1. Immunization Services DR. KANUPRIYA CHATURVEDI DR.S.K. CHATURVEDI

2. Objectives Describe what comprises routine immunization services –Components –Activities within components –Role of a Plan of Action

3. 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

4. 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

5. Routine services: Ensuring that all children receive the WHO recommended vaccination schedule AgeEPI visit VaccineHepatitis B - options Option1Option2Option3 Birth0BCG (OPV)Hep B 6 weeks1OPV1, DTP1, Hib1 Hep B1 monovalent or in combo DTP-Hep B1 10 weeks2OPV2, DTP2, Hib2 Hep B2 monovalent or in combo Hep B2 (monovalent) DTP-Hep B2 14 weeks3OPV3, DTP3, Hib3 Hep B3 monovalent or in combo Hep B3 (monovalent) DTP-Hep B3 9-12 months 4Measles (Rubella)

6. Service delivery Vaccine Supply & Quality Logistics Advocacy & Communication Surveillance WHO’s Approach: Components of routine immunization systems

7. Components glued together by: Planning Management Coordination Supervision Training Financing Components & “glue” exist at national, provincial, district & local level…. Cascading effect

8. Vaccine Supply & Quality Activities…………….. National level..Policy on 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

9. Logistics 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

10. Surveillance National level Policy Standards & guidelines Case definitions Disease, coverage, adverse events monitoring for nation Data management systems Improving data quality Laboratory Services Activities……. Local level Disease, adverse events monitoring Vaccine supply Vaccination info management Register Tally sheets

11. Surveillance Activities……. 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

12. Advocacy & Communication National Level Technical documents & guidelines Capacity building Partnerships with media Social Mobilization Activities……… Local Level Partnerships with the community Social Mobilization

13. Service delivery National Level Supporting local level Local level Vaccination activities Activities…………

14. Service delivery Delivery modes - Fixed sites - Outreach - Mobile services - Pulse campaigns - Campaigns Activities………… Each mode has its own advantages & disadvantages, its own indications for use, $$ considerations No single mode is appropriate for all circumstances/diseases

15. 5 key components of EPI The “glue” 1. Planning 2. Management 3. Coordination 4. Supervision 5. Training 6. Financing Activities to get the job done National provincial district health facility

16. 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

17. 5 key components of EPI Plans of Action (POA) 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

18. Plans of Action Different formats in different countries, regions Should contain –For each component Goals/objectives Key activities Timeline Cost Responsibility –For each type of glue Key activities Timeline Cost

19. District Plans of Action Important for efficient service delivery Similar to national, but with emphasis on –High risk areas –High risk populations –Special activities, e.g., outreach, mobile services –Social promotion –Supervision –Local funding – sources and channels

20. 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