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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..