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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 2012 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

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

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 MO Locations, India 274 locations
8 Labs 339 SMO s 38 SRTLs/ OSA 7 RTL Positions 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 “Field Volunteer”
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
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 Acute Flaccid Paralysis Surveillance Laboratory Network
India Poliovirus Laboratory Network Acute Flaccid Paralysis Surveillance Laboratory Network Kasauli Delhi Lucknow Ahmedabad Kolkata Mumbai Bangalore Chennai 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 14

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 > 1 million children vaccinated
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 2010 2011

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. Rotary UNICEF 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 Translated into key elements of support

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
State Sessions monitored Children surveyed 0 to 11 months 12 to 23 months Bihar 40,990 226,127 107,407 Jharkhand 8,646 35,519 16,913 Karnataka 526 2,136 1,242 Uttar Pradesh 112,859 591,170 244,724 West Bengal 1,426 8,238 5,627 TOTAL 164,447 863,190 375,913 RI monitoring is being expanded to new states in the coming months: Maharashtra, Madhya Pradesh, Kerala, Tamilnadu, Chhattisgarh….. AVE: 8, , , ,110 In 2011, more than 13,000 session sites and 100,000 children monitored per month in priority states of Bihar, UP and Jharkhand 24

25 % Fully immunized children, Uttar Pradesh: January – December 2011
State: UP Total Children (12-23) 244,724 Percent (%) of FI 56% Dist with Minimum Coverage Jaunpur (34) Dist with Maximum Coverage Hamirpur (85) <=20 21-40 41-60 61-80 >80 Not Monitored HR Blocks: UP Total HR Blocks 66 Total Children (12-23) 47,193 Percent (%) of FI 49% Source : RI HtH Monitoring data; children months of age N = No. of children monitored

26 Availability of all vaccines and diluents, Bihar: January – December 2011
tOPV Stock-out N= State: Bihar Session held 37,368 All Vaccine available 23,840 Percent (%) 64 Dist with Minimum value Supaul (29) Dist with Maximum value Kishangabj (89) HR Block: Bihar Total HR blocks 41 Session held 4,232 All Vaccine available 2,927 Proportion 69 <=70 71-80 81-90 >90 Not Monitored Dip in UIP Vaccines & Diluents availability due to : %TOPV availability Month wise : Jul’11 – 69%, Aug’11 -57%, Sep’11 -44%, Oct’11 -52%, Nov’11 -66%, Dec’11-77% . Source: RI monitoring data

27 MCV2 introduction through catch-up campaigns
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 RI: MCV1 > 80% SIA: MCV1 <80% 27

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

29 Serologically confirmed# measles, rubella and mixed outbreaks, 2011 India
Vaccinated Unvaccinated Unknown > 90% of measles cases are found among years old 172 Measles outbreaks confirmed 15 Rubella outbreaks confirmed 13 Mixed outbreaks confirmed ~ 70% of measles cases are unvaccinated * data as on 16th Jan, 2012 # Outbreak confirmation for Measles: ≥ 2 cases IgM positive for measles, Similarly for Rubella @ Surveillance started from June, 2011 in Bihar and July 2011 in Assam and Jharkhand

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)

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