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Immunization Update

Immunization Update. DIO/M&E Officers Sensitization & review mtg 18 Aug 2010. Dr OR Goldie Dr Balwinder Singh, DHS Office, Punjab. Presentation outline. EPI Coverage: Where does Punjab stand ? Efforts to strengthen RI Measles second dose Way forward. High priority districts in Punjab.

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Immunization Update

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  1. Immunization Update DIO/M&E Officers Sensitization & review mtg 18 Aug 2010 Dr OR Goldie Dr Balwinder Singh, DHS Office, Punjab

  2. Presentation outline • EPI Coverage: Where does Punjab stand ? • Efforts to strengthen RI • Measles second dose • Way forward

  3. High priority districts in Punjab • Based on composite indicators (CBR, MMR, IMR socio economic & demographic progress) GoI has identified 264 districts in the country to focus & improve • 4/20 districts in Punjab declared high priority • Nawan shahar • Mukatsar • Jalandhar • Faridkot • NRHM asked to tilt PIP for any interventions (if reqd) • Focused monitoring from state task force is planned.

  4. RI coverage Understanding who and where the unvaccinated children are located

  5. What do we mean by a fully immunized child ?? A child that has received BCG + 3 doses of DPT +3 doses of OPV +3 doses of Hep B +Measles before completion of one year of age. All the above doses of vaccine before the first birthday of the child

  6. DLHS III Punjab : Full Immunization coverage DLHS-III (2007-08)

  7. Fully Immunization status DLHS 3 (2007-2008)(most latest evaluated coverage available)

  8. DLHS III : BCG Coverage We do start the program well… DLHS-III (2007-08)

  9. < 10% 10% to 20% 20% to 30% > 30% DLHS3- DROP-OUT (BCG-DPT3 Punjab (distts) Number of BCG-DPT3 Dropout Children (10%) 46350 Slide Source : Punjab state ppt SEPIO mtg 7-9 June 2010

  10. DLHS III : Measles Coverage Punjab (distts) A few districts pull down State immunization coverage… DLHS-III (2007-08)

  11. BCG to measles coverage dropDLHS 3 (2007-2008)

  12. AFP Cases (Age 6 Mths – 5 Yrs) Status of OPV Dose : Polio SIAs - 2009 Punjab Migrant Non- Migrant N=218 N=55 Slide Source : NPSP Data (from CIF)

  13. AFP Cases (Age 6 Mths – 5 Yrs) Status of OPV doses: Routine Immunization – 2009 Migrant PUNJAB Non- Migrant Special RI strategy required for migrant populations (N=215) (N=52) Slide Source : NPSP Data (from CIF) data as on 26th June, 2010

  14. Possible reasons for low access • Not reaching the community (Weak microplans) • Immunization session site not in the microplan • Session site in the microplan but poor service delivery (services not provided by the vaccinator – leave, post vacant, not going to the site) • Hard to reach areas – not being reached • Over reported data. Inadequate data analysis & feedback • Weak monitoring support by district officials. DIO / M&E review mtg,18 Aug 2010

  15. NRHM Initiatives for RI service delivery • Strengthening of monitoring • AEFI surveillance • Strengthening program management capacity • Introduction of Auto Disabled syringes • Introduction of under utilized and new vaccines. DIO / M&E review mtg,18 Aug 2010

  16. Efforts to strengthen routine immunization DIO / M&E review mtg,18 Aug 2010

  17. Not Started < 30% 30 % - 50% 50 % -80% > 80% Immunization Training of Medical Officers • Immunization Handbook, Fac. Guide and Training kits developed in 2008. • TOTs conducted for 1500 trainers from all states during 2009. • MO-Training started and ~11500 out of 62000 (18%) MOs trained. • Slow / No progress in 22 states. • Monitoring needs to be strengthened. Punjab As on 1 June10 DIO / M&E review mtg,18 Aug 2010

  18. < 30% 30% - 50 % 50 % - 80 % > 80 % Completed Immunization training of Health workers • Immunization Handbook and Facilitator Guide developed in 2006 • ToTs held in 2007 • HW Trainings started in 2007-08 • ~175,000 out of 220,000 (79%) HWs trained. • Performance Assessment of HW-Training conducted in 40 districts across 7 states during 2009. Punjab As on 1 June 10 DIO / M&E review mtg,18 Aug 2010

  19. Immunization trg :Scenario-2009-10 DIO / M&E review mtg,18 Aug 2010 Slide Source : Punjab state ppt SEPIO mtg 7-9 June 2010

  20. Microplanning and child tracking • Improve RI micro-planning by using existing polio micro-plans to: • Strengthen linkages with pulse polio teams: • Polio microplan to include RI session site information (where, when and by whom) • Teams to share information during H-t-H vaccination • Pulse polio vaccinator training to include key messages on routine immunization • Use of pulse polio newborn information (if being collected) to follow up on RI doses • Name based child tracking

  21. Improved monitoring to identify programme gaps • GoI RI monitoring system revised in 2009 • Started in in Bihar, Jharkhand and UP • Shortly starting in Rajasthan, Maharashtra, N Delhi, MP, Gujarat. • Data outputs • Session site: • Availability of manpower and logistics • Reasons for session not held • Safe injection practices and waste disposal • Household (community) monitoring • RI coverage and gaps in community • Reasons for left-outs and drop-outs

  22. Introduction of Measles 2nd Dose into RI Corneal scarring, causing blindness Pneumonia and Diarrhea Encephalitis

  23. Measles Mortality Reduction 47 UNICEF / WHO Priority Countries December, 2008 Nationwide second measles opportunity introduced (46) No second opportunity introduced (1) DIO / M&E review mtg,18 Aug 2010

  24. Secretary health letter Punjab- 2nd dose Measles

  25. 2nd dose Of MeaslesMeasles Mortality Reduction Strategies for India • National Technical Advisory Group on Immunization (NTAGI) has recommended • States with MCV1 coverage <80%: Second opportunity through measles catch-up campaigns in 9 mo-10 yrs age group • States with MCV1 coverage >80% second dose (MCV2) through routine immunization • Applying the cut-off of 80% MCV1 evaluated coverage (DLHS-3) • 14 states which qualify for catch-up campaign • 21 states which qualify for MCV2 through UIP • 4 States/UTs viz. Delhi, Goa, Sikkim & Poducherry already introduced 2nd dose in RI DIO / M&E review mtg,18 Aug 2010

  26. 2nd opportunity of Measles vaccine: State specific Delivery strategies Punjab States <90% Measles Coverage 2nd Dose of RI (>80%) Catch-up Campaigns (<80%) DIO / M&E review mtg,18 Aug 2010 * DLHS3 data Not Available

  27. Requirements for Measles Control with 2nd dose Measles in RI Achieve 1st dose coverage (at 9-12 months) of >90-95% Also achieve 2nd dose coverage (at 16-24 months) of >90-95% Sustain high coverage Backed by good measles surveillance system DIO / M&E review mtg,18 Aug 2010

  28. DPT Booster coverage in States proposed for RI Punjab DIO / M&E review mtg,18 Aug 2010 Source: CES, 2006

  29. Times of India Factors Affecting Introduction of Measles 2nd Dose • The key factor is a well functioning Routine Immunization Programme. • Some of factors for low coverage are: • Inadequate access- Lack of outreach services • High Dropout- Weak tracking system • Human resources- Poorly trained or untrained staff • Lack of supervision • Poor monitoring and reporting systems • Weak community demand DIO / M&E review mtg,18 Aug 2010

  30. Challenges Managing competing priorities Linking polio efforts with RI activities Specific RI messages by vaccinators during polio SIAs Use of newborn tracking data Reaching unreached in urban and peri-urban areas Strengthen inter-agency coordination Improving the reporting and utilization of RI data Improving social mobilization and demand generation for immunization DIO / M&E review mtg,18 Aug 2010

  31. Way forward from here…. Microplans Update fixed day, fixed site microplans (Mamta Diwas) Wed/ Sat to be immunization day Update and operationalize RI micro-plans . Monitor fund utilization / program performance Scale-up revised RI session and house-to-house monitoring targeting high risk areas Increase district involvement in RI monitoring & review mech. Before start of 2nd dose Measles - Improve DPT booster (16-24 mths) HW and data handlers trainings Data handlers proposed for Sept-Oct 2010. Distt Cold chain store incharge training proposed Sept 2010.

  32. Issues in Pulse Polio Expenditure Report 2008-09 GOI is repeatedly asking Punjab to reconcile and produce desired information

  33. List of EPI Reports to be forwarded from District

  34. Thank you for your time !! DIO / M&E review mtg,18 Aug 2010

  35. Additional slides

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