 7.49 4.99 12.39 0.09 TT 12.43 41.9 37.5 16.83
  21. 21. Key issues regarding vaccine stocks Details of Stock Out & Stock in (10-11)   Stock Out Stock In Remarks Measles (RI) 15-Sep-10 27th Sept-10 12 days 9-Oct-10 10-Nov-10 32 days 14-Dec-10 3-Mar-11 48 Days Total Days Stock out 92 Days Topv (RI) 21-Apr-10 23-Apr-10 1 day 8-Jun-10 30-Jun-10 22 days 12-Aug-10 21-Aug-10 9 days 8-Sep-10 27-Sep-10 19 days 9-Oct-10 21-Oct-10 12 days 24-Nov-10 2-Feb-11 70 days 11-Feb-11 24-Feb-11 13 days Total Days Stock out 146 Days AD 0.1 ml sy 5-Aug-10 15-Sep-10 40 days 18-Nov-10 27-Dec-10 16 days Total Days Stock out 56 Days 5ml sy. 17-Apr-10 30-Jun-10 73 days <ul><ul><li>Issues : </li></ul></ul><ul><ul><li>Indent not done till exhaustion of stocks by Districts </li></ul></ul><ul><ul><li>Guidelines for buffer stock maintenance not followed. </li></ul></ul>
  22. 22. Status and Issues in MCTS <ul><li>Full-fledged Online Entry Started in Ramgarh </li></ul><ul><li>Hazaribag, Giridih, Garhwa, Gumla, Latehar, East Singhbhum, Sahibgunj and Saraikela also Started Online Entry </li></ul><ul><li>Ranchi and Giridih still have issues with Common Master Data Entry </li></ul><ul><li>Internet Connectivity and Poor Electricity is major Issue in Different parts of the state </li></ul>
  23. 23. Measles Catch-up Campaign Coverage Sr No Name of District Target Population Vaccinated % Coverage 9 m to < 5 y 5 y to < 10 y Total Number 1 DEOGHAR 283016 114976 136096 251072 88.7 2 JAMTARA 146181 54807 64289 119096 81.5 3 GUMLA 196745 83936 100619 184555 93.8 4 LOHARDAGA 90514 33930 43569 77499 85.6 5 KHUNTI 110085 40751 48605 89356 81.2 State Total 826541 328400 393178 721578 87.3
  24. 24. Lesson Learned <ul><li>Fixation of dates well in advance is utmost importance for effective programme implementation. </li></ul><ul><li>Centralized IEC material will help to maintain quality and timeliness. </li></ul><ul><li>Cold chain assessment should be done in advance so that electrical cold chain equipment & non electrical cold chain equipment will be supplied as per actual need for phase II. </li></ul><ul><li>More clear financial guideline required to districts either from central or State level. </li></ul><ul><li>Blocks & districts should follow the training guidelines given by Govt. of India. </li></ul>
  25. 25. Lesson Learned <ul><li>Inclusion of more private practitioners for AEFI treatment will be beneficial for the programme and in long run also. </li></ul><ul><li>For better involvement of schools, there should be letters to concerned departments from higher levels (national-state-district) well in advance. </li></ul><ul><li>Grass root level workers should be made accountable for information to schools & AWW into these areas. </li></ul><ul><li>Blocks need to learn to implement programme in planned manner & specific instruction should be given to them from higher authorities in this regard. </li></ul>
  26. 26. <ul><li>RI Related IEC Status </li></ul><ul><li>Any state level communication strategy for routine immunization - YES </li></ul><ul><li>Any budget marked for RI related IEC - YES </li></ul><ul><li>Activities undertaken through </li></ul><ul><ul><li>Local TV/Cables/ Radio network. Production of audio jingle 30 Sec (3nos.) And Broadcasting on AIR & local Fm channels. </li></ul></ul><ul><ul><li>Broadcasting of visual adds in regional channels like Sahara, ETV, Mahuaa, Taaza, </li></ul></ul><ul><ul><li>Banner/Poster/Handouts on RI. </li></ul></ul><ul><ul><li>Hoardings on RI </li></ul></ul>Budget (In Lakhs) 2010-2011 2011-2012 Nil ROP not Finalized
  27. 28. New State initiatives for improving coverage & quality <ul><li>New tally sheet cum due list in sustainable booklet format </li></ul><ul><li>Monthly feedback of monitoring data to Deputy Commissioner for their review in monthly review meetings. </li></ul><ul><li>Saugat Campaign – enrollment of new born children in software </li></ul><ul><li>Implementation of new MCH card all over the state </li></ul><ul><li>Emphasis on estimation of beneficiaries from MCH tracking register </li></ul><ul><li>Distribution of Full Immunization certificate </li></ul><ul><li>Establishment of the data loggers at cold chain points </li></ul><ul><li>Regional cold chain store (1 WIC & 1 WIF) installed at Deoghar </li></ul>
  28. 29. Key issues and possible solution Issues Solution Estimation of beneficiaries not done properly <ul><li>More emphasis on estimation of beneficiaries from MCH tracking register/head count </li></ul>Inadequate monitoring of programme at district/block level <ul><li>Letter from state in this regard and timely feedback to the concerned official specially DC/CS </li></ul>Difficulties in implementation of tally sheets cum due list <ul><li>Timely supply of tally sheets in booklet forms. </li></ul><ul><li>Intense monitoring and feedback to concerned </li></ul>
  29. 30. Immunization Budget Status *State resources/funds also used for RI, IEC & training on Surveillance of VPD’s. Consolidated status 2010-11* Total Funds released to state (Immunization PIP fund) Total Allocation ` 1662.13 Lakh A OB = ` 505.00 Receiving = ` 556.00 Total = ` 1061.00 Lakh Total Funds Utilized based on SOEs recd from districts (upto 31 st Mar’11) B ` 429.00 Lakh Unspent balance available with State as on 1/4/2011 A-B ` 632.00 Lakh
  30. 31. Component wise expenditure 2010-11 Consolidated year status Alt. Vaccine delivery Alt. Vaccinators Hired Social Mobilizers (ASHA/ Others) Computer Assistants Waste disposal pits Printing /Stationery Fund Allotted (PIP fund approved) 240 50.40 500 30.60 30.90 55 Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 122 15.91 104.05 23.36 1.56 55 % age Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 50.83 31.56 20.81 76.34 5.04 100
  31. 32. Component wise expenditure 2010-11 Other heads under which funds utilized Supervisory Visits (funds for State level) Supervisory Visits (Funds for District Level) RI Review meetings (State & below Level) Fund Allotted (PIP fund approved) 13 129.70 Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 6.88 7.84 % age Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 52.92% 6%
  32. 33. What works!! <ul><li>2 best performing district as per HMIS report are Pakur & Jamtara </li></ul><ul><li>Intense monitoring at all levels </li></ul><ul><li>Proper estimation of beneficiaries </li></ul><ul><li>Extensive partner support </li></ul><ul><li>Supportive supervision twice a year </li></ul><ul><li>All these interventions are replicable to other districts </li></ul>
  33. 34. What doesn’t work!! <ul><li>2 least performing district as per HMIS report are Ramgarh & Khunti </li></ul><ul><li>Issues: </li></ul><ul><li>Improve reporting especially from private practitioners/hospitals </li></ul><ul><li>Inadequate supervision at all level </li></ul><ul><li>What can be done: </li></ul><ul><li>Identification of private practitioner/hospitals & ensure the reporting from them </li></ul><ul><li>Supportive supervision, intense monitoring at all levels </li></ul><ul><li>Frequent reviews at district level with participation from state. </li></ul>
  34. 35. Bottlenecks/Hurdles System Components Main Problems Causes Solutions Service Delivery <ul><li>Many post of ANMs are still vacant </li></ul><ul><li>Stock out of vaccines </li></ul><ul><li>All infants not enlisted </li></ul><ul><li>Lack of manpower </li></ul><ul><li>Not supplied from national level </li></ul><ul><li>Inadequate monitoring </li></ul><ul><li>Recruitment of new manpower and internal management within the district </li></ul><ul><li>Timely supply of vaccine </li></ul><ul><li>Monitoring of the MCH tracking register </li></ul>Weak reporting system – poor data quality <ul><li>tally sheet not filled – 62% as per monitoring data </li></ul><ul><li>Improper distribution of the tally sheet within the districts </li></ul><ul><li>Issues will get solved with the new booklet form of tally sheet </li></ul>Program Management – including supervision <ul><li>inadequate monitoring </li></ul><ul><li>Monitoring data not entered at district level </li></ul><ul><li>Lack of responsibility by some medical officers </li></ul><ul><li>Data entry operator given other jobs at district level </li></ul><ul><li>Feedback to the CS/DC regarding their monitoring status </li></ul><ul><li>Reducing the workload of data entry operator </li></ul>
  35. 36. Bottlenecks/Hurdles System Components Main Problems Causes Solutions Surveillance and Monitoring – including AEFI, VPD <ul><li>minor AEFI not reported </li></ul><ul><li>Fear of action among the HW </li></ul><ul><li>Sensitization and training of HW regarding the need of AEFI reporting </li></ul>Vaccine Supply, Quality and Logistics <ul><li>stock out at sate & district level </li></ul><ul><li>Inadequate supply from GoI </li></ul><ul><li>Timely supply </li></ul>Advocacy and Communication <ul><li>mobilization not done in proper way </li></ul><ul><li>Aganwadi centers not established in every village </li></ul><ul><li>many shaiyas are not competent </li></ul><ul><li>Mobilization by AWW in neighboring village </li></ul><ul><li>PRI member involvement for mobilization </li></ul>Poor Bio-medical waste disposal practices <ul><li>shortage of hub cutters </li></ul><ul><li>Sharps not returned to CHC </li></ul><ul><li>Not supplied from GoI </li></ul><ul><li>AVD not staying at session site till the end of session </li></ul><ul><li>Timely supply/local procurement </li></ul><ul><li>AVDs should bring the waste materials to the CHCs </li></ul>
  36. 37. Achievements in 2010-11 <ul><li>Supportive supervision done in 5 districts of Santhal Pargana division </li></ul><ul><li>(Bad indicators for RI) </li></ul><ul><li>Training of Medical officers at state level( 42 batches done) </li></ul><ul><li>Revised RI monitoring workshop done in 11 districts </li></ul><ul><li>Bimonthly RI cell meetings were conducted </li></ul><ul><li>State AEFI review meeting was done on 31 st December to review AEFI cases of 2011 </li></ul><ul><li>Capacity building of Local NGO ( through CINNI) was done for RI monitoring </li></ul><ul><li>Formation of AEFI management centers </li></ul><ul><li>Participated in study conducted for effect of measles campaign on RI </li></ul><ul><li>Procured nonelectrical cold chain equipment at state level because of acute shortage. </li></ul>
  37. 38. Challenges for next year <ul><li>Full implementation of MCH tracking system </li></ul><ul><li>Increasing sample size of monitoring </li></ul><ul><li>Encouraging MO to do monitoring in High risk and hard to reach area </li></ul><ul><li>Appointment of ANMs especially in hard to reach area and implementation of RI session in those area </li></ul><ul><li>Estimation of beneficiaries by head count to decrease left outs </li></ul><ul><li>Involvement of ICDS/PRI members for monitoring </li></ul><ul><li>Strengthening review of RI at district level </li></ul><ul><li>Improvement of record and report of immunization at every level </li></ul>
  38. 39. Way forward <ul><li>Complete the health worker trainings as per GOI guidelines </li></ul><ul><li>Supportive supervision in remaining districts </li></ul><ul><li>Bimonthly RI cell meeting at district level </li></ul><ul><li>Formation of AEFI management centers in all districts </li></ul><ul><li>Quarterly AEFI committee meeting at district level </li></ul><ul><li>Full implementation of MCH tracking registers, use of new due list and estimation of beneficiaries according to that </li></ul><ul><li>Completion of Medical officers training at state level </li></ul><ul><li>Stringent monitoring in all districts and review of monitoring data in monthly meetings at district level </li></ul>
  39. 40. Suggestions <ul><li>Inclusion of RI monitoring session in Medical officers trainings </li></ul><ul><li>Inclusion of some questions related to MCH tracking register and other record and reports in monitoring formats ( eg. Whether the ANM is entering all newborn and pregnant women in register and whether she is tracking all of them) </li></ul>
  40. 41. Support Required Support Required / Expectations Agency <ul><li>Timely supply of vaccines </li></ul><ul><li>Allocation of fund as soon as possible </li></ul><ul><li>Supply of non electrical cold chain equipment </li></ul><ul><li>Mobility support (Funds) for PHCs for regular monitoring and supervision. </li></ul><ul><li>Vehicles for Medical Officers of PHCs </li></ul><ul><li>Supply of Twin buckets </li></ul>MoHFW, GoI <ul><li>Technical assistance in Santhal Pargana division </li></ul><ul><li>Shared responsibility </li></ul><ul><li>Community mobilization </li></ul><ul><li>Field review and sharing of information </li></ul><ul><li>Monitoring at different level </li></ul><ul><li>Documenting the lesson learnt </li></ul>Partners
  41. 42. Vision…Where do we want to reach? System Component Indicator* Target by 2012 Service Delivery % Fully Immunized Children (FIC) 80 % Dropout Rate (BCG-DPT3) <10 % Program Management Supportive supervision system established in state All 24 districts Monitoring and Surveillance % districts monitored by government functionaries 100% AEFI surveillance system established Already established in all districts Reporting system and data quality Timely monthly HMIS reports 100% Advocacy and communication Communication Strategy made In place
  42. 43. <ul><li>Thank you </li></ul>

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