This document provides an update on India's immunization program. It notes that the program is one of the largest public health interventions in the country, targeting over 26 million infants and 30 million pregnant women in 2009-2010. It is centrally sponsored under the National Rural Health Mission. The document reviews coverage levels by state, discusses progress in training health workers, and outlines plans to introduce additional vaccines like hepatitis B and pentavalent vaccines in more states. It also addresses ongoing challenges like improving routine immunization coverage and strengthening cold chain management.

1. An Update
Immunization Division, MOHFW, Govt. of India

2.  One of the largest, ongoing public health
interventions in the country
 Centrally sponsored programme under
National Rural health Mission - NRHM (2005-
12)
 Programme targeted ~ 26 million infants and
30 million pregnant women in 2009-10
 All the vaccines are procured by central
government with 100% domestic funding
Immunization Division, MOHFW, Govt. of India

3. Immunization Division, MOHFW, Govt. of India
Coverage States/UT
Low
(<50%)
Uttar Pradesh, Meghalaya, Madhya Pradesh,Tripura,
Arunachal Pradesh, Bihar, Manipur and Rajasthan
Medium
(50-70%)
Mizoram, Assam, Jharkhand, Gujarat, Chhattisgarh,
Haryana, Orissa, Jammu & Kashmir, Uttarakhand, Andhra
Pradesh, Delhi, D&NH and Maharashtra
High
(>70%)
Chandigarh,West Bengal, Karnataka, Sikkim, Kerala, Punjab,
Pondicherry, Himachal Pradesh,Tamil Nadu, Lakshadweep,A
& N Islands, Daman & Diu and Goa

4. Applying the 80% MCV1 coverage cut-off and applying DLHS-3
survey data there are
▪14 states qualify for catch-up campaign in 9 mo-10 yrs age
group
▪21 states qualify for MCV2 through routine immunization
4 states viz. Delhi, Goa, Poducherry & Sikkim already introduced 2nd dose
Operational guidelines for Measles catch-up campaign
developed
State planning for second opportunity of Measles started
Immunization Division, MOHFW, Govt. of India

5. 99.1
97.6
94.5
92.8
92.5
91.9
91.1
90.9
89.1
88.6
87.9
87.3
85.2
84.5
84.4
83.9
83.1
82.8
82.1
81.4
81.1
79.9
72.6
70.5
69.0
67.5
65.5
64.4
58.9
57.7
54.2
52.5
51.8
47.0
0
10
20
30
40
50
60
70
80
90
100
Catch-up Campaigns
India : 69.6%
Immunization Division, MOHFW, Govt. of India
2nd Dose of RI

6. * data as on 25 June 2010
State P1 P3 Total
Jammu & Kashmir 1 0 1
Maharashtra 1 0 1
West Bengal 3 0 3
Uttar Pradesh 0 10 10
Bihar 0 6 6
Haryana 0 1 1
Total 5 17 22
WPVs
Most recent virus
28 May 2010
Birbhum, WB

7.  Remaining gaps in SIA quality in high-risk
areas
 High-risk populations missed during SIAs,
especially migrant populations
 Low routine OPV3 immunization coverage
 Poor sanitation and Hygiene
 Convergence of these risk factors in high-risk
blocks

8. State WIC WIF Status as per record
Chhattisgarh 2 1 Site Not Identified;
1 WIC lying for 3 yrs
H.P 1 1 Site NOT Identified
Manipur 1 - Site NOT Identified
West Bengal 4 1 Sites Identified, Civil work NOT
started
• All the states were informed of these installation in Nov’09
• Other states need to expedite the civil work so that
WIC/WIF installation can be completed by end of July’10

9.  High sickness rate, response time and break down period
of cold chain equipments.
 Temperature monitoring of vaccines requires
strengthening
 Cold chain management is poor in some places (including
private practices), particularly for temperature recording and
risk of freezing the freeze-sensitive vaccines.
 There is need to assess adequacy of trained manpower
with essential qualifications at every level.
 Disposal of condemn equipments – occupying un-
necessary space. Needs to be dispose off on priority basis

10. (As on 1 June 10)
< 30%
50 % - 80 %
> 80 %
30% - 50 %
Completed
 Rest of the states have completed the training or achieved 90% ofTotal training load
 HWTrainings started in 2007-08; ~175,000 out of 220,000 (79%) HWs trained
RAJ ASTH AN
ORIS SA
GUJ AR AT
MAH AR ASH TR A
MAD H YA PR ADESH
BIHAR
KARN AT AKA
UT TAR PR ADE SH
AND H RA PR AD ESH
JAM M U & KAS HM IR
ASSAM
TAM IL NAD U
CH H ATT ISGAR H
PUN JAB
JH ARKH AN D
W EST BEN GAL
ARU N ACH AL PR .
HAR YAN A
KERALA
UT TAR AN CH AL
HIM AC HAL PR AD ESH
MAN IPU R
MIZ OR AM
MEG HALAYA
NAG ALAND
TR IPUR A
SIKKIM
GOA
A&N ISLAN D S
D&N H AVELI
PON DIC H ERR Y
LAK SHAD W EEP
Immunization Division, MOHFW, Govt. of India
State/UT s Annual Target Trained in 2009-10
Andhra Pr 6728 19413
Arunachal Pr 319 0
Assam 1567 0
Bihar 5558 0
Chattisgarh 2266 5638
Haryana 1211 0
J & K 574 483
Kerala 3297 2687
Madhya Pr 7077 5937
Maharashtra 13057 8131
Orissa 4587 2408
Punjab 933 150
Rajasthan 4758 0
Sikkim 200 0
Uttar Pradesh 6700 0
West Bengal 7855 13795
Total 69397 41763

11. As on 1 June10
< 30%
50 % -80%
30 % - 50%
> 80%
Not Started
 TOTs conducted for
1500 trainers from all
states during 2009-10.
 MO-Training started
and ~11500 out of
62000 (18%) MOs
trained so far.
 Slow / No progress in
22 states.
 Monitoring needs to be
strengthened.
RAJ ASTH AN
ORIS SA
GUJ AR AT
MAH AR ASH TR A
MAD H YA PR ADESH
BIHAR
KARN AT AKA
UT TAR PR ADE SH
AND H RA PR AD ESH
JAM M U & KAS HM IR
ASSAM
TAM IL NAD U
CH H ATT ISGAR H
PUN JAB
JH ARKH AN D
W EST BEN GAL
ARU N ACH AL PR .
HAR YAN A
KERALA
UT TAR AN CH AL
HIM AC HAL PR AD ESH
MAN IPU R
MIZ OR AM
MEG HALAYA
NAG ALAND
TR IPUR A
SIKKIM
GOA
A&N ISLAN D S
D&N H AVELI
PON DIC H ERR Y
LAK SHAD W EEP
Immunization Division, MOHFW, Govt. of India

12.  Hepatitis B
 Already in 10 states and selected cities
and districts of the country
 Expansion of Hepatitis B vaccine in the
remaining states of country in phased
manner is under consideration
 Service delivery issues -Birth dose of
Hep B not being given within 24 hours
Reluctance to use due to concerns
about AEFI and vaccine wastage
(Punjab &Tamil Nadu)
 Pentavalent
 Introduction of Hib-containing
pentavalent in select states is under
process
Immunization Division, MOHFW, Govt. of India
Hepatitis B States
Hepatitis B Pilot Districts
Hepatitis B Pilot Cities

13. Immunization Division, MOHFW, Govt. of India
0%
20%
40%
60%
80%
100%
120%
140%
BCG OPV3 Measles FIC*(12-23 months)
Source: HMIS

14. Immunization Division, MOHFW, Govt. of India
0%
50%
100%
150%
200%
250%
BCG OPV3 Measles FIC*(12-23 months)

15. Ministry of Health & Family Welfare
15

16. • Name-based tracking of
– pregnant women - for ANCs, Delivery & PNCs
– children - for immunisation
• To facilitate
– Closer monitoring of regular check-ups of pregnant
women and reduce avoidable complications
– Complete immunisation of children
• For closer monitoring of mortality indicators
(IMR and MMR)
16

17. • PregnantWomen
– All pregnant women since 1st April, 2009
– In the first instance from 1st December, 2009
– Emphasis on ALL pregnancies
• Irrespective of whether ANCs are done by public or private
health provider
• Children
– All Births since 1st April, 2009
– In the first instance from 1st December, 2009
– Emphasis on all births – public or private
17

18. PREGNANT WOMEN
 Location Details
 State, District, Block, Address
 Identification details
 Name, DOB, Phone No, JSY, caste
 Health Provider details
 HSC, ANM,ASHA, Linked facility
for delivery
 ANC details
 LMP, ANC dates,TT, IFA,Anemia,
complications
 Pregnancy Outcome
 Place, delivery date, JSY benefits
 PNC Details - dates
 Infant details
INFANTS
 Location Details
 State, District, Block,Address
 Identification details
 Name, DOB, Phone No, JSY,
caste
 Health Provider details
 HSC, ANM,ASHA
 Immunization details
 Dates for BCG, OPV, DPT,
Hepatitis, Measles,Vit A
18

19. Digits (Nos) Item Description /Remarks
01-02 (2) State Code As per Census codes
03-04 (2) DistrictCode As per Census codes
05-07 (3) Block PHC/CHC Code As per Census codes given to Block HQ
08-09 (2) Health Sub-Centre Code To be serially given by Block HQ.
10-10 (1) PregnantWoman – Code 1;
Child – Code 2
11-12 (2) Year Code Last 2 digits for the year is to be given, for
example, for the year 2009, “09” will be
entered and so on
13-16 (4) To be given serially to each
mother / child from 1st
December, 2009 starting from
5000
From 1st April each year, the codes will be
given afresh starting from 0001.
19
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2 3 2
2 1 1 3 1 6 1 0
1 0 0 0 1

20. States Status
Chhattisgarh •Mother & Child tracking registers printed;
•Data entry in registers started,
•Computerization to be done
Orissa •Standardized Formats for data collection
•Data entry at blocks in standardized excel sheets developed
by state
West Bengal •Standardized formats for data collection
•Data entry started at block levels in excel sheets designed at
blocks; lack of uniformity
Uttarakhand •Standardized formats for data collection
•Data entry started at block levels in excel sheets designed at
blocks
Based on recent observations during field tours

21.  Special software required for this process
To generate beneficiary list
To maintain uniformity
To avoid duplication of beneficiaries
To access data for supervision/monitoring
To calculate coverage
 Data entry at block level being done by Block
Accounts Assistant; no data entry operator
Huge volume of data coming monthly
 Power supply & connectivity issues at blocks

22.  Name Based InformationTracking System
(NBITS) being developed by NHSRC and
piloted in MP
 This would address some of the issues raised

23. Immunization Division, MOHFW, Govt. of India