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RI P Halder may 11


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RI P Halder may 11

  1. 1. Routine Immunization current status & low coverage areas identification Strategy & way forward SEPIO meeting 18-20 May 2011 Dr Pradeep Haldar, MoHFW, GoI
  2. 2. Presentation Outline <ul><li>Routine immunization Current Status </li></ul><ul><li>Evidence from the field </li></ul><ul><li>Low RI coverage area - Identification </li></ul><ul><li>Way forward </li></ul>
  3. 3. Routine Immunization in India Proportion of Fully immunized children (12 – 23 months) CES 2009: FI 61 % Source:
  4. 4. Challenges: Access & Utilisation Source: DLHS-3 Data
  5. 5. Improved access but declining utilisation Source: DLHS-2 and DLHS-3
  6. 6. Assessing utilisation and access of services DLHS 2 versus DLHS 3 Full Immunization Improved Utilisation Improvement Decline Access Improvement Andhra Pr, Assam, Goa, HP, Karnataka, Kerala, Lakshadweep, Mizoram, Orissa, Punjab, Uttarakhand, WB Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh, D&D, Jharkhand Decline A & N Islands, Chandigarh, Delhi, Gujarat, Haryana, J&K, Manipur, Meghalaya, Tripura
  7. 7. Analysis of gaps <ul><li>Low Access : </li></ul><ul><ul><li>Immunization session sites are not included in microplan </li></ul></ul><ul><ul><li>Session not attended by ANM – leave, post vacant, not going to the site </li></ul></ul><ul><li>Poor utilisation: </li></ul><ul><ul><li>Irregular sessions, variable quality of services </li></ul></ul><ul><ul><li>Non-availability of vaccine/logistics </li></ul></ul><ul><ul><li>Poor messaging and communication </li></ul></ul><ul><ul><li>Low community confidence in services </li></ul></ul>
  8. 8. DLHS-2 v/s DLHS 3 Full Immunization Declined Utilization Improvement Decline Access Improvement Tamil Nadu Decline D& NH, Poducherry, Maharashtra,
  9. 9. BCG (HIMS 10-11 Vs CES-09)
  10. 10. BCG (HIMS 10-11 Vs CES-09)
  11. 11. DPT (HIMS 10-11 Vs CES-09)
  12. 12. DPT (HIMS 10-11 Vs CES-09)
  13. 13. Measles (HIMS 10-11 Vs CES-09)
  14. 14. Measles (HIMS 10-11 Vs CES-09)
  15. 15. Vaccine Supply Vs HIMS 10-11
  16. 16. Vaccine Supply Vs HIMS 10-11 Cont
  17. 17. Findings from RI Monitoring
  18. 18. % RI session held – UP, Bihar and Jharkhand (Year - 2010) n=number of sessions monitored 15 to 25% sessions not held / not held as per microplan Due to absence of ANM and/or vaccine, logistics
  19. 19. Availability of vaccine & diluent at RI sessions January – December 2010 n=number of RI session found conducted
  20. 20. % availability of all Vaccines on 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)
  21. 21. Availability of all UIP vaccines and diluent at RI sessions, Bihar - 2010 Year 2010: Total 30,604 RI sessions monitored
  22. 22. % Sessions where all RI vaccines and AD syringes were available, Jan-Dec 2010, Jharkhand State average 2010: 69.8% Source: RI session monitoring data N = 5692 RI session found held
  23. 23. Full immunization status and BCG-measles drop out rates, 2010 – Uttar Pradesh FIC (Fully immunized coverage) BCG-measles drop out rate n= 1,76,634 children 12 to 23 month of age
  24. 24. Full immunization status and BCG-measles drop out rates, Bihar, Jan-Mar 2011 FIC (Fully immunized coverage) BCG-measles drop out rate n = 20,872 children 12 to 23 month of age
  25. 25. Jharkhand: Monitoring community coverage gaps: % Fully immunized children, children 12-23 months By district, Year 2010 State average : 76.1% Source: RI h-t-h monitoring data N = 12485 Children 12-23 month Percent fully immunized
  26. 26. Improving access and utilisation of RI: Lessons from pulse polio activities (1) <ul><li>Social mobilization in Polio to increase utilisation; </li></ul><ul><ul><li>Messages tailored for specific audience </li></ul></ul><ul><ul><li>Use of local resources (community members, local leaders, and influential people) </li></ul></ul><ul><ul><li>Religious sites and gatherings for message delivery </li></ul></ul><ul><li>Strengthen linkages with pulse polio teams activities: </li></ul><ul><ul><li>Polio microplans to include RI session site information (where, when and by whom) </li></ul></ul><ul><ul><li>Teams provide RI card to families during the house-to-house visits and share information on RI sessions </li></ul></ul>
  27. 27. Improving access and utilisation of RI: Lessons from pulse polio activities (2) <ul><li>Strong inter-sectoral coordination (health, education and ICDS): </li></ul><ul><ul><li>Pooling of human resources, venue, vehicles and leadership prior and during rounds </li></ul></ul><ul><ul><li>ANM and ASHA (Health), AWW (of ICDS), School teachers (education) works together. </li></ul></ul><ul><ul><li>Evening briefings attended by MOI/Cs, CDPOs, BEO and community members for better planning </li></ul></ul><ul><li>Replicating and extending coordination in support of RI: </li></ul><ul><ul><li>RI monitoring feedback during coordination meetings </li></ul></ul><ul><ul><li>Preparing joint strategies to strengthen RI at different levels </li></ul></ul>
  28. 28. Low coverage area Identification <ul><li>populations known to have a disproportionate share of the disease burden; </li></ul><ul><li>un-immunized or under-immunized children in urban and peri-urban areas; </li></ul><ul><li>populations in places where sanitation is poor; </li></ul><ul><li>populations inhabiting difficult or mountainous terrain, marshy areas, islands </li></ul><ul><li>refugees, internally displaced persons, migrant workers and other transient populations; </li></ul><ul><li>politically and or socially marginalized populations or minority groups; </li></ul><ul><li>religious groups that oppose vaccination. </li></ul><ul><li>Communities at international borders and Intra-State administrative borders. </li></ul>
  29. 29. Identification and prioritization low coverage areas <ul><li>URBAN Strategy </li></ul><ul><li>Rural Strategy </li></ul><ul><ul><li>First priority to the villages/habitations which are never (rarely) reached </li></ul></ul><ul><ul><li>Then the villages / habitations in which immunization was planned but not held during previous 3-4 months. </li></ul></ul><ul><ul><li>Villages where RI is normally done but coverage is low </li></ul></ul><ul><ul><li>Convergence of Microplan – for uncovered areas </li></ul></ul>
  30. 30. Way forward <ul><li>Experience from Polio SIAs to be used for RI improvement </li></ul><ul><ul><li>Improved access and utilization </li></ul></ul><ul><ul><li>Updating micro-plans </li></ul></ul><ul><ul><li>Social mobilization </li></ul></ul><ul><li>Expand RI monitoring to other states and locations </li></ul>
  31. 31. Thank you