RI monitoring


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by arindam Ray

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  • This is just a reminder; already presented by SB.
  • Unknown: information not entered by monitor: ? Training of monitors
  • No need for 2011 map.
  • I think this is “% Session sites where hubcutter is used to cut syringe immediately after use”.
  • Note: for each indicator the n changes e.g. for the use of AD syringe. n= those sites where monitor could observe the use of type of syringe while giving injectable vaccines. For Syringe cut immediately after use: ‘n’= no of sessions where AD syringes was available and ANM was observed for activities of handling the syringe after injecting vaccine to a beneficiary. Note: For question no. 13, the data is obtained for “Does ANM touch any part of the needle while giving injection” but for analysis, converted into “Does ANM not touching any part of the needle while giving injection”, the value thus taken as (100-n of elicited value as TRUE)
  • For Village Health Nutrition Day (VHND), the component of BP apparatus (antenatal care & health check up); Weighing machine ( antenatal care) and Nutritional supplements were taken as surrogate indicator. At only 1.4% of session sites, all the three components were found available
  • Review of RI monitoring data in at least once during last 2 DTFs
  • Not necessary
  • RI monitoring

    1. 1. Sca ing-up RI programme monitoring Dr Arindam Ray M&E Focal Person, WHO NPSP SEPIO Meeting: 20 th May, 2011
    2. 2. Presentation outline <ul><li>Strategy </li></ul><ul><li>Generating evidence </li></ul><ul><li>Feedback and action </li></ul><ul><li>Expansion of the system </li></ul><ul><li>Way forward </li></ul>
    3. 3. Strategy
    4. 4. Recommendations on M&E for RI <ul><li>GoI has circulated RI monitoring formats & SOPs to all states in July, 2009 </li></ul><ul><li>IEAG, 2010 recommended that RI monitoring should be conducted in high priority, low coverage areas </li></ul><ul><li>Programme monitoring is a key component in national MO Training Handbook </li></ul>
    5. 5. RI monitoring Strategy <ul><li>Strategic monitoring of HRAs </li></ul><ul><ul><li>Recognized HRAs (polio SIA microplan) </li></ul></ul><ul><ul><li>Areas missed in RI microplan </li></ul></ul><ul><ul><li>Villages with vacant sub-centres </li></ul></ul><ul><ul><li>Peri-urban underserved areas </li></ul></ul><ul><ul><li>ANM with large catchment population </li></ul></ul><ul><ul><li>Migrant locations </li></ul></ul><ul><li>Session monitoring </li></ul><ul><ul><li>Availability of vaccines & logistics </li></ul></ul><ul><ul><li>Safe injection practices </li></ul></ul><ul><ul><li>Tracking & mobilisation efforts </li></ul></ul><ul><li>H-t-H (Community) monitoring </li></ul><ul><ul><li>Immunization status in community </li></ul></ul><ul><ul><li>Reason for Left out & Drop out </li></ul></ul><ul><li>Coordinate between Govt counterparts and partner organizations </li></ul><ul><li>Timely feedback (Block, District and State) for programme decisions </li></ul>
    6. 6. Consulted RI and SIA Microplan Plan for monitoring based on Priority Session Site Session held Session Monitoring Session not held Area for House to House Monitoring Ten Households with 12-35 m children Information from RI card & family members Feedback to ANM No Session Monitoring <ul><li>Listed HRA (SIA Microplan) </li></ul><ul><li>Areas missed in Microplan </li></ul><ul><li>Villages with vacant Subcentres </li></ul><ul><li>Peri-Urban Underserved areas </li></ul><ul><li>ANM with large catchment population </li></ul><ul><li>6. MOB/ WPV / VDPV area </li></ul><ul><li>7. Migrant/ mobile </li></ul>RI Monitoring Process 30 min ~1 hour 1~2 hours Visit Block for monitoring & feedback
    7. 7. 1st & 3 rd Wed- 2 nd Sat - Wed- 2 nd 3 rd Sat - 4 th Wed- 4 th Sat - 1 st Sat - SIA Microplan RI Microplan ? ? ? Plan for Mubarakpur S/C (Session) and Bind tola(HtH) 1 2 eqckjdiqj QkeZ eqckjdiqj QkeZ Uskan toli inkol gom ;kno Vksyk ioyrk
    8. 8. Generating evidence
    9. 9. Indicators derivable from RI session monitoring <ul><li>Sessions held or not? If not, reasons why </li></ul><ul><li>ANM/vaccinator was present as per microplan (%) </li></ul><ul><li>Utilization of AVD </li></ul><ul><li>Availability of vaccine and logistics: </li></ul><ul><ul><li>Vaccines (BCG,DPT,OPV, MCV,TT, Hep B, JE, PV) </li></ul></ul><ul><ul><li>Diluents (for BCG, MCV, JE) </li></ul></ul><ul><ul><li>Syringes (AD: >0.1ml & 0.5ml, Disposable). </li></ul></ul><ul><ul><li>Unusable vaccines </li></ul></ul><ul><li>Mobilisation of beneficiaries </li></ul><ul><li>Injection safety </li></ul><ul><li>AEFI management & reporting </li></ul><ul><li>Waste disposal </li></ul><ul><li>New born tracking </li></ul><ul><li>Vaccine safety (frozen, unusable VVM, expired vaccine etc.) </li></ul><ul><li>Key RI messages conveyed to parents of beneficiaries </li></ul><ul><ul><li>Which message is missed </li></ul></ul><ul><li>Availability of other logistics: </li></ul><ul><ul><li>Vit A, PCM, ORS </li></ul></ul><ul><ul><li>Hub cutter, RI cards, R&B bags </li></ul></ul><ul><li>Stock-outs </li></ul><ul><li>Supervisory visits </li></ul>Key Indicators Additional Indicators
    10. 10. Planned sessions not conducted: Jan10-Dec10: Bihar (with reasons) Source: RI monitoring data (Jan10-Dec10) Reason for session not held (n=4356)
    11. 11. % Availability of all vaccines at 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)
    12. 12. Mobilisation of Children Bihar, 2010 Due List Prepared Counterfoils Updated N=21,706 N=26248 N=26,248 N=24511 Mobilisers Delivery of 4 key messages
    13. 13. % Any Mobilizer (ICDS/ASHA/Others) present at the session sites, Jan-Mar 2011, Bihar State average Jan-Mar2011: 91 % Source: RI session monitoring data by WHO NPSP and Govt. of Bihar N = 7840 RI session found held
    14. 14. % Due list availability at the session site, Jan-Dec 2010, Jharkhand Source: RI session monitoring data N = 5,426 RI sessions found held State average 2010: 65 % Nil 1 – 30 % 31 – 60% 61 – 80 % > 80 % Data Not Available
    15. 15. Safe Injection Practices Bihar, Jan – Dec 2010 DPT Given at Mid-Thigh ANM Touching the needle n=24,706 n=21,909 n=23,607 n=1078 Time of Reconstitution Mentioned on Vial Hub of syringe is cut in hub cutter immediately n = number of RI sessions monitored
    16. 16. % Syringes being cut by hubcutter immediately after use, Jan-Mar 2011, Bihar Source: RI session monitoring data by WHO NPSP and Govt. of Bihar N = 1,151 sites where Vaccination seen State average Jan-Mar2011: 85 %
    17. 17. Monitored sessions with safe injection practices, Uttar Pradesh n=monitored sessions where corresponding activities were observed ( 2010 / 2011- 1 st Quarter)
    18. 18. Monitored sessions with availability of logistics, UP, February 2011 Indicators of VHND Source: RI monitoring data (February'11) n = 6,490 monitored sessions found held
    19. 19. Indicators derivable from household monitoring <ul><li>No of Children in 12-35 months fully immunized (%) </li></ul><ul><li>Children receiving age specific antigens including </li></ul><ul><ul><li>Hep B, MCV2, DPT Booster </li></ul></ul><ul><li>Reasons for not getting the due vaccine </li></ul><ul><li>Drop out and left out rate </li></ul><ul><li>Reasons for drop out & Left out </li></ul><ul><li>Areas where RI sessions are not held in last 3 months </li></ul><ul><li>Mobilisation of beneficiaries </li></ul><ul><li>Presence of ASHA/ AWW </li></ul><ul><li>Participation by PRI/ SHG/ NGO </li></ul><ul><li>Vaccination status in community: </li></ul><ul><ul><li>By migration </li></ul></ul><ul><ul><li>By religion </li></ul></ul><ul><ul><li>By caste </li></ul></ul><ul><ul><li>By gender </li></ul></ul><ul><ul><li>By occupation </li></ul></ul><ul><ul><li>By education </li></ul></ul><ul><li>No of beneficiaries provided with RI/ MCP card (%) </li></ul><ul><li>Retention of RI / MCP card (%) </li></ul>Key Indicators Additional Indicators
    20. 20. Immunization status of monitored children 12-23 months, UP, Jan-Dec 2010 n=Number of children 12 to 23 month of age (176,634) Fully immunized: 47.1% Partially immunized: 39.1% Left-outs: 13.9%
    21. 21. Full immunization status and BCG-measles drop out rates, Bihar, Jan-Dec 2010 FIC (Fully immunized coverage) BCG-measles drop out rate n = 72,162 children 12 to 23 month of age
    22. 22. Immunization status of monitored children, Jan-Dec, 2010, Bihar Reason for children not being fully immunized Fully Immunized Partially Immunized No Immunization n=children 12 to 23 months of age N=23,783 N=4,234
    23. 23. Indicators derivable from Block/ District monitoring <ul><li>Linkage with session monitoring </li></ul><ul><li>ANM/vaccinator vacancy status </li></ul><ul><li>Utilization of AVD </li></ul><ul><li>Availability of vaccine and logistics (stock outs) </li></ul><ul><li>Cold Chain </li></ul><ul><li>Report-returns </li></ul><ul><li>Training status </li></ul><ul><li>Supportive supervision </li></ul><ul><li>Review mechanism </li></ul><ul><li>AEFI reporting </li></ul><ul><li>VPD surveillance </li></ul><ul><li>Functioning of committees: </li></ul><ul><ul><li>Task Force </li></ul></ul><ul><ul><li>ERT/ RRT </li></ul></ul><ul><ul><li>AEFI committee </li></ul></ul>Key Indicators Additional Indicators
    24. 24. Feedback and action
    25. 25. RI monitoring feedback in high risk areas: Use of District Task Force (DTF) November 2010: 8 of 19 districts (39%) Districts with HR blocks where RI monitoring data reviewed during the DTF meeting at least once during 2 months January 2011: 19 of 19 districts (100%) Districts with HR blocks where RI monitoring data not reviewed during the DTF meeting at least once during 2 months Districts with no HR blocks Data not available
    26. 26. Information feedback process <ul><li>Core indicators: </li></ul><ul><ul><li>Immediate verbal and/or written feedback to Block MO and District Immunization Officer </li></ul></ul><ul><ul><li>Written feedback of core indicators forwarded to State Immunization Officer </li></ul></ul><ul><li>Detailed analysis: </li></ul><ul><ul><li>Data is compiled, entered and cleaned at state level </li></ul></ul><ul><ul><li>Exhaustive analysis (by district and blocks) shared with districts by states </li></ul></ul>RI Monitoring feedback is regularly discussed and shared in RI Cell meetings in Jharkhand, Bihar, UP, Orissa….
    27. 27. Expansion of the system
    28. 28. Scaling up RI monitoring <ul><li>Following a state review meeting, Karnataka has started monitoring with special emphasis on northern districts </li></ul><ul><li>Rajasthan has also initiated RI monitoring since end of 2010 </li></ul><ul><li>Govt officials in Punjab are spearheading monitoring of RI sessions for last six months </li></ul><ul><li>West Bengal has also initiated RI monitoring with more emphasis on HR districts like Murshidabad, Howrah etc </li></ul><ul><li>Medical colleges in Orissa are monitoring RI sessions in selected districts </li></ul><ul><li>Govt of Delhi has also launched RI monitoring in last 1 year </li></ul><ul><li>RI monitoring is planned to be introduced in the coming months to: Maharashtra, Madhya Pradesh, Kerala, Tamilnadu, Chhattisgarh, Assam ….. </li></ul>Every state to operationalise RI monitoring with GoI formats
    29. 29. Formats to be used by all States: Session and household monitoring
    30. 30. Formats to be used by all States: Block and District level Easy to use Structured MCQ KEYs given One pager
    31. 31. Way forward… <ul><li>All states are expected to initiate monitoring </li></ul><ul><li>Adapt strategy and tools to local situations </li></ul><ul><li>Ensure feedback and follow-up interventions </li></ul><ul><li>Technical assistance is available from partners </li></ul><ul><li>New technologies: OMR/ PDA </li></ul><ul><li>Oversight is critical to ensure quality of data </li></ul><ul><li>Monitoring to be dynamic to capture changing practices and priorities </li></ul>
    32. 32. Thank You
    33. 33. Strengthening Monitoring <ul><li>Problem in the content: </li></ul><ul><ul><li>Multiple variables clubbed </li></ul></ul><ul><ul><li>Some essential components missing </li></ul></ul><ul><ul><li>No data on determinants </li></ul></ul><ul><ul><li>No monitoring for mid-level operations at the Block and District levels </li></ul></ul><ul><li>Change in the Context: </li></ul><ul><ul><li>Evolving practices and priorities since 2009 </li></ul></ul><ul><ul><li>MCV2 and Pentavalent are being introduced </li></ul></ul><ul><ul><li>Hep B to be rolled out to all remaining states </li></ul></ul><ul><ul><li>Lessons from session & RCA monitoring in MCUP </li></ul></ul><ul><ul><li>Need for universalisation of the monitoring tools </li></ul></ul><ul><li>Data tools also need further updating and revision </li></ul>