Transcript Document

Emergency Preparedness and Response Planning
– risk analysis, actions taken in HR areas &
preparedness status for mop ups :
West Bengal
24th Meeting of India Expert Advisory Group on Polio
New Delhi 15-16 March 2012
Dr Rashmi Kamal,IAS
Addl State Mission Director, NRHM &
Jt Secy to Govt of West Bengal
Outline of the presentation
• Risk assessment
• Sustaining high population immunity in HRAs
– SIAs
– Routine Immunization
• Status of AFP Surveillance
• Preparedness for responding to importations
Risk assessment
Risk assessment in West Bengal
Location of wild polio cases
(2002 to 2011)
WPV cases
HR districts
HR districts
Sub district risk assessment
(based on past epidemiology & performance)
Howrah
9 districts
36 blocks/ urban areas
HR Gram Panchayats/ wards
identified in each district
Identification of High Risk Areas, WB
Migrant sites
= 10 Migrant site
~ 5,200 Migrant sites
High risk areas in
settled population
= 10 HR site
~ 10,122 HR areas in settled population
Progress on Emergency Preparedness
& Response Plan
• EPRG constituted – Two EPRG
meetings held since December
to assess progress
Dr Soumitra Roy
Dr Kalyan Mukherjee
Dr J K Mehta
• RRT members selected and
trained
Dr Amabasu Das
Dr Dipankar Maji
• High Risk districts allocated to
RRT members
Dr S S Basu
Dr Prasanta Biswas
Dr Pramit Ghosh
• EPRP prepared and
implemented
• Sustaining high population immunity
in HRAs
–SIAs
–Routine Immunization
Intensive Government Oversight
• Regular video conferences by Principal Secretary for polio SIAs
with DMs /Mayors & Chair persons of urban bodies and Health /
ICDS officials
• Senior state officials assigned to HR districts for monitoring
• District, sub divisional and block task forces to review
preparedness & supervise operations
• Daily evening review meetings at districts & block PHCs
District Magistrate Howrah monitoring
activity
Urban area task force meeting in
progress at Maheshtala
Intensification of underserved strategy
Polio advocacy at Urs
•Endorsement from religious
institutions
•Compilation of appeals for teams
working in HRAs
Sensitization of Hajis
•Announcement from mosques
•Advocacy in religious gatherings
•Inauguration by religious leaders
Rally by madarsa students
•Sensitization of Hajis before and
after return from Haj pilgrimage
•Rally by Madarsa students
Special initiatives to reduce missed children in HR districts of
West Bengal
Health camps : Murshidabad
120
Clinic booths: Howrah
Impact of health camps : Khargram
Sick children vaccinated at clinic booths
100
5000
80
4800
60
123 clinic
booths
4600
40
4400
20
4200
0
Dec-10 Jan 27
2011
Feb 5
2011
Feb 27 Mar 27 Apr 24 May 29 June 26 Aug 28 Sept 25 Nov 13 Jan 15
2011
2011
2011 2011 2011
2011 2011
2011
2012
Remaining houses with reluctance to vaccination
4000
May 2011
June 2011
Aug 2011
Sept 2011
Children vaccinated
Nov 2011
Jan 2012
Partner supported Social Mobilization / Advocacy
• 1600 Field volunteers and supervisors from 23 NGOs deployed by
Unicef in 6 HR district
• Social Mapping is being done in HR areas for planning
appropriate area specific intervention
• Sensitization meetings with all PRI members and urban councilors
– 24 Pgs South
– Howrah
• SIA inauguration and advocacy by Cricketers
– Kolkata Knight Riders
– West Indies team
Special immunization plans for Congregations
•
•
•
•
Ganga sagar Mela
Urs in different Mazars
Eid congregations
Other religious festivals
Vaccination at Ganga sagar mela
Vaccination at Urs
~ 20,000 children
vaccinated at various
congregations in 2012
Social mobilization to overcome refusals
Number of houses with reluctance to vaccination: 2011 vs 2012
North Bengal districts
1800
1200
600
0
UttarDinajpur
Maldah
Murshidabad Bardhaman
Feb-11
Birbhum
Feb-12
South Bengal districts
12000
8000
4000
0
Howrah
Kolkata
Feb-11
Feb-12
24 Pgs South
Vaccination of children in transit
> 500,000 children
vaccinated in transit
during each campaign
in the state
Children vaccinated at transit points: 2011 vs 2012
30000
20000
10000
0
Murshidabad
How rah
Kolkata
Feb-11
Feb-12
24 Pgs North
24 Pgs South
Other special initiatives to improve coverage
•Targeted X-P conversion : Doctors from
Medical colleges visit reluctant families (X
houses) with medicines immediately after the
round.
•Distribution of Motivational items from booths
Medical college doctors visiting an X house
•ICDS feeding on booth day
Trend in remaining X houses – Kolkata & Murshidabad
10000
9000
8000
7000
KOLKATA
6000
5000
4000
MURSHIDABAD
3000
2000
1000
0
Apr-10
Jul-10
Aug-10
Jan-11
Feb-11
Mar-11 Apr-May- 29-May11
11
Jun-11
Aug-11
Sep-11
Nov-11
Jan-12
Outcome : Reduction in remaining X houses
ICDS feeding on booth day
12
Northern districts, West Bengal
Percent unvaccinated children
End-of-round survey
10
Percent
8
6
4
2
0
Mar-10 Jun-10 Jul-10 Aug-10 Sep-10 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Aug-11 Sep-11 Nov-11 Jan-12 Feb-12
N=
1,371 4,490
2,996 4,020 3,515 6,556 7,574
7,686 7,065 10,320 6,461 6,651 7,996 6,890 8,924
12
Southern districts, West Bengal
10
Percent
8
6
4
2
0
N=
mid Feb-11 end Feb-11 Mar-11
Apr-11
7,525 6,665 8,193 11,933
May-11
11,027
Jun-11
Aug-11
11,787 12,602
Sep-11
11,343
Nov-11
Jan-12
11,816 10,919
Feb-12
17,450
Strengthening Routine immunization
• Merger with SIA microplans in process
– Identification of new RI/VHND sites through
SIA microplan
– Incorporating RI session plan in SIA
microplan
– Identification of newborns during SIA and
their inclusion in RI
• Training of MOs and Cold chain handlers
• Quarterly review of RI performance at
state level
RI sessions planned vs held – West Bengal
May 2011 – January 2012
100%
5%
5%
4%
3%
3%
3%
0%
4%
4%
95%
95%
96%
97%
97%
97%
100%
96%
96%
90%
80%
70%
60%
50%
40%
Reason for session not held
(N=57)
30%
20%
10%
0%
May'11(193)
Jun (114)
Jul (329)
Aug (222)
Sep (58)
Session held
Oct (115)
Nov (99)
Dec (296)
Jan'12(156)
Session not held
State N = 1,582
0%
ANM and Vaccine/Logistics absent
26%
49%
7%
26%
49%
ANM present without Vaccine/Logistics
7%
Vaccine/Logistics available but ANM absent
18%
Other reason
Reason not known
Source: Session RI Monitoring data (May 2011-January 2012)
18%
Immunization status of monitored children,
West Bengal, May 2011 - January 2012
100%
8%
5%
3%
3%
24%
23%
13%
90%
80%
27%
1%
28%
2%
1%
3%
4%
19%
21%
22%
22%
Reasons for children not being fully
immunized
70%
10%
60%
4%
50%
86%
40%
30%
65%
67%
73%
74%
37%
79%
78%
75%
74%
37%
Not aware of need
20%
10%
10%
2%
0%
May'11(611) Jun (450)
Jul (1,259)
Fully Immunized
Aug (898)
Sep (248)
Oct (438)
Partially Immunized
Nov (393)
Dec (1,228) Jan'12 (698)
Unimmunized
N= 1,629
Fear of AEFI
Unaware of session site
Beneficiary not available
Programmatic Reason
Other Reasons
State N (children 12 to 23 months of age)= 6,223
• Status of AFP Surveillance
Status of AFP Surveillance - 2011
Non-polio AFP rate
Stool collection rate
87%
7.18
AFP Surveillance is
sensitive enough to
pick any transmission
in the state
India
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP case
* data as on 3 March 2012
• Preparedness for responding
to importations
Preparedness for responding to importation
• Prepared to hold first mop up within 7 days of detection of
transmission, as demonstrated in the past.
Mop up conducted
Vaccine & other
logistics reach blocks
•National level partners meeting
•Media plan operationalized
•Vaccine arrived in district
•State & District Task Force Meetings
•14 additional SMOs arrive in districts
•IEC plan developed
•Marker pens & other logistics procured
•Field Investigation (NCDC/NPSP/UNICEF)
•National Technical Group Meeting
•Decision on mop up
Chief Minister &
Chief Secretary WB
informed by GoI
WPV
notified
Day 0
7 Feb 2011
Day 1
Day 2
Day 3
Day 4
Day5
Day 6
13 Feb 2011
Preparedness for responding to importation
• Logistics plan
• Running rate contract exists for marker pens – supplies
expected to districts within 7 days of placing order
• Printing of formats have been decentralized to districts – may
be done in 5 days
• Vaccine distribution to block PHCs (including hard to reach
areas) within 4 days of receipt at state
• Communication plan
• Running rate contract exists for printing of banners/posters and
delivery to districts
• UNICEF is ready with the prototype IEC materials, will be
updated in minimum time
Preparedness for responding to importation
• Cold chain
• Adequate vaccine carriers available in High risk blocks and
urban areas
• Repair of cold chain equipments has been decentralized to
district level to minimize delay
• Microplanning
• Microplans of all high priority planning units are reviewed and
rationalized before each round
• Manpower & training
• Training of all high priority teams will be conducted within 6
days of notification
Preparedness for responding to importation
• EPRG & RRT
– EPRG is meeting from time to time to assess ongoing
activities for increasing / sustaining population immunity
and maintaining sensitive AFP surveillance
– can be activated within 24 hours
• District, Sub division and Block / Urban area task
force
– will meet as soon as campaign is decided.
Highest level of
political commitment
to keep West Bengal
polio free
Thank You