Transcript Slide 1

Routine Immunization:
Recent initiatives and progress in
high risk areas
23rd India Expert Advisory Group
13-14 July, 2011
Dr Pradeep Haldar, MoHFW, GoI
Presentation outline




Status and performance of RI
Efforts to strengthen RI
Continued challenges
Way forward
Routine immunization
performance
Proportion of Fully immunized children
(12 – 23 months)
CES 2006
CES 2009
FI: 62%
• OPV3: 68%
• DPT3: 68%
• Measles: 71%
FI: 61%
• OPV3: 70.4%
• DPT3: 71.5%
• Measles: 74.1%
JAMMU & KASHMIR
HIMACHAL PRADESH
PUNJAB
UTTARANCHAL
HARYANA
ARUNACHAL PR.
SIKKIM
RAJASTHAN
UTTAR PRADESH
BIHAR
GUJARAT
India State
DLHS-2
Below 40
40 to 50
50 to 60
60 to 70
Above 70
MADHYA PRADESH
ASSAM
NAGALAND
MEGHALAYA
JHARKHAND
WEST BENGAL
MANIPUR
TRIPURA
MIZORAM
CHHATTISGARH
ORISSA
D&N HAVELI
MAHARASHTRA
ANDHRA PRADESH
GOA
KARNATAKA
A&N ISLANDS
PO NDICHERRY
TAMIL NADU
LAKSHADWEEP KERALA
Source: http://www.mohfw.nic.in
Full immunization coverage: CES 2009 vs CES 2006
Only 12 states improved
23 states declined
30
Rajasthan: +6 %
Maharastra: +6 %
20
Bihar: +11 %
Punjab: +8 %
UP: +4 %
Jharkhand: +7 %
10
0
AN AP AC AS BI CH CG DN DD DL GO GU HA HP JK JH KA KE LD MP MH MN ME MZ NA OR PD PB RJ
SI TN TR UP UA WB
-10
-20
Delhi: - 14 %
-30
Haryana: -3 %
WB: - 5 %
MP: - 11 %
OPV3 coverage: CES 2009 vs CES 2006
28 states improved
7 states declined
UP: +34.4 %
Jharkhand: +27.8 %
40
Rajasthan: +28 %
Maharastra: +20.7 %
35
Bihar: +17 %
30
Punjab:
+14.8 %
MP: - 14.2 %
25
Haryana: -7.7 %
WB: +4.2 %
20
15
10
5
0
AP
AC
AS
BI
CG
DL
GO
GU
HA
HP
JK
JH
KA
KE MP MH MN
ME MZ
NA
OR PB
RJ
SI
-5
-10
-15
Delhi: - 1.6 %
Andhra Pradesh: - 8 %
Tamilnadu: - 7 %
TN
TR
UP
UA WB
Full immunization coverage: RI monitoring
UP & HR Blocks, June’10 – May’11
UP State
HR blocks
70
SHP
65
57
60
MZN
55
MRT
GZA
GBN
JPN MRD
RMP
PIL
BRL
BLS
ALG
SHA
KAN
HTR
47
51
45
40
30
35
25
ETA
FKB
AGR
50
35
BAD
MTR
percentage (%)
BGT
BJN
FER
MAI
20
Jun'10
Jul
Aug
Sep
Oct
Nov
Dec
Jan'11
Feb
HR Blocks Cumulative
Average = 43%
Children 12-23 months: 39,346
BCG_0M
0 - 40
40.1 - 60
60.1 - 80
80.1 - 100
Up.shp
Visited
1Data not available
BCG_0M
0<=
- 40
40%
40.1
- 60
40% to
60%
60.1
80
60% to 80%
80.1
- 100
>= 80%
Not monitored
Up.shp
Visited
1
MZN
BGT
May
State Average = 51%
Children 12-23 months: 207,811
BJN
MRT
JPN
GZA
RMP
MRD
GBN
PIL
BRL
BLS
KRI
BAD
ALG
SHA
KAN
MTR
Apr
UP State
SHP
ETW
Mar
HTR
AGR
SRW
ETA
FER
STP
FKB
BRC
BRP
HDO
MAI
SDN
KNA
LNO
ETW
AUR
BST
KPD
KSN
GRP
DOR
ABN
KPN
RBL
JAL
CSN
FTP
SUL
AZG
MAU
BAL
PTG
JNP
JNS
MHB
SKN
FAI
UNN
HMP
MHG
GND
BBK
KSM
BNA
CKT
AHB
GZP
BDH VRN
MZP
CND
LLP
SBD
Full immunization : RI monitoring
Bihar & HR Blocks, June’10 – May’11
HR Blocks cumulative
Average = 66%
2
Children 12-23 months: 9,733
Col No.
Cham para n We st
Cham para n Eas t
Sheohar
Sitam ar hi
Gopalga nj
Madhubani
Supaul
Kishanganj
Ar aria
Muz affa rpur
Siw a n
Darbhanga
Sar an
Purnia
Sahar sa
Vais hali
Madhepura
Sam a stipur
Buxar
Bhoj pur
Begusar ai
Patna
Nalanda
Ar w al
Jehanabad
Sheik hpur a
Rohtas
Khagaria
Katihar
Bhagalpur
Munger
La khisar ai
Kaim ur
Aura ngaabad
Naw ada
Jam ui
Banka
Ga ya
BCG_0M
0 - 40
40.1 - 60
60.1 - 80
80.1 - 100
Up.shp
Visited
1Data not available
BCG_0M
0<=
- 4040%
40.1
41%- 60
to 60%
60.1 - 80
61% to 80%
80.1
- 100
> 80%
Up.shp
Not monitored
Visited
1
Bihar State
State Average = 66%
Children 12-23 months: 87,474
Champaran West
Gopalganj
Champaran East
Sitamarhi
Sheohar
Madhubani
Supaul
Kishanganj
Araria
Muzaffarpur
Siwan
Darbhanga
Saran
Buxar
Bhojpur
Arw al
Rohtas
Nalanda
Munger
Katihar
Bhagalpur
Lakhisarai
Sheikhpura
Kaimur
Aurangaabad
Gaya
Nawada
Purnia
Khagaria
Begusarai
Patna
Jehanabad
Madhepura
Saharsa
Sam astipur
Vaishali
Jamui
Banka
Immunization status through RI monitoring:
June 2010 – May 2011
Fully Immuniz ed
P art ialy Immuniz ed - " drop out s "
No Immuniz at ion - " lef t out s "
100%
5%
2%
12 %
7%
20%
80%
30%
32%
37%
60%
40%
78%
66%
6 1%
5 1%
20%
0%
Bihar
UP
J har k hand
Wes t Bengal
( n=87,474)
( n=207,811)
( n=11,599)
( n=1,020)
*WB data for May & June, ’11 only
Reasons for being partially immunized: June 2010 – May 2011
Aw a re n e ss & In fo rm a ti o n g a p
Op e ra ti o n a l g a p
AEFI a p p re h e n si o n
D a ta n o t a va i l a b l e
Oth e r re a so n s
100%
18 %
80%
18 %
16 %
22%
16 %
16 %
16 %
22%
60%
23%
40%
8%
20%
33%
23%
11%
26%
5%
9%
5%
4 1%
37%
37%
UP
Jh a rkh a n d
WB
0%
Bi h a r
*WB data for May & June, ’11 only
% RI sessions not held: UP & HR blocks
June’10 to May‘11
HR Blocks
State Average: 8.6%
Sessions not Held:
1,196 out of 13,856
BGT
BJN
MRT
JPN
RMP
MRD
GZA
GBN
PIL
BRL
BLS
HR blocks
26
45
40
35
percentage (%)
SHP
MZN
UP state
50
30
25
11
20
15
BAD
10
ALG
SHA
KAN
MTR
HTR
5
0
ETA
FKB
FER
8
17
Jun'10
Jul
Aug
Sep
Oct
Nov
Dec
Jan'11
Feb
Mar
Apr
May
MAI
UP districts – cumulative
AGR
SHP
State Average: 8.5%
Sessions not held:
6,613 out of 70,851
ETW
MZN
BGT
BJN
MRT
JPN
GZA
% Sessions not held
RMP
MRD
GBN
KRI
BAD
ALG
SHA
KAN
> 20%
15% to 20%
10% to 15%
PIL
BRL
BLS
MTR
HTR
AGR
SRW
ETA
FER
STP
FKB
BRC
BRP
HDO
MAI
SDN
KNA
LNO
ETW
AUR
BST
KPD
RBL
CSN
DOR
FTP
SUL
AZG
BAL
JNP
KSM
BNA
CKT
AHB
GZP
BDH VRN
MZP
CND
LLP
Source: RI monitoring data, GoUP and NPSP
MAU
PTG
JNS
MHB
KSN
GRP
ABN
KPN
HMP
SKN
FAI
UNN
JAL
< 10%
MHG
GND
BBK
SBD
Due list available: Bihar & HR blocks
June ’10 to May ‘11
5
Bihar State
Col No.
HR Block
70
Cham para n We st
56
55
60
Cham para n Eas t
Sheohar
Sitam ar hi
Gopalga nj
50
Supaul
Kishanganj
Ar aria
Muz affa rpur
Siw a n
Darbhanga
Sar an
Purnia
Sahar sa
Vais hali
Madhepura
Sam a stipur
Buxar
Bhoj pur
Begusar ai
Patna
Jehanabad
Katihar
Sheik hpur a
40
42
41
30
20
Bhagalpur
Munger
Nalanda
Ar w al
Rohtas
Khagaria
percentage (%)
Madhubani
10
La khisar ai
Kaim ur
Aura ngaabad
Naw ada
Jam ui
0
Banka
Ga ya
Jun'10
Jul
Aug
Sep
Oct
Nov
HR Blocks Cumulative
Dec
Jan'11
Feb
Mar
Apr
May
Bihar districts Cumulative
HR blocks average = 52 %
Col No.
State average = 42 %
1,770 out of 3,386
13,294 out of 31,736
Champaran West
Gopalganj
Champaran East
Sitamarhi
Sheohar
Madhubani
Supaul
< 40%
Kishanganj
Araria
Muzaffarpur
Siwan
Darbhanga
Saran
40% to 60%
61% to 80%
Buxar
Bhojpur
> 80%
Arw al
Rohtas
Nalanda
Munger
Katihar
Bhagalpur
Lakhisarai
Sheikhpura
Kaimur
Aurangaabad
Gaya
Nawada
Purnia
Khagaria
Begusarai
Patna
Jehanabad
Madhepura
Saharsa
Sam astipur
Vaishali
Jamui
Banka
Availability of hub-cutter: UP & HR blocks
June ’10 to May ‘11
Bihar State
HR Blocks
50
Average = 20%
MZN
BGT
Hub-cutter available:
40
2,513 out of 12,660
35
BJN
MRT
44
28
30
25
20
27
23
15
JPN
RMP
MRD
GZA
percentage (%)
SHP
45
HR Block
10
GBN
PIL
BRL
BLS
5
0
BAD
Jun'10
ALG
Jul
Aug
Sep
Oct
Nov
Dec
Jan'11
Feb
Mar
Apr
May
SHA
KAN
MTR
HTR
ETA
UP districts Cumulative
SHP
FKB
FER
MZN
MAI
AGR
BGT
MRT
JPN
GZA
ETW
State Average = 29%
BJN
< 40%
40% to 60%
60% to 80%
> 80%
Hub-cutter available:
RMP
MRD
GBN
BLS
KRI
BAD
ALG
SHA
KAN
MTR
HTR
AGR
SRW
ETA
FER
20,234 out of 70,851
PIL
BRL
STP
FKB
BRC
BRP
HDO
MAI
SDN
KNA
LNO
ETW
AUR
BST
KPD
KSN
GRP
DOR
ABN
KPN
RBL
JAL
CSN
FTP
SUL
AZG
MAU
BAL
PTG
JNP
JNS
MHB
SKN
FAI
UNN
HMP
MHG
GND
BBK
KSM
BNA
CKT
AHB
GZP
BDH VRN
MZP
CND
LLP
SBD
Mobilization of beneficiaries at monitored RI
session sites, Uttar Pradesh April ’10-March ‘11
By ASHA
By ICDS
SHP
SHP
MZN
BGT
BJN
MZN
MRT
BGT
JPN
GZA
PIL
BRL
RMP
MRD
GBN
ALG
FER
ALG
SRW
ETA
STP
FKB
BRC
MTR
SDN
KNA
LNO
ETW
AUR
BST
KPN
RBL
CSN
FTP
AZG
KSM
AHB
LLP
SBD
RBL
JAL
HMP
GZP
CSN
20% to 40%
40% to 60%
MHB
DOR
FTP
SUL
AZG
MAU
BAL
PTG
JNP
JNS
< 20%
KSN
GRP
ABN
KPN
CND
BST
SKN
FAI
UNN
KPD
MAU
MHG
GND
BBK
LNO
AUR
BAL
MZP
BRP
SDN
KNA
ETW
BDH VRN
BRC
HDO
MAI
DOR
JNP
CKT
FER
STP
FKB
SUL
JNS
MHB
SRW
ETA
GRP
PTG
BNA
AGR
KSN
ABN
JAL
HMP
SKN
FAI
UNN
KPD
HTR
MHG
GND
BBK
SHA
KAN
BRP
HDO
MAI
KRI
BAD
SHA
KAN
PIL
BRL
BLS
KRI
BAD
AGR
JPN
GZA
BLS
HTR
MRT
RMP
MRD
GBN
MTR
BJN
KSM
BNA
CKT
AHB
GZP
BDH VRN
MZP
CND
LLP
SBD
> 60%
UP districts - cumulative
<Empty Picture>
UP districts - cumulative
State Average = 63.5%
State Average = 34.2%
ASHA found present: 44,981 out of 64,653
ICDS found present: 24,249 out of 64,653
Source: RI monitoring data, GoUP and NPSP (Apr’10 to Mar’11)
Efforts to strengthen RI
Risk scoring: Karnataka, 2011
(Score 7-16)
Criteria for risk categorisation (Karnataka):
A summed scored index is computed on following criteria Estimated unimmunized for OPV3 in 2010-11 (coverage
assumed at DLHS-3 levels)
 WPV importations in previous years since 2002
 Bordering WPV importation districts
 Clustering of compatibles in the past 3 years
 AFP Surveillance quality: surveillance index &
 Migratory population (<5 yr children)
(Score 4-6)
(Score 1-3)
BIDAR
GULBARG A
BIJAPUR
YADG IR
BAGALKOT
RAICHUR
BE LGAUM
KO PP AL
DHARWAD
GADAG
BE LLARY
UTTAR KANNAD
HAVE RI
DAVANAG ERE
CHITRADURGA
SHIMO GA
CHICKABALLAPUR
UDUP I
TUMKUR
CHIKMAG LUR
BANGALORE( R) KO LAR
HASS AN
DAKSHIN KANNAD
BANGALORE (U)
MANDYA
RAMANAGARA
KO DAG U(COO RG)
MYSO RE
CHAMARAJNAG AR
Suggested additional criteria for states:
• Measles outbreak data
• Vacancy status of service providers
• VDPV data
• Hard-to-reach areas
Mapping RI sites in Polio SIA plan:
Karnataka, 2011
RI session information
added to polio SIA
microplan
Planning for Migrants/
high-risk populations
Nearest RI
session site for
each HtH team
day area
identified
Percent validated migrant sites
included in RI micro plan, India
 Emergency Preparedness
and Response Plan, 2011
emphasizes mapping
migratory / mobile
populations to cover them in
both SIA & RI
 Mapping & validation of
migrant sites is ongoing in
states
RI microplans should be updated every
 Following mapping, sites are
6 months
the inclusion of
being incorporated
in to
RI ensure
plan
shifting migrant populations
 Final data is being compiled
from UP, Bihar, Maharastra,
Gujarat
Data being compiled
Harmonization of Polio SIA & RI Microplan
District: Bulandshahr, Uttar Pradesh
SIA component
Village visited by
SIA team
Every polio SIA team carries this plan
and must inform parents of when and
where RI sessions are held
RI component
Special RI session for Brick Kilns in Meerut, UP
Special initiatives must to be sustained &
incorporated in regular RI microplan
Brick
Kilns
Village
Distance
from
PHC
Owner &
manager of Kiln
ANM
4 monthly
drives
Improving and expanding RI monitoring
RI monitoring: June 2010 – May 2011
State
Sessions
monitored
Children surveyed
0 to 11 months
12 to 23 months
Bihar
36,362
200,015
87,474
Jharkhand
5,158
24,303
12,998
UP
83,890
500,719
170,100
TOTAL
125,410
725,037
270,572
 In 2011, more than 9,000 session sites and 90,000
children monitored per month in 3 high priority states
 RI monitoring expanding to other states: West Bengal,
Karnataka, Rajasthan, Punjab, Orissa, Delhi, Assam
Use of data for action
 RI monitoring systematically shared with District and
Block health officials
– DTFs pre/post polio SIA
– Quarterly DIO review meetings
 Jharkhand:
– RI Cell meetings held bi-monthly chaired by Director Health
– Development Partners attend the meeting
– 2 DIOs (one from better & one from weaker district) are invited
by rotation
 Bihar:
– At the PHC/Block Level by FVs (every day)
– At the District level by SMOs (every week) during District Control
Room meetings
– At the State Level (both weekly & monthly)
 Other states are instituting RI Cell Meetings
Initiatives in cold chain and vaccine
management Strengthening
 Human Resource
–
–
–
–
Recruitment of National vaccine Logistics manager
Cold chain Consultants in state of UP , Jharkhand and Orissa
Regional Vaccine Logistics mangers in Orissa
221 state trainers, 762 district trainers and 6586 CC handlers trained
 Infrastructure strengthening (Dec ’10 – July ’11)
–
–
–
–
27 WIC, 8 WIF, 4650 ILR, 6070 DF supplied
300 combo solar equipment supplied to 16 states
Temperature monitoring devices installed in 9 State vaccine stores
National Cold Chain and Vaccine management Resource Center at
NIHFW initiated
 National Cold chain MIS developed by SHTO-Pune
 Reviews and Monitoring
– National partners and experts subgroup meeting in Jan 2011
– CCOs review in April 2011
Improving AEFI surveillance
 National AEFI guidelines revised
in 2010
 25,000 copies disseminated to all
the states
 Training package with revised
AEFI guidelines prepared,
workshops conducted in several
states to date
 50,000 copies of SOPs on AEFI
operational guidelines for BMOs in
print
 Post Marketing Surveillance
(PMS) network in Maharashtra
 Training on causality assessment
is scheduled for September/
October
New vaccine introduction
 Hepatitis B vaccine expansion
– Ongoing in 15 states/UTs
– Expansion to all remaining areas
 Pentavalent (DPT-HepB-Hib)
– Introduction to TN and Kerala
 Measles 2nd dose in RI
– Given with 1st DPT booster (16-24
months) in 21 states
– MCUP in phases in 14 states
– MCV2 in RI for districts that have
completed MCUP 6 m back
Continued challenges
Involvement of Govt in RI monitoring:
HR blocks of Jharkhand, June ’10 – May ‘11
20
HR Blocks monitored (2 Blocks)
HR Blocks not monitored (28 Blocks)
4
2
n=number of sessions monitored
LA
AR
IB
AG
H
JA
M
TA
RA
KH
UN
TI
KO
DE
RM
A
LA
TE
HA
LO
R
HA
RD
AG
A
PA
LA
M
U
RA
M
GA
RH
RA
N
CH
SA
I
H
IB
GA
SA
NJ
RA
IK
EL
LA
SI
SI
M
NG
DE
HB
GA
HU
SI
M
NG
EA
HB
ST
HU
M
W
ES
T
GU
M
HA
Z
RA
DE
OG
HA
R
DH
AN
BA
D
DU
M
KA
GI
RI
DI
H
GO
D
DA
CH
AT
KA
RO
BO
RH
W
GA
PA
KU
R
A
0
Involvement of Govt in RI monitoring:
HR blocks of Bihar, June ’10 – May ‘11
14
12
Cham para n We st
Cham para n Eas t
10
Sheohar
Sitam ar hi
Gopalga nj
Madhubani
Supaul
Kishanganj
Ar aria
Muz affa rpur
Siw a n
Darbhanga
8
Sar an
Madhepura
Sam a stipur
Buxar
6
Purnia
Sahar sa
Vais hali
Bhoj pur
12
Khagaria
Begusar ai
Patna
Jehanabad
Bhagalpur
Munger
Nalanda
Ar w al
Sheik hpur a
Rohtas
Katihar
La khisar ai
Kaim ur
4
Aura ngaabad
Jam ui
Naw ada
Banka
Ga ya
2
n=number of sessions monitored Jun10 to May11
VAISHALI
SITAMARHI
SAMASTIPUR
PURNIA
PATNA
NAWADA
NALANDA
MUZAFFARPUR
MADHUBANI
MADHEPURA
KHAGARIA
JEHANABAD
GAYA
DARBHANGA
BHAGALPUR
BEGUSARAI
ARARIA
SAHARSA
1
CHAMPARAN EAST
0
HR Blocks monitored (3 blocks)
HR Blocks not monitored (38 blocks)
Involvement of Govt in RI monitoring:
HR blocks of UP, June ’10 – May ‘11
SHP
Utilisation of Govt manpower for
RI monitoring – still scope for
improvement
BJN
MRT
JPN MRD
GZA
RMP
PIL
BRL
BLS
BAD
ALG
SHA
KAN
MTR
HTR
ETA
FKB
FER
AGR
MAI
ETW
245
203
PI
LI
BH
IT
H
JA
H
A
N
P
U
R
SH
A
R
A
G
N
A
48
G
A
K
AN
U
TA
M
SH
B
U
D
H
BA
R
A
LI
G
O
ZA
EI
LL
Y
RH
D
R
A
G
N
A
M
IR
A
R
R
FA
89
71
60
D
A
H
AB
U
K
AM
R
ZI
AB
H
A
PU
R
AD
U
T
R
G
N
PU
A
AR
M
EE
R
N
U
D
A
SA
H
G
N
A
n=number of sessions monitored Jun10 to May11
BA
AR
T
R
ZA
FF
A
M
U
BA
G
H
A
H
PA
R
O
R
BU
LA
N
D
SH
A
AB
AD
R
BI
JN
AD
R
A
G
M
O
59
48
43
154
140
126
BA
109
99
126
111
A
148
FE
R
168
157
N
A
PH
U
LE
BGT
GBN
340
320
300
280
260
240
220
200
180
160
140
120
100
80
60
40
20
0
JY
O
TI
BA
MZN
HR Blocks monitored (39 blocks)
HR Blocks not monitored (27 blocks)
Way forward
 States are to convene quarterly review meeting of DIOs
on RI with participation from GoI and partners
 Continued RI-polio convergence:
– Migrant & mobile mapping
– Updating RI microplan with polio microplans
– Polio SIA newborn tracking for RI – link with MC tracking
 Intensifying RI monitoring:
– All states to initiate monitoring
– Adapt GoI strategy and tools to local context
– Ensure feedback and use of data for programme decisions
 RIMS to be universally used for RI data uploading and
analysis for local action
Thank you
Additional slides