Measles Catch-up Campaign: Lessons learnt and planning for Phase-II

State: BIHAR

Dr Gopal Krishna, SEPIO

State Perspective regarding MCUP

• Initially only 2 districts were allotted for first phase

• Following request by Principal Secretary & Secretary cum Executive Director, SHSB, the state was allowed to go for 5 districts.

• In 2nd Phase, the State is willing to go for all the remaining 33 districts.

Gaya

Patna

Jamui

Rohtas

Purnia

Kaimur

Banka

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

Measles SIA Campaign 2010 at a glance

• 5 Districts, 64 blocks• Target population (9m-10yrs): 2,715,743 (25% of Total Population)• Total immunization posts: 24,088• Total schools: 8,919• Total ANMs: 1,899• Total health workers (ANMs+ASHAs): 16,700

Name of the District

Dates of Campaign

Total population MCV-1 Coverage (%) –

DLHS 3

Fully Immunized Coverage (%) –

DLHS 3

ARWAL 13 Dec10 -15 Jan11

732994 NA NA

AURANGABAD 13 Dec10 -17 Jan11

2443884 76.5 60.7

GAYA 13 Dec10 -22 Jan11

4337821 51.2 35.7

JEHANABAD 13 Dec10 -31 Jan11

1154545 63.3 44.7

NAWADA 13 Dec10 -19 Jan11

2260061 58 46.5

State 10929305 54.1 41.4

BIHAR : Overview

Pre activity preparations Status

• Coordination and high-level oversight – A state level co-ordination committee under the chairmanship

of Principal Secretary Health was done.– Health, Education and WCD (ICDS) participated in this meeting.

• State level committees and Operation Groups– SOG was functional under the chairmanship of Secretary Health

cum Executive Director, SHSB– The members were SIO, Director ICDS, Director Education,

WHO-NPSP, UNICEF & other partner agencies.– Stress was put on microplanning, training, AEFI management,

waste management, media management, IEC etc.

Pre activity Preparation Status• State level TOT was done, where 6 trainers (DIO & 5

MOs) from each 5 districts were trained.

• Decentralised review meeting at divisional level by SEPIO to assess the preparedness

• State Level Control Room under the chairmanship of SEPIO was formed.– To review the preparedness of each district on day to day

basis– Timely feedback and follow-up system was established

Constraints which were tackled during the campaign

• Assembly Elections• Strike of the Health Staffs• Festivals• Shortage of injectors mainy in urban areas• Cold Weather conditions

District Task Force Meeting Status

Name of the District

No. of DTFs held for MCUP

Total No. of participants

No. of DTFs attended by DM or ADM (%)

No. of DTFs attended by CMO or DIO (%)

ARWAL5 99 80% 100%

AURANGABAD5 176 80% 100%

GAYA5 190 20% 80%

JEHANABAD 5 102 80% 100%

NAWADA 5 113 100% 100%

Total 25 680 72% 96%

First 2 DTFs were done during preparatory phase.Next 2 DTFs during the implementation phase &5th DTF was post campaign to assess the completeness of activity& to plan the repeat activity in areas with poor activity.

State Pre activity preparations: District and Block level trainings

District MCUP planning

workshops

AEFI workshops

ANM & Supervisors training

AWW & ASHA training

No. held

No. trained

No. held

No. trained

No. held

No. of ANM and

supervisors trained

No. held

No. of ASHA, AWW &

volunteers trained

Arwal 1 30 1 20 5 115 20 1257

Aurangabad 1 60 1 50 12 449 78 4038

Gaya 1 59 2 97 44 826 168 6094

Jehanabad 1 45 1 32 8 233 32 1590

Nawada 1 53 1 56 23 339 56 3149

Total 5 247 6 255 92 1962 354 16128

District-wise coverage

Name of the District

Campaign start dates

Target population Total number of

children vaccinated% Coverage

(9 months-10 years)

ARWAL 13 Dec10 -15 Jan11

183248

174928 95.46

AURANGABAD 13 Dec10 -17 Jan11

613599

577614 94.14GAYA 13 Dec10 -

22 Jan111084457

971988 89.63JEHANABAD 13 Dec10 -

31 Jan11269429

232472 86.28NAWADA 13 Dec10 -

19 Jan11565010

506526 89.65Total 2715743

2463528 90.71

Monitoring findings• A total of 9724 sessions were monitored• Findings are mentioned below-

% session site with adequate vaccine & syringes 97%% sites where diluents kept cool before reconstitution 98%% sites where time of reconstitution written on vial 93%% sites where reconstituted vials kept in the hole of 1 icepack 98%

% sites where sterile part of syringe remained untouched 96%% sites where vaccinators following ‘no recapping’ 90%% sites where vaccinators know what to do in case of a serious AEFI

92%% sites having functional hub cutter 89%% sites where supervisor visited once in a day 68%

RCA Findings: Coverage

DistrictNo. of

children checked

No. of Children

found missed

% Children

found missed

No. of Areas visited

No. of Area

>=20% missed children

No. of Area

>=10% missed

children

ARWAL 6581 655 10 313 17 100

AURANGABAD 13533 1405 10 678 86 202

GAYA 16127 1823 11 803 103 289

JEHANABAD 9129 809 9 456 24 111

NAWADA 10506 1732 16 470 107 271

BIHAR 55876 6424 11 2720 337 973

Reason for not Vaccinating the child during the campaign

25%

14%

12%12%

12%

10%

2%2%

2%0%

8%

Parents didn't give importance(25%)

Fear of injection(14%)

Parents did't know about place ordate of the campaign(12%)

Traveling(12%)

Parents didn't know about thecampaign (12%)

The child was sick(10%)

Fear of AEFI(2%)

There was no vaccine at the site(2%)

Site was too far(2%)

There was no vaccinator at thesite(1%)

Very long queue(2%)

Other Reason(8%)

Left outs can be decreased with better IEC & IPC

Management of AEFIsName of the District

No. of children

vaccinated

Non Serious AEFIs

Serious AEFI

Count Incidence/million doses

Count Incidence/million doses

No. of deaths

Incidence/million doses

Arwal 174928 7 40 1 6 0 0

Aurangabad 577614 26 45 0 0 0 0

Gaya 971988 37 38 0 0 0 0

Jehanabad 232472 7 30 0 0 0 0

Nawada* 506526 31 61 12* 24 0 0

TOTAL 2463528 108 44 13 5 0 0

* Clustering at Nawada in a school following measles vaccination

Communication and social mobilization• Activities carried out

– Distribution of invitation cards to parents by AWW & ASHA

– Distribution of Flip Charts & FAQs to AWW & ASHA

– Separate sessions on mobilisation trainings of AWWs & ASHAs

– State level Media workshop along with divisional & District level media briefings by CS

– Rally of school children

– School activity worked in favour of communication and social mobilisation

– Inauguration of campaign by Minister, Divisional Commissioner, DMs & Civil Surgeons.

Communication and social mobilization• Areas for improvement

– Delayed printing of Invitation cards & other formats

– Proper use of due list for both school & outreach session sites

– Sensitisation of Principal of private schools

– Sensitisation of private practitioners regarding 2nd dose for measles

– Use of Village Health & Sanitation Committee

Lessons learnt ..1• Best practices

1. Co-ordination & oversight• Strong oversight from State • Involvement of DM in DTFs

2. Trainings• All the ANMs, AWWs, ASHAs, Volunteers & Supervisors • Deployment of DIO and 2 MOs of remaining 33 districts to the

implementing districts with support from WHO-NPSP

3. Management of AEFI• AEFI kits with MOs while provision of AVIL & DEXONA to each

vaccination team

4. Safe injection practices

Lessons learnt ..2• Best practices

5. Cold chain maintenance • even with shortage of vaccine carriers & icepacks

6. Safety Pits - Ensuring the availability of Safety pits

7. Fund - Timely release of funds to the blocks

8. Media Management• State level media workshop in presence of Principal Sec & Secretary• Media briefing at divisional & district level

9. Monitoring & Feedback• Strong Monitoring at field level with daily sharing of feedback at all

level along with DCRs at district & State level.

Lessons learnt..3• Areas for improvement

1. Strong advocacy for co-ordination among - Health, Education & ICDS during the preparation &

implementation phase.

2. Microplanning & Human resource management in Urban areas

3. Identification & Involvement of private schools

4. Involvement of private practitioners for support in AEFI management

Lessons learnt..4• Areas for improvement

5. Timely printing & procurement of logistic

6. Better display of IEC materials and use of Invitation cards for IPC

7. One week before the start of campaign, the bottom-up target of beneficiaries must get fixed at all levels

8. Ensuring availability of reserve teams at PHC to cover the areas with poor activity.

Future Plans for subsequent Phase• No. of Districts – All remaining 33 districts

• Target beneficiaries – 2,32,18,410

• Plan for addressing shortcomings– All the DIOs of remaining 33 districts had been sensitised

during their State review meetings.– State level review meeting done in April 11– Final document to be circulated to all the PHCs

• Timeline – – Anticipating national level meeting for 2nd Phase in June 11– Starting of preparation at State & district level in July- Aug 11– Implementation of campaign Sep 11 onwards

Support from GOI for Next Phase• Letter to concerned departments for co-ordination at State &

District level

• Supply of new vaccine carriers & icepacks

• AD Syringes must be compatible with the hub cutters.

• Diluents in plastic containers.

• Financial support for Monitoring of activity

• Elaborate financial guidelines, especially for – Supervisors per diem & mobility– Per diem for cold chain handlers & personnel managing waste at PHCs

DIO of Arwal District in District Microplanning Workshop

State Level Media Workshop before the SIA – Principal Secretary & Secretary

Use of Hoardings

Use of Audio-Visual during training sessions

Rally of School Children at Gaya district – CS Gaya

AEFI Kit

Use of Alternate Vaccine Delivey System

A session site with AD syringes, Hub cutters, keeping vial in hole of icepack

Children waiting for their turn at school session site

A DIO on deployment, from non-implementing district, doing monitoring

Children Under Observation following Vaccination

Monitoring by CS Arwal & WHO-NPSP

RCA – availability of Vaccination & Invitation Cards

Monitoring in a Brick Kiln by State Officials

Thank You