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NPSP – Structure and Function

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  1. NPSP – Structure and Function National Polio Surveillance Project - India

  2. Past to the Present • 1997 • NPSP created as a WHO-GoI collaboration • 57 Surveillance Medial Officers (SMOs) for Acute Flaccid Paralysis (AFP) surveillance • 2012 • 339 SMOs • AFP surveillance, Supplementary Immunization Activities (SIA) assistance, Research, Routine Immunization (RI) and measles

  3. Structure of NPSP • National Polio Surveillance Unit (Delhi) • Field staff (regional team leaders, sub regional team leaders, SMOs, Administrative Assistants, drivers) • Field Volunteers and External Monitors

  4. The National Polio Surveillance Unit • the country HQ of the project • provides • technical support to the MOHFW • technical, administrative and logistic support to the field staff • support to the lab network

  5. WHO INDIA NATIONAL SURVEILLANCE PROJECT WR – India Nata Menabde Finance & Accounts Team Routine Immunization & Measles Team Deputy Project Manager UIP Stephen Sosler HR & Personnel Team Deputy Project Manager Operations Virginia Swezy Project Manager Hamid Jafari 1. Surveillance 2. SIA 3. Data 4. Research Polio Team Senior Technical Advisor Sunil Bahl Admin. Team Regional Team Leaders ( 7 ) Field Units RAFFPs ( 10 ) Planning Officer Kudzai Chisewe

  6. The Field Offices • led by the Surveillance Medical Officer (SMO) • one administrative assistant and one driver • typically located in government premises • holder of imprest accounts for managing expenses

  7. NPSP Field Staff • Currently over 384 medical officers (SMOs plus Regional, Sub-Regional Team Leaders and Officers on Special Assignment) • Average no of districts covered by one SMO now: • UP and Bihar: 1 per district • West Bengal/Jharkhand: 1 to 3 districts • Rest of India: ~ 5 districts

  8. (7 Regions)

  9. Positions RTL ’ s 7 SRTLs/ 38 OSA ’ s SMO ’ s 339 Labs 8 MO Locations, India 274 locations • Average no of districts covered by one SMO now: • UP and Bihar: 1 per district • West Bengal/Jharkhand: 1 to 3 districts • Rest of India: ~ 5 districts

  10. WHO / NPSP Structure National Polio Surveillance Unit National Regional Team leader Regions (1-7 states) Sub-regional Team Leader Sub-regions Surveillance Medical Officer District (<1-11 districts) “Field Volunteer” Blocks, in HR areas

  11. Main Functions • High quality Acute Flaccid Paralysis (AFP) surveillance • Technical support to mass polio vaccinations campaigns - supplementary immunization activities (SIAs) • Research activities for refinement of polio vaccination strategies • Monitoring SIAs and Routine Immunization • Measles Surveillance and SIAs

  12. Acute Flaccid Paralysis Surveillance Reporting Network N=35,824 • Reporting network consists of govt. and private hospitals, health centers, medical practitioners, traditional healers, temples etc. • More than 151,000 visits made to these reporting sites for active case searches by the SMOs during 2011 • Nearly 2000 training workshops on surveillance conducted by SMOs in 2011 – 70,000 people trained Reporting site *Data as on 10 February 2012

  13. Kasauli Delhi Lucknow Ahmedabad Kolkata Mumbai Bangalore Chennai India Poliovirus Laboratory Network Acute Flaccid Paralysis Surveillance Laboratory Network National labs Upgraded national labs Reference lab

  14. Polio SIAs in India – a massive effort National Immunization Days (NIDs) • Children vaccinated: 172 million • Houses visited: 220 million • Vaccinators deployed: 2.3 million • Supervisors: 150,000

  15. Support to polio immunization campaigns • Developing guidelines • Refining strategies for reaching children during campaigns – newborns, resistant families, migrants, hard to reach areas etc. • Building capacity of government staff and vaccinators through ongoing training • Monitoring campaigns to support corrective actions

  16. Some recent initiatives based on epidemiological analysis provided to the programme > 1 million children vaccinated (April to December 2011) Overcoming challenges of access in Kosi river area of Bihar to reach the unreached Mitigating the risk of importations Identifying, vaccinating and tracking all new borns for polio vaccination Multipronged strategy for 107 high risk blocks in UP & Bihar

  17. Monitoring SIAs • Independent monitoring system • 3500 monitors across India (2000 of these in UP and Bihar) • SMOs and field volunteers of WHO-NPSP • Monitors hired locally by SMOs for the duration of the campaign • WHO staff • Scope of monitoring in UP and Bihar: • 420,000 houses checked (1% of total houses) each round • 11,000 vaccination teams checked (8% of total teams) each round • 680,000 children checked (1% of total children) each round

  18. Monitoring SIAs • Daily feedback to supervisors and block medical officers at block and to CMO/DM at district during evening meetings • Rapid survey at the end of the round to assess the overall coverage in the area • Data generated through WHO-NPSP monitoring is used by the state, district and sub-district governments to improve quality of polio campaigns

  19. Coverage in field huts of Kosi area, Bihar % unimmunized children in field huts in Kosi riverine area ~ 3,000 children checked each round Source of data : NPSP monitoring 2008 2009 2011 2010

  20. Supporting Research for Polio Eradication • Vaccine immunogenicity studies- Best vaccines • Sero-prevalence studies- Population immunity levels • Mucosal immunity study- Immunity levels & vaccines to boost it • Product development (IPV studies, vaccine delivery techniques) • Operational researches planned • Informed program decisions: • Switch from tOPVs to the use of mOPVs and bOPVs • Monitor the seroprevalence against polio in the HRAs • Strategize for polio “end game” and post eradication approach (Type of vaccines, RI schedule)

  21. GoI Polio Partners • W.H.O. • Surveillance • Operations • Monitoring • Rotary • Advocacy • Communication • Fundraising • UNICEF • Vaccine • Communication • Monitoring

  22. Expanded NPSP support to GoI and States National-level Policy and strategic formulation, standards and norms Development of national guidelines – measles outbreak surveillance, RI monitoring, Hepatitis B and Hib-pentavalent vaccine introduction, AEFI surveillance, measles catch-up campaigns Participation in National Technical Advisory Group on Immunization meetings Immunization curriculum development for Medical Officers and Health Workers Operations research in key programme areas State and district level Harmonization of polio and RI microplans Expansion of measles outbreak surveillance and laboratory network Support for VPD surveillance introduction in select states Program monitoring, data management, analysis and feedback New vaccine introduction support and training

  23. Improving and expanding RI monitoring • Methodology revised in 2009 • Initially rolled out to UP, Bihar and Jharkhand • Expanded to West Bengal, Karnataka, Rajasthan • Data outputs • Session site: • Availability of manpower and logistics • Reasons for session not held • Safe injection practices and waste disposal • Household surveys • RI coverage and gaps in community • Reasons for left-outs and drop-outs

  24. RI monitoring: January – December 2011 In 2011, more than 13,000 session sites and 100,000 children monitored per month in priority states of Bihar, UP and Jharkhand

  25. % Fully immunized children, Uttar Pradesh:January – December 2011 N= Source : RI HtH Monitoring data; children 12-23 months of age N = No. of children monitored

  26. Availability of all vaccines and diluents, Bihar:January – December 2011 tOPV Stock-out N= Source: RI monitoring data

  27. MCV2 introduction through catch-up campaigns SIA: MCV1 <80% RI: MCV1 > 80% • 14 states, children 9m – 14 yrs • Approximately 130 million • Role of WHO NPSP: • Strategy formulation, guideline and training module development • Pre-campaign planning, training, establishment of AEFI management networks • External monitors for RCA monitoring and feedback

  28. 2006 2007 2009 2010 2011 Reporting of Clinical Measles cases, linked with AFP weekly reporting in these states; Weekly aggregate data shared with IDSP NPSP assisted measles surveillance One state level lab strengthened in each state for Lab testing for measles and rubella IgM. Surveillanceinitiated

  29. Serologically confirmed# measles, rubella and mixed outbreaks, 2011 India 200 outbreaks > 90% of measles cases are found among 1 - 10 years old ~ 70% of measles cases are unvaccinated # Outbreak confirmation for Measles: 2011 ≥ 2 cases IgM positive for measles, Similarly for Rubella @ Surveillance started from June, 2011 in Bihar and July 2011 in Assam and Jharkhand * data as on 16th Jan, 2012

  30. Challenges • Ensuring that the message of polio eradication remains on the top of the agenda (we are not done yet!) • Trying to meet the increasing expectations to be involved in other areas; • Field MOs trying to balance all the priorities at the field level (increasing activities and overall work of already overloaded MOs); • Managing a level of uncertainty and anxiety from the field in the context of transition; • Maintaining donor funding over next 5 years (through certification and post eradication phase)