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transcript
Routine Immunization current status & low coverage areas
identification Strategy & way forward
SEPIO meeting18-20 May 2011
Dr Pradeep Haldar, MoHFW, GoI
Presentation Outline
• Routine immunization Current Status
• Evidence from the field
• Low RI coverage area - Identification
• Way forward
CES 2009: FI 61 %
Routine Immunization in India Proportion of Fully immunized children (12 – 23 months)
Source: http://www.mohfw.nic.in
DLHS-2Below 4040 to 5050 to 6060 to 70Above 70
India State
Challenges: Access & Utilisation
Source: DLHS-3 Data
Improved access but declining utilisation
Source: DLHS-2 and DLHS-3
Assessing utilisation and access of servicesDLHS 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
Analysis of gaps
• Low Access :– Immunization session sites are not included in
microplan– Session not attended by ANM – leave, post vacant,
not going to the site
• Poor utilisation: – Irregular sessions, variable quality of services– Non-availability of vaccine/logistics– Poor messaging and communication – Low community confidence in services
DLHS-2 v/s DLHS 3
Full Immunization Declined
Utilization
Improvement Decline
Access
Improvement Tamil Nadu
Decline D& NH, Poducherry, Maharashtra,
BCG (HIMS 10-11 Vs CES-09)
BCG (HIMS 10-11 Vs CES-09)
DPT (HIMS 10-11 Vs CES-09)
DPT (HIMS 10-11 Vs CES-09)
Measles (HIMS 10-11 Vs CES-09)
Measles (HIMS 10-11 Vs CES-09)
Vaccine Supply Vs HIMS 10-11
Vaccine Supply Vs HIMS 10-11 Cont
Findings from RI Monitoring
% RI session held – UP, Bihar and Jharkhand (Year - 2010)
n=number of sessions monitored
83.0% 82.5%74.5%
3.0% 4.3% 14.6%
14.0% 13.2% 10.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bihar (n=30,604)
Jharkhand(n=3,164)
Uttar Pradesh(n=65,500)
Session held as per microplan Session held not as per microplan Session not held
15 to 25% sessions not held / not held as per microplan
Due to absence of ANM and/or vaccine, logistics
Availability of vaccine & diluent at RI sessions January – December 2010
n=number of RI session found conducted
94% 98%92% 93%
83%94% 98% 92% 93%
81%89%
98% 92%86%
74%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
BCG + Diluent DPT tOPV Measles +Diluent
All Vaccine +Diluent
UP (n=58,368) Bihar (n=26,248) Jharkhand (n=2,746)
% availability of all Vaccines on sessions sites (Year – 2010 & 1st Quarter 2011)
JBSA – Jachha Bachha Suraksha Abhiyan -UP
80% 80% 80% 80%
70%
80% 80%
70%
50%
80%
90%
80% 81% 80%
88%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
JBSA started form August’10
Visited1
Up.shp
BCG_0M0 - 4040.1 - 6060.1 - 8080.1 - 100
Visited1
Up.shp
BCG_0M0 - 4040.1 - 6060.1 - 8080.1 - 100
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
UP districts CumulativeJan’11 – Mar’11: State Average- 83%
Sessions held- 17,573
KRI
SBD
STP
LLP
HDO
JAL
JNS
AHB
BJN
BAD
BRC
PIL
RBL
SHA
SUL
MZP
BBK
BRL
FTP
BNA
JNP
UNN
AZG
MZN
AGR
ALG
SHP
HMP
BLS
GND
PTG
KSN
MRD
BRP
GZP
BAL
GRPBST
KPN
CKT
MTR
MAI
KPD
MHB
FAI
ETA
SDN
MRT
LNO
DOR
JPN
FKB
CND
FER
ABN
RMP
MHG
ETW
KNA
KAN
AUR
GZA
HTR
KSM
SRW
MAU
SKN
VRN
BGT
GBN
BDH
AEFI of Mohanlal Ganj (Lucknow)
KRI
SBD
STP
LLP
HDO
JAL
JNS
AHB
BJN
BAD
BRC
PIL
SHA
MZP
BRL
FTP
BNA
JNP
UNN
AZG
MZN
AGR
ALG
SHP
BBK
HMP
BLS
GND
PTG
KSN
MRD
BRP
RBL
FAI
GZP
BAL
GRPBST
KPN
CKT
MTR
MAI
KPDSULCSN
MHB
ETA
SDN
MRT
LNO
DOR
JPN
FKB
CND
FER
ABN
RMP
MHG
ETW
KNA
KAN
AUR
GZA
HTR
KSM
SRW
MAU
SKN
VRN
BGT
GBN
BDH
KRI
SBD
STP
LLP
HDO
JAL
JNS
AHB
BJN
BAD
BRC
PIL
SHA
MZP
BRL
FTP
BNA
JNP
UNN
AZG
MZN
AGR
ALG
SHP
BBK
HMP
BLS
GND
PTG
KSN
MRD
BRP
RBL
FAI
GZP
BAL
GRPBST
KPN
CKT
MTR
MAI
KPDSULCSN
MHB
ETA
SDN
MRT
LNO
DOR
JPN
FKB
CND
FER
ABN
RMP
MHG
ETW
KNA
KAN
AUR
GZA
HTR
KSM
SRW
MAU
SKN
VRN
BGT
GBN
BDH
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Availability of all UIP vaccines and diluent at RI sessions, Bihar - 2010
Year 2010:Total 30,604 RI sessions monitored
Col No.
KAIMURKATIHARKHAGARIAKISHANGANJLAKHISARAIMADHEPURAMADHUBANIMUNGERMUZAFFARPURNALANDANAWADAPATNAPURNIAROHTASSAHARSASAMASTIPURSARANSHEIKHPURA
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
<=50%51 - 70%70 - 90%91 - 100%
75 77 80 82 82 84 84 8480
76 78 79
0
10
20
30
40
50
60
70
80
90
100
Jan'1
0
Feb'1
0
Mar
'10
Apr'10
May
'10
Jun'10
Jul'1
0
Aug'10
Sep'1
0
Oct'10
Nov'10
Dec'10
GUMLA
GIRIDIH
RANCHI
PALAMU
DUMKA
LATEHAR
CHATRAGARHWA
SIMDEGA
SINGHBHUM WEST
HAZARIBAGH
KHUNTI
GODDA
BOKARO
PAKUR
DEOGHAR
SARAIKELLA
DHANBAD
JAMTARA
SINGHBHUM EAST
SAHIBGANJ
RAMGARH
KODERMA
LOHARDAGA
% Sessions where all RI vaccines and AD syringes were available, Jan-Dec 2010, Jharkhand
State average 2010: 69.8%
Nil1 - 30 %31 - 59 %60 - 79 %>= 80 %Data Not Available
Source: RI session monitoring dataN = 5692 RI session found held
Full immunization status and BCG-measles drop out rates, 2010 – Uttar Pradesh
Fully Immunized20 % to 40 %40 % to 50 %50 % to 60 %60 % to 76.3%
Up.shpBCG-Measles Drop-out
Below 1010 % to 30 %30 % to 50 %50% to 60 %
Up.shpFIC (Fully immunized coverage)
BCG-measles drop out rate
n= 1,76,634 children 12 to 23 month of age
KRI
SBD
STP
LLP
HDO
JAL
JNS
AHB
BJN
BAD
BRC
PIL
RBL
SHA
SUL
MZP
BBK
BRL
FTP
BNA
JNP
UNN
AZG
MZN
AGR
ALG
SHP
HMP
BLS
GND
PTG
KSN
MRD
BRP
GZP
BAL
GRPBST
KPN
CKT
MTR
MAI
KPD
MHB
FAI
ETA
SDN
MRT
LNO
DOR
JPN
FKB
CND
FER
ABN
RMP
MHG
ETW
KNA
KAN
AUR
GZA
HTR
KSM
SRW
MAU
SKN
VRN
BGT
GBN
BDH
KRI
SBD
STP
LLP
HDO
JAL
JNS
AHB
BJN
BAD
BRC
PIL
RBL
SHA
SUL
MZP
BBK
BRL
FTP
BNA
JNP
UNN
AZG
MZN
AGR
ALG
SHP
HMP
BLS
GND
PTG
KSN
MRD
BRP
GZP
BAL
GRPBST
KPN
CKT
MTR
MAI
KPD
MHB
FAI
ETA
SDN
MRT
LNO
DOR
JPN
FKB
CND
FER
ABN
RMP
MHG
ETW
KNA
KAN
AUR
GZA
HTR
KSM
SRW
MAU
SKN
VRN
BGT
GBN
BDH
Full immunization status and BCG-measles drop out rates, Bihar, Jan-Mar 2011
BCG-Measles Drop-outBelow 1010 % to 30 %30 % to 50 %50% to 60 %
Up.shpFIC (Fully immunized coverage)
BCG-measles drop out rate
n = 20,872 children 12 to 23 month of age
Col No.
KAIMURKATIHARKHAGARIAKISHANGANJLAKHISARAIMADHEPURAMADHUBANIMUNGERMUZAFFARPURNALANDANAWADAPATNAPURNIAROHTASSAHARSASAMASTIPURSARANSHEIKHPURA
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
Col No.
KAIMURKATIHARKHAGARIAKISHANGANJLAKHISARAIMADHEPURAMADHUBANIMUNGERMUZAFFARPURNALANDANAWADAPATNAPURNIAROHTASSAHARSASAMASTIPURSARANSHEIKHPURA
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
20 - 39%40 - 49%50 - 59%60 - 90%
GUMLA
GIRIDIH
RANCHI
PALAMU
DUMKA
LATEHAR
CHATRAGARHWA
SIMDEGA
SINGHBHUM WEST
HAZARIBAGH
KHUNTI
GODDA
BOKARO
PAKUR
DEOGHAR
SARAIKELLA
DHANBAD
JAMTARA
SINGHBHUM EAST
SAHIBGANJ
RAMGARH
KODERMA
LOHARDAGA
By district, Year 2010State average : 76.1%
Jharkhand: Monitoring community coverage gaps:% Fully immunized children, children 12-23 months
Upbijh.shp16.3 - 4040.1 - 6060.1 - 8080.1 - 100
Upbijh_state.shpPercent fully immunized
Source: RI h-t-h monitoring dataN = 12485 Children 12-23 month
Improving access and utilisation of RI:Lessons from pulse polio activities (1)
• Social mobilization in Polio to increase utilisation;– Messages tailored for specific audience
– Use of local resources (community members, local leaders, and influential people)
– Religious sites and gatherings for message delivery
• Strengthen linkages with pulse polio teams activities:
– Polio microplans to include RI session site information (where, when and by whom)
– Teams provide RI card to families during the house-to-house visits and share information on RI sessions
Improving access and utilisation of RI:Lessons from pulse polio activities (2)
• Strong inter-sectoral coordination (health, education and ICDS):– Pooling of human resources, venue, vehicles and leadership
prior and during rounds– ANM and ASHA (Health), AWW (of ICDS), School
teachers (education) works together. – Evening briefings attended by MOI/Cs, CDPOs, BEO and
community members for better planning
• Replicating and extending coordination in support of RI:– RI monitoring feedback during coordination meetings– Preparing joint strategies to strengthen RI at different
levels
Low coverage area Identification
• populations known to have a disproportionate share of the disease burden;
• un-immunized or under-immunized children in urban and peri-urban areas;
• populations in places where sanitation is poor;
• populations inhabiting difficult or mountainous terrain, marshy areas, islands
• refugees, internally displaced persons, migrant workers and other transient populations;
• politically and or socially marginalized populations or minority groups;
• religious groups that oppose vaccination.
• Communities at international borders and Intra-State administrative borders.
Identification and prioritization low coverage areas
1. URBAN Strategy
2. Rural Strategy1. First priority to the villages/habitations which are
never (rarely) reached
2. Then the villages / habitations in which immunization was planned but not held during previous 3-4 months.
3. Villages where RI is normally done but coverage is low
4. Convergence of Microplan – for uncovered areas
Way forward
• Experience from Polio SIAs to be used for RI improvement
– Improved access and utilization
– Updating micro-plans
– Social mobilization
• Expand RI monitoring to other states and locations
Thank you