TN RI may18 20

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TN RI may18 20

  1. 1. Joint Director Immunization Tamil Nadu
  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 10.97 12.06 83.2 10.7 1,84,000 1,17,000
  3. 3. Categorization of districts according to FI coverage (DLHS 3) Less than 30% 30% - 50% 50% - 70% More than 70% <ul><li>Madurai (60) </li></ul><ul><li>Theni (61) </li></ul><ul><li>Virudhunagar (65) </li></ul>27 Districts
  4. 4. Categorization of districts according to Drop-outs (DLHS 3) Less than 10% 10% - 20% 20% - 30% More than 30% NIL 1 VILLUPURAM 2 TUTICORIN 3 NAGAPATTINAM 4 PUDUKOTTAI 5 TIRUCHIRAPALLI 6 THIRUVALLUR 7 THE NILGIRIS 8 THIRUVARUR 9 ERODE 10 KANCHEEPURAM 11 RAMANAD 12 THANJAVUR 13 CUDDALORE 14 PERAMBALUR 1 THIRUVANNAMALAI 2 DHARMAPURI 3 CHENNAI 4 NAMAKKAL 5 MADURAI 6 VELLORE 7 KARUR 8 DINDIGUL 9 KRISHNAGIRI 10 SIVAGANGA 11 KANYAKUMARI 12 TIRUNELVELI 1 COIMBATORE 2 SALEM 3 THENI 4 VIRUDHUNAGER
  5. 5. >50% < 30% 30% to 40% 40% to 50%
  6. 6. Drop-out (BCG-DPT3 ) > 30% 20% to 30% 10% to 20 %
  7. 7. Current Scenario Micro planning No. of Districts with micro plans revised in 2010 Percent Planned sessions held No. of Sub centers without VHN posted Number of Alternate Vaccinators hired (last FY) 30 Districts 98% 140 81
  8. 8. Cold Chain Equip ment Total Needed Total Available Functional Remarks / Reasons ILR Small 951 2855 2821 New requirement +Conversion of CFC to NCFC DF Small 1010 1973 1961 ---- Do ----- ILR Large 25 134 130 ---- Do ----- DF Large 36 243 238 ---- Do -----
  9. 9. Cold Chain Equipment Total Needed Total Available Functional Remarks / Reasons WIC 3 * 15 11 <ul><li>1 no required for expansion </li></ul><ul><li>2 Nos required for Conversion of CFC to NCFC . </li></ul>WIF 2 * 2 2 <ul><li>1 no required for expansion </li></ul><ul><li>1 No required for Conversion of CFC to NCFC . </li></ul>Cold Box (L) 1000 2822 2059 New requirement + Replacement Cold Box (S) 400 1647 1481 ---- Do ----- Vaccine Carrier 5000 79964 76240 ---- Do -----
  10. 10. Current Scenario Health Workers’ (HWs) Training M.O. Trainning Training Load Trainings Completed No. of Health Workers No. of Batched Planned No. of Batches Completed No. of HWs Trained % HWs Trained 21000 525 HW Training module received on 24-2-2011 and training will be completed in 6 months Training Load Trainings Completed No. of MO No. of Batched Planned No. of Batches Completed No. of MO Trained % MO Trained 4155 105 Training will be completed in 6 months
  11. 11. AEFI 2010 No. of Districts with AEFI Committees No of Serious AEFI Reported No. of AEFI Deaths Reported No. of Serious AEFI Investigated 31district 14 9 (Coincidental) 14
  12. 12. Access analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-DPT3, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) All districts 26 districts Low (< 70%) Nil **** **** 4. Districts 1 COIMBATORE 2 SALEM 3 THENI 4 VIRUDHUNAGER
  13. 13. Utilization analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-Measles, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) All districts All districts Nil Low (< 70%) Nil Nil
  14. 14. <ul><li>MCP card with growth monitoring chart issued to all mothers </li></ul><ul><li>IEC activities – through TV channal – on all Saturdays </li></ul><ul><li>Modernizing PHC Infrastructure on par with PVT. Hospitals which enhance confidence among the public to avail PHC service. </li></ul><ul><li>All PHCs 24 hours </li></ul><ul><li>Immunization is also planned on Village Health Nutrition day (ie on Fridays) to cover dropout </li></ul><ul><li>Creation of community awareness and self help women group participation through village health sanitation committee </li></ul>Demand Generation Activities
  15. 16. Status : Alternate Vaccine Delivery 2009-10 2010-11 Issues Sessions Planned (Nos) 214722 196531 Held (Nos) 211022 192485 % age Held 98 % 98 % Alternate Vaccine Delivery (AVD) No of sessions planned with AVD 36792 38634 No of sessions held with AVD 16518 4864 % Sessions held with AVD 45 13
  16. 17. Status : Alternate Vaccinators & Mobilizers 2009-10 2010-11 Issues Sessions planned using Alternate Vaccinators Planned (Nos) 27840 29140 *** Held (Nos) 16148 22240 *** % age Held 58 76 *** Mobilizers (Paid mobilizers like ASHAs/ Link workers/ Others) No of sessions planned with soc mobilizers Not relevant No of sessions held with mobilizers % Sessions held with mobilizers
  17. 18. Status :Computer Assistants 2009-10 (Nos) 2010-11 (Nos) Issues Computer Assistants Required in State 30 30 Hired 20 18 Quit from work % CA s in place 67 56
  18. 19. Status of RI supervision State & District level 2009-10 2010-11 Issues No.of Visits by State officials ( Director, Addl. Director, JD) 60 120 No.of Visits made by district officials 24024 (includes visits by Mid level Supervisors-SHN/CHN ) 24024 (includes visits by Mid level Supervisors-SHN/CHN )
  19. 20. Existing Supervisory Mechanism in state <ul><li>Field level: </li></ul><ul><li>Mid level supervisors CHN / SHN at PHC & Block : </li></ul><ul><li>To verify the immunization status of minimum 20 children in a month. The mechanism is under progress. </li></ul><ul><li>Medical officer is verifying dropout children during his field visit. </li></ul><ul><li>District level: </li></ul><ul><li>Deputy Director of Health Services supervises the conduct of immunization sessions. </li></ul><ul><li>District Maternal Child Health Officer, Assistant Director (SBHI), Personal Assistant (Technical) provides regular visits to the PHC to supervise immunization sessions. </li></ul>
  20. 21. <ul><li>Dropouts /missed out/migrant children identified and covered. </li></ul><ul><li>Injection safety ensured. </li></ul><ul><li>Adequate availability of vaccine, AD syringes and other logistics ensured. </li></ul><ul><li>Co-ordination with ICDS staff strengthened. </li></ul><ul><li>Ensuring proper disposal of bio-medical waste management. </li></ul>Outcome/ Impact of Supervisory visits
  21. 22. RI review mechanism in State <ul><li>Weekly Review meeting is conducted by Medical officer on every Tuesday at PHC to review the field activities with reference to completeness and qualitative aspect. </li></ul><ul><li>Block level review is conducted by the Block Medical Officer </li></ul><ul><li>Monthly review meeting is conducted by district officers with all Medical Officers in the 1st week of every month at district head quarters. </li></ul><ul><li>Once in 3 months, State level review meeting for district officials </li></ul>
  22. 23. Status of RI Review Meeting – contd.. <ul><li>Key participants </li></ul><ul><li>State level- Review by Director / Programme Office </li></ul><ul><li>1.District Officers( Deputy Director of Health Services), Corp. Health Officer </li></ul><ul><li>2.Asst. Director, District Maternity and Child Health Officer, District Statistician </li></ul><ul><li>District level- Review by Deputy Director of Health Services </li></ul><ul><li>1. Block Medical Officers, PHC Medical Health Officer and Corp. Health Officer, Municipal Health Officer and Medical Officers </li></ul><ul><li>2. Asst. Director, District Maternity and Child Health Officer, District Statistician </li></ul><ul><li>3. Community Health Nurse, Sector Health Nurse, Pharmacists </li></ul>
  23. 24. Status of RI Review Meeting – contd.. <ul><li>Key participants </li></ul><ul><li>Block level- Review by Block Medical Officer </li></ul><ul><li>Community Health Nurse, Sector Health Nurse, Pharmacists, Village Health Nurse </li></ul><ul><li>PHC level – Review by PHC Medical Officer </li></ul><ul><li>Sector Health Nurse, Pharmacists, Village Health Nurse, Anganwadi worker </li></ul>
  24. 25. Status of RI Review Meeting – contd.. <ul><li>Key issues discussed </li></ul><ul><li>Performance indicators, Outreach immunization, vaccine stock management, Cold Chain management , dropouts children, migrant population. VPD, Outbreak of Measles, AEFI. </li></ul><ul><li>Key Recommendations of meetings </li></ul><ul><li>Immunization to drop out children during VHNDs. Special efforts to cover migrant children. Management of AEFI. Ensure complete reporting of Measles cases. </li></ul>
  25. 26. Dropout coverage BCG > Measles (10%)
  26. 27. Inconsistency Measles > FI
  27. 28. Inconsistency in DPT vaccination
  28. 29. Inconsistency in DPT vaccination
  29. 30. <ul><li>Steps to improve </li></ul><ul><li>1. Supervisory components needs to be strengthened. </li></ul><ul><li>2. Refresher training to field functionaries and supervisors. </li></ul><ul><li>3. Special focus in High risk areas /inaccessible / remote / migrants </li></ul>
  30. 31. Status : Disposal pits Waste Disposal Pits 2009-10 (Nos.) issues Reqd. in State 1598 Pits Built 1473 % age pits in place 92
  31. 32. <ul><li>State Level </li></ul><ul><li>BCG - A bulk supply of 6.95 lakh doses was made </li></ul><ul><li>during February 2011 after a gap of 8 months </li></ul><ul><li>TT - A quantity of 6.00 lakh doses were during </li></ul><ul><li>January2011 with short expiry (June 2011)- </li></ul><ul><li>CDRL, Kausali </li></ul><ul><li>Measles - Diluents supplied by IIL, Hyderabad were found </li></ul><ul><li>in broken stage (5,000) which was replaced. </li></ul>Key issues regarding vaccine stocks
  32. 33. Key issues regarding vaccine stocks <ul><li>State Level </li></ul><ul><li>DPT </li></ul><ul><li>Irregular supply by BE,Hyderabad – A bulk quantity of 10.00 lakh doses supplied during Feb’11 (which should have been supplied during Sep - Oct ’10). </li></ul><ul><li>Another bulk quantity of 17.37 lakh doses during Mar.’11(which should have been supplied during Nov –Dec. ’10) </li></ul>
  33. 34. HMIS <ul><li>HMIS is being implemented in all districts. </li></ul><ul><li>Proper training has been given to all district officials to assess quality of data through outlayers </li></ul><ul><li>District officials have started uploading the data. </li></ul>
  34. 35. Measles vaccination <ul><li>Status of measles 2 nd dose in RI – Implemented in the State during 1-3-2011 in all districts. </li></ul>
  35. 36. JE vaccination 2010-11 (status of integration in UIP) JE vaccination is implemented in 9 Districts S.NO DISTRICT Target Children No. of children covered % coverage 1 CUDDALORE 39171 22660 58 2 VILLUPURAM 58645 24823 42 3 TANJAVUR 40624 13113 32 4 TIRUVARUR 20340 5591 27 5 TIRUCHIRAPALLI 40265 24193 60 6 PERAMBALUR 20821 7721 37 7 MADURAI 51500 16029 31 8 VIRUDUNAGAR 30557 11193 37 9 THIRUVANNAMALAI 40542 10824 27   Total 342465 136147 40
  36. 37. <ul><li>Activities undertaken </li></ul><ul><li>- Publicities through display material </li></ul><ul><ul><li>- Publicities through FM radio and Doordharshan </li></ul></ul><ul><ul><li>- ICDS co-ordinated with immunization and other health activities in the field </li></ul></ul><ul><ul><li>- NGOs/ self help group / Students involved in campaign activities </li></ul></ul>RI related IEC Status
  37. 38. <ul><li>All Immunization clinics are conducted under the supervision of Medical Officer </li></ul><ul><li>All children and mothers are screened by a Doctor before vaccination </li></ul><ul><li>Separate counters are opened for different vaccination in the Health facilities. </li></ul><ul><li>Multiple checks are done for ensuring quality of vaccines and AD syringes before administration. </li></ul><ul><li>Mobile Medical teams deputed to cover remote and inaccessible population. </li></ul>New State initiatives for improving Coverage & Quality
  38. 39. <ul><li>Key Issues </li></ul><ul><li>Many health programmes are implemented in the field, so prioritization to the immunization programme reduced. </li></ul><ul><li>Solutions </li></ul><ul><li>GOI may give such advertisements about the importance of Routine immunisation through various prominent media channels as was done in early years. </li></ul><ul><li>IEC through various TV channels and electronic media about the need, safety, and importance of different immunization to create demand generation among the community. </li></ul>Key Issues and possible Solutions
  39. 40. <ul><li>Key Issues </li></ul><ul><li>Cold chain maintenance in the state and the District to be strengthened . </li></ul><ul><li>Transport of vaccines to the Regional store to be strengthened </li></ul><ul><li>Requirement of Warehouse store at regions as frequent supply of immunisation materials </li></ul><ul><li>Repair van suppiled for HER unit </li></ul>Key Issues and possible Solutions
  40. 41. <ul><li>Solutions : </li></ul><ul><li>Refrigerated vans are required at State Directorate to re-distribute vaccines to the Regional and District Stores. (proposed under NRHM additionality.) </li></ul><ul><li>14 no. of vaccine carrier vans are required at District level </li></ul><ul><li>4 no. of shell type vans are required for Health Equipment Repair </li></ul><ul><li>Unit(HER unit) </li></ul><ul><li>Warehouses: As voluminous quantity of AD syringes and other cold chain equipments are supplied in frequent interval to the regions/districts, it is required to have warehouses at the specified regional stores. (a minimum of 10 stores are required) </li></ul><ul><li>Funds may approved under PIP 11-12 additionality </li></ul>
  41. 42. What works!! <ul><li>Supervisory component is good </li></ul><ul><li>Field level monitoring CHN/SHN at mid level is good </li></ul><ul><li>Refresher training cum review during collection of report from SHN. </li></ul><ul><li>Adequate manpower. </li></ul><ul><li>1. Virudhunagar 2. Madurai district </li></ul>
  42. 43. What doesn’t work <ul><li>List reasons why the performance is low- </li></ul><ul><ul><li>Field staff & Medical officer post vacant </li></ul></ul><ul><li>What can be done to improve routine immunization in these districts </li></ul><ul><ul><ul><li>Vacancy position to be filled up. </li></ul></ul></ul><ul><ul><ul><li>Field monitoring to be strengthened </li></ul></ul></ul><ul><ul><ul><li>Out reach sessions to be strengthened </li></ul></ul></ul><ul><ul><ul><li>MMU – Immunisation to be monitored </li></ul></ul></ul><ul><li>1. Pudukottai 2. Nagapattinam </li></ul>
  43. 44. Definitely needs Improvements We will achieve ..
  44. 45. * Funds released for 2009-10 is utilised for 2010-11 Immunization Budget Status Consolidated status 2009-10* Total Funds released to state (Immunization PIP fund) A 1,79,43,950 Total Funds Utilized based on SOEs received from districts (upto 31 st Mar’11) B 95,77,203 Unspent balance available with State as on 1/4/2011 A-B 62,26,468
  45. 46. Immunization Budget Status Consolidated status 2010-11 Total Funds released to state (Immunization PIP fund) A Nil Total Funds Utilized based on SOEs received from districts (upto 31 st Mar’11) B Unspent balance available with State as on 1/4/2011 A-B
  46. 47. * Funds released for 2009-10 is utilized for 2010-11 Component wise expenditure during 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) 19.32 5.12 ---- 38.4 ---- 37.90 Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11)* 4.53 2.43 ---- 13.47 --- 37.90 % age Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 23 47 ---- 35 --- 100
  47. 48. * Funds released for 2009-10 is utilized for 2010-11 Component wise expenditure during 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) 17.00 7.00 Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 10.98 6.89 % age Fund Utilized based on SOEs recd from districts (as on 31 st Mar’11) 65 98
  48. 49. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Vaccine Supply, Quality and Logistics <ul><li>Short and irregular supply </li></ul><ul><li>Manufacturer not supplying the vaccine in time </li></ul><ul><li>Regular and long expiry vaccine to be supplied </li></ul>Poor Bio-medical waste disposal practices <ul><li>state has planned only for UGPHC with CTF </li></ul><ul><li>No proper implementation of BMWM </li></ul><ul><li>State BMWM has been prepared & it will be implemented </li></ul>
  49. 50. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Service Delivery <ul><li>Difficult areas like Inaccessible / Remote / Urban Slums / SC /ST areas not properly covered. </li></ul><ul><li>Villages far away from Institution </li></ul>Proper Mapping of difficult areas like Inaccessible / Remote / Urban Slums / SC /ST areas not properly done To cover the Dropouts in these areas , Proposed to conduct outreach Session by VHN after completing intensive refresher training to all VHNs.
  50. 51. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Weak reporting system – poor data quality Online Data entry thro ‘ HMIS at PHC /Urban centre is yet to pickup in certain PHCs Depending on field staff who has to make data entry besides her routine field work. Net connectivity problem in rural areas. One person (SHN/HI) is exclusively nominated to each block to ensure complete data This temporary arrangement will continue till the data management is streamlined.
  51. 52. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Program Management – including supervision Female Health worker is not spending adequate time for immunisation at field . Mid level supervision is weak in certain areas. Due to the implementation of various new health programmes at times (Chikunkunia, DEC, etc ), the health workers are not fully involved in Immunization programme. The post of SHN s are vacant in certain areas. Some HSC are most populated with vast area . <ul><li>Action is taken then and there to fill up the vacant posts. </li></ul><ul><li>Support of village link volunters & SHG is strengthened . </li></ul><ul><li>Re- organisation og HSC with Population. </li></ul><ul><li>New HSCs and new VHN whever population is high </li></ul>
  52. 53. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Advocacy and Communication Importance of regular Immunization and knowledge of quality in Govt. vaccination is less among mother community in certain areas. Due to lack of IEC/IPC Acutual cases are not seen by the community now so seriousness of the disease is not known to the rural community. At the time of malicious rumour spread by media after occurrence of AEFI <ul><li>Already IEC is going on thro’ Podhigai TV every week. </li></ul><ul><li>GOI may give General mass media advertisement for routine immunisation . </li></ul>
  53. 54. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Expired JE vaccine Require disposal guidelines for disposing short expiry /VVM change vaccines. (JE vaccine after JE Mass campaign) Due to the supply of short expiry /VVM discard vaccines, they are to be disposed.
  54. 55. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Vaccine Supply, Quality and Logistics Short expiry vaccine supplied (TT) Some times Bulk supply received (DPT) Manufacturer not supplying the vaccine in time . Hence short expiry vaccine received from CRL Kosouly Regular with long expiry vaccine to be supplied
  55. 56. Bottlenecks/Hurdles System Components Main Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes (Causes for the problems to be identified here) Solutions (with existing and extra resources) Bio-medical waste disposal practices Poor Bio-medical waste disposal practices No uniform guidelines developed Disposal is effectively done in certain Blocks thro’ CTF wherever CTF is available. Uniform guide lines developed after training it will be implemented
  56. 57. Vision…Where do we want to reach? System Component Indicator* Target by 2012 Service Delivery % Fully Immunized Children (FIC) 100 % Dropout Rate (BCG-DPT3) Less than 5 % Program Management Adequate man power Adequate logistics Strengthening supervision 100 % Monitoring and Surveillance Non-polio AFP rate, stool collection rate AFP rate 2 per one lakh under 15 popn. Stool collection rate 100 % Reporting system and data quality Entry status (%) Out layer (%) Entry status 100 % Out layers checked for100 % Advocacy and communication IEC IPC VHND/AN Clinic More than 95%
  57. 58. Support required Support Required / Expectations Agency <ul><li>Mass media advertisements on need and </li></ul><ul><li>effective of Immunization thro’ prominent TV channel as was done during introduction of UIP </li></ul><ul><li>2. Refrigerated Van at State store </li></ul><ul><li>3. Replacement of vaccine carrier van </li></ul><ul><li>4. Supply of Long expiry vaccine </li></ul><ul><ul><li>MoHFW, GoI </li></ul></ul><ul><ul><li>MoHFW, GoI </li></ul></ul><ul><ul><li>MoHFW, GoI </li></ul></ul><ul><ul><li>MoHFW / Supplier </li></ul></ul>
  58. 59. T H ANK YOU
  59. 62. NANDHIVARAM PHC
  60. 64. Inside of the PHC & Entrance of the Operation Theatre
  61. 66. Medavakkam PHC…

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