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AcceleratingImmuniz
(Issue and C
UNICE
24 Septemb
Neonatal Resuscitation: A Herculean Task
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Schema of presentation
1. Key Milestones/ Policies and Guidelines: RI programme in In
2. National Immunization Schedule
3. Universal Immunisation Programme National perspect
comparative analysis of UP, Bihar, Orissa, Assam and Jharkha4. Field Visit (Cold Chain Points/ RI Session Sites)
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Immunization program in India KEY MilestOldest (almost 30 yrs) and Largest Public Health Programme in the World
1978 Expanded
Program onImmunization(EPI)
BCG, DPT, OPV,Typhoid
1985 Universal
ImmunizationProgram (UIP) Measles added
1995 Pulse Polio
Immunization Days
201 M
st 2n
Mad
2011 Last Polio Case National
Vaccine Policy Hepatitis B
universalized Pentavalent
Vaccineintroduced
2012 Year of IRI;
ImmunizationWeeks
2013 RMNCH+A Launched 2 doses for JE Multi dose Open Vial
Policy GAVI- Health
StrengtheningSupport (GAVI-HSS)
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National Immunization Schedule (NIS)Infants Children
At birth BCG, OPV- 0 dose within15 days of birth,Hepatitis B- 0 dosewithin 24hrs of birth
6 Weeks BCG (if not given at birth)DPT- 1 st doseOPV- 1 st doseHepatitis B- 1 st dose
10 Weeks DPT- 2 nd doseOPV- 2 nd doseHepatitis B- 2 nd dose
14 weeks DPT- 3 rd doseOPV- 3 rd doseHepatitis B- 3 rd dose
9 months Measles 1 st dose,
16-24 months DPT booster, Measles 2Vit-A 2 nd dosJE in selected district
2 to 5 years Vit-A 3 rd to 9interval of 6 months (total of 7 doses)
5 years DPT booster
10 years T.T. booster
16 years T.T. booster
For Mother:
T. T. Pregnant women 2 doses in4-6 weeks interval, onedose if previouslyvaccinated within 3 years.
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Recent policies/guidelines and newer vaccines
1. Open vial policy2. Immunization weeks to reached HRAs, 4 rounds per year
regular basis3. MNTE validation for remaining states by end 20154. Newer vaccine introductions
Pentavalent vaccine expansion to entire country Rubella vaccine introduction Measles elimination by 2020 End game polio strategy & introduction of IPV into routine
immunization in 2015 Introduction of Rota Virus vaccine
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Site and Route of Vaccination
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Drop-outs: Children whoreceive one or more
vaccination, but do not returnfor subsequent doses. Left-outs: Children who do
not receive any vaccination
Left -outs and Drop- outs Full Immunization Coverage (FIC)
Full Immunization : Child who received One dose of BCG , Tof DPT and OPV each and One dose of Measles before one ye
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Vaccination prevents an estim2.5 million deaths each year.
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Proper Cold Chain and Vaccine managementSystemUpdated Microplan ( Planning of immunization t
every infants )
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F ll I i i C (FIC)
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Full Immunization Coverage (FIC)
64.565.663.7
69.1 6
55
62.3
45.2 48.152
0
10
20
30
40
50
60
70
80
2010-2011 2011-2012 2012-2013
Full Immunization
Full Immunization in the region
Bihar Jharkhand Odisha Uttar Pradesh
Od
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Immunization Dropout Rate (%)
35.5 36.3
45
54.8
34.4 30.937.7
30.1 30.1 31.2
0
10
20
30
40
50
60
Bihar Jharkhand Odisha Uttar Pradesh
Immunization dropout in the region, AHS
2010-2011 2011-2012 2012-2013
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Equitable Access to Immunization is a
component of the Right to Health
Snap shot Inequity Key drivers
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69% of partially and un-
immunized children in 6 Uttar Pradesh Bihar Madhya Pradesh, Rajasthan West Bengal Gujarat
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
UTTAR PRADESH
KARNATAKA
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHANDWEST BENGAL
ARUNACHAL PR.HARYANA
KERALA
UTTARANCHAL
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYANAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
Below 4040 to 5050 to 6060 to 70Above 70
Fully immunized children(12 23 months)
Coverage Evaluation
Snap shot Inequity Key drivers
>7 millions children not immunized in India
Full Immunization Coverage (FIC)
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Full Immunization Coverage (FIC)Huge Gaps
UTTAR PRADESH (52.7) UTTARAKHAND (79.6)
AHS 2012-13
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Full Immunization- Bihar
3
2 45
5
95
96
26
2
6
76
3
6
8
6
9
6 6
9
6
1
6
1
6
3
6
3
6
6
6
9
7
47
6
7
17
4
7
8
7
8
7
87 7
5
7
67
2
0102030405060708090
100
Ks
P
b
C
mpa
Jmu
P
m C
mpa
Aaa
Muaap
B
a
B
L
s
a
BB
p
B
p
D
b S
K
mu
B
GK
h
Stamah
Bh
R
a
SNwa
Mu
N
a
S
s
G
gPn
V
sSwa
S
k
a
KISHANGANJ (26.6) MA56.2
AHS 2012-13
AHS 2012-
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BIHAR:Highest: -Madhubani-87Lowest: Kishanganj- 32.
High gap between high andlow coverage districts
ODISHA:
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ODISHA:Highest: -Kendrapara-87.4%Lowest: Malkangiri- 29.6%
Coverage in Southern Odisha is low
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UTTAR PRADEHighest: -SaharanLowest: Shrawas
Gap between higlowest coverage
80.0
JHARKHAND:
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JHARKHAND:Highest: -Lohardaga-88.1%Lowest: Giridih-46.5%High Gap (41.6%) between high and
low coverage districts
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0 - 20%21 - 40%41 - 60%61 - 80%81 - 100%
Monitoring finding of WHO-UNICEFFocused Action
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Why not immunized
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0 5 10 15 20 25 30
Service not available
Vaccine not availableANM absent
Long waiting time
Do not have time
Time not convenient
Place not convenient
Place too far
Not knowing where to go for immunization
Not knowing about vaccines
Did not feel need
Wrong advice by someone
fear of side effects
cannot afford vaccines
S y s t e m
S u p p
l y
H u m a n
R e s o u r
c e
T i m e
A c c e s s
G e o g r a p
h i c
a l A c c e s s
L a c k o
f
i n f o r m a t i o n
F i n
a n c
i a l
b a r
r i e r
O t h
e r
2.1
6.2
3.9
2.1
6
8.9
3.8
2.1
10.8
26.3
28.2
3
8.1
12
11.8
Reasons for Unimmunized children
Demandissu
Supply issu
Why not immunized
Evolution GAVI States Perf framewoReporting DeliverablesObjectives
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ObjectivesA. Strengthen vaccine logistics and cold chain management
1. Improve Human Resources to improve cold chain performance
2. Supportive Supervision to ensure quality implementation3. Implement EVM improvement plans4. Institutional Capacity building to strengthen the cold chain system
B. Increasing demand for RI through Innovations in BCC Strategies1. Implement Multi pronged BCC strategy development and operational plans
2. Enhance Infrastructure and HR Capacity to develop and implement BCC strate3. Strengthen systems for effective inter personal communication and social mobili
using Polio Social Mobilization Network (SMNet)4. Develop and Broadcast immunisation messages through mass media5. Promote advocacy with media for creating an enabling environment for increas
demand for RI services
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Reaching the Unr Raising Awarenes Generating dema Empowering the
HealthRoutine Immunization
ORS ZINC
WaterSanitation
hygiene
NutritionInfant Youngchild feeding
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Hard WORK
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Hard WORK and Intelligent WORK
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BVLMS
Web based MIS application for vaccine and logistics management
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Web based MIS application for vaccine and logistics managementBVLMS)
1. To monitor the real time stock availability
2. Interpretations of stocks availability in terms of requirement
3. Helps in Rational Distribution of vaccine and logistics
4. Prevent over stocking of stocks at any location
5. Real time text message in the form of SMS alert to concern person regarding stock
6. Facilitate Batch no. and expiry date tracking7. Auto Alert mechanism before approaching stock outs
8. Helps in wastage assessment and its control
9. Strengthening of EEFO(Earliest-Expiry-First-Out) and FIFO (First-In-First-Out) fo
management
Cold Chain Point
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Cold Chain Point
VHSND Session Site
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VHSND Session Site
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Media will make
India children be
immunized.
Thanks
F d A ti I iti t d
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Focused Action Initiated
1. H-H Survey by ASHA/AWW and 100% updation of Duelist
2. Special mobile teams to immunize the children and PW
3. Involvement of ICDS and Joint supportive supervision with Additional mobility
for RI/VHND Supportive supervision
4. Introduction of BVLMto strengthen the system of vaccine & logistic managemen
5. Performance based incentives
6. Timeline with responsible person of each activity to be fixed
7. Regular follow up : DCR meeting, District Taskforce Meeting etc..
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