Transcript Immunization Services DR. KANUPRIYA CHATURVEDI DR .S.K. CHATURVEDI Objectives • Describe what comprises routine immunization services – Components – Activities within components – Role of a Plan.

Immunization Services
DR. KANUPRIYA CHATURVEDI
DR .S.K. CHATURVEDI
Objectives
• Describe what comprises routine
immunization services
– Components
– Activities within components
– Role of a Plan of Action
What is “routine immunization”
• No standard definition
– Hard to define
– Means different things to different people
– Regional and agency differences
• The sum of human and logistical
activities/events to ensure the regular
delivery & uptake of vaccines & the
monitoring of their positive & adverse
impact
What is “routine immunization”
• Implies the “regular” delivery, i.e.,
known schedule, of EPI vaccines
– Fixed posts &/or outreach
• Part of a larger plan
• Not time limited
• Goal to provide needed vaccines to
all eligible persons and to
successive birth cohorts
Routine services: Ensuring that all
children receive the WHO
recommended vaccination schedule
Age
EPI
visit
Vaccine
Hepatitis B - options
Option1
Option2
Option3
Hep B
Hep B
Birth
0
BCG (OPV)
6 weeks
1
OPV1, DTP1,
Hib1
Hep B1
OPV2, DTP2,
Hib2
Hep B2
Hep B2
monovalent
or in combo
(monovalent)
OPV3, DTP3,
Hib3
Hep B3
Hep B3
monovalent
or in combo
(monovalent)
10 weeks
14 weeks
9-12
months
2
3
4
Measles
(Rubella)
DTP-Hep B1
monovalent
or in combo
DTP-Hep B2
DTP-Hep B3
WHO’s Approach:
Components of routine immunization systems
Vaccine Supply &
Quality
Logistics
Service delivery
Surveillance
Advocacy &
Communication
Components glued together by:
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Planning
Management
Coordination
Supervision
Training
Financing
Components & “glue” exist at national,
provincial, district & local level….
Cascading effect
Activities……………..
Vaccine Supply &
National level
..Policy on
Quality
•Procurement
•Quality
•Local production
•National Regulatory Authority
•Strategies for international procurement
•Timely vaccine ordering
•Financial security for purchase
•Supply planning (VVMs, vaccines, syringes)
Lower Levels
..Ordering & supply planning
..Getting vaccine & supplies to the lower
levels for administration
Activities………
National Level
.Policy statement & implementation
• Injection safety
• Health care waste disposal
• Cold chain
• National central cold store
• Vaccine/supply management
• Transport management
•Supplies, supervision
•Lower levels
• Vaccine/supply management
• Cold chain
•Transport
• Getting the vaccine to the people
Logistics
Activities…….
Surveillance
National level
•Policy
•Standards & guidelines
•Case definitions
•Disease, coverage, adverse
events monitoring for nation
•Data management systems
•Improving data quality
•Laboratory Services
Local level
•Disease, adverse
events monitoring
•Vaccine supply
•Vaccination info management
•Register
•Tally sheets
Activities…….
Surveillance
Types of surveillance in EPI
•Routine
•Generally passive, provides
idea on trends, impact of
program
•Special routine – AFP,
fever/rash
•Sentinel
•Complements weak routine
for key diseases
•Early warning for outbreaks
•Special Surveys
•Set baseline disease burden
Activities………
National Level
•Technical documents & guidelines
•Capacity building
•Partnerships with media
•Social Mobilization
Local Level
•Partnerships with the community
•Social Mobilization
Advocacy &
Communication
Activities…………
National Level
• Supporting local level
Local level
• Vaccination activities
Service delivery
Activities…………
Delivery modes
- Fixed sites
- Outreach
- Mobile services
- Pulse campaigns
- Campaigns
Service delivery
Each mode has its own
advantages & disadvantages, its
own indications for use,
$$ considerations
No single mode is appropriate
for all circumstances/diseases
The “glue”
5 key components of EPI
1. Planning
2. Management
3. Coordination
4. Supervision
5. Training
6. Financing
Activities to get the job done
National
provincial
district
health facility
Monitoring Program Performance
• Key indicators (an example)
– Coverage levels
• Fully vaccinated child, individual antigens
– Access to services
• BCG and/or DTP1 coverage
– Tracking & follow up activities
• Dropout - DTP1 to Measles
• Median age of receipt of vaccines
– Missed opportunities
– Cold chain quality
• Vaccines at correct temperature
– Provider knowledge/practices
Plans of Action (POA)
5 key components of EPI
1. Planning
2. Management
3. Coordination
4. Supervision
5. Training
POAs.. ..Detailed & costed activities to ensure adequate
implementation of key components and the “glue”
… 5 year & 1 year plan
… National, provincial, district level plans
Must be a living document used to monitor routine
immunization services
Plans of Action
• Different formats in different countries,
regions
• Should contain
– For each component
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Goals/objectives
Key activities
Timeline
Cost
Responsibility
– For each type of glue
• Key activities
• Timeline
• Cost
District Plans of Action
• Important for efficient service delivery
• Similar to national, but with emphasis on
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High risk areas
High risk populations
Special activities, e.g., outreach, mobile services
Social promotion
Supervision
Local funding – sources and channels
Inter-agency Coordinating Committee (ICC)
• Composition
– Example: MOH, WHO, UNICEF, USAID, Rotary,
NGOs, etc
– Varies by country
• Promotes collaboration & cooperation
• Prevents
– Duplication of activities
– Ensures that all activities/components/”glue”
are covered and will be addressed in the POA