Routine Immunization: R ecent initiatives and progress in high risk areas 23 rd India Expert Advisory Group July, 2011 Dr Pradeep Haldar, MoHFW, GoI

Presentation outline  Status and performance of RI  Efforts to strengthen RI  Continued challenges  Way forward

Routine immunization performance

FI: 61% OPV3: 70.4% DPT3: 71.5% Measles: 74.1% Proportion of Fully immunized children (12 – 23 months) Source: FI: 62% OPV3: 68% DPT3: 68% Measles: 71% CES 2006 CES 2009

Full immunization coverage: CES 2009 vs CES 2006 Delhi: - 14 % Haryana: -3 % Punjab: +8 % Rajasthan: +6 % Bihar: +11 %UP: +4 % MP: - 11 % Only 12 states improved 23 states declined Jharkhand: +7 % Maharastra: +6 % WB: - 5 %

OPV3 coverage: CES 2009 vs CES 2006 Delhi: % Haryana: -7.7 % Punjab: % Rajasthan: +28 % Bihar: +17 % UP: % MP: % 28 states improved 7 states declined Jharkhand: % Maharastra: % WB: +4.2 % Tamilnadu: - 7 % Andhra Pradesh: - 8 %

Full immunization coverage: RI monitoring UP & HR Blocks, June’10 – May’11 Data not available <= 40% 40% to 60% 60% to 80% >= 80% Not monitored UP State State Average = 51% Children months: 207,811 HR Blocks Cumulative Average = 43% Children months: 39,346

Data not available <= 40% 41% to 60% 61% to 80% > 80% Not monitored Bihar State State Average = 66% Children months: 87,474 HR Blocks cumulative Average = 66% Children months: 9,733 Full immunization : RI monitoring Bihar & HR Blocks, June’10 – May’11

Immunization status through RI monitoring: June 2010 – May 2011 *WB data for May & June, ’11 only

Reasons for being partially immunized: June 2010 – May 2011 *WB data for May & June, ’11 only

% RI sessions not held: UP & HR blocks June’10 to May‘11 UP districts – cumulative State Average: 8.5% Sessions not held: 6,613 out of 70,851 > 20% 15% to 20% 10% to 15% < 10% % Sessions not held Source: RI monitoring data, GoUP and NPSP HR Blocks State Average: 8.6% Sessions not Held: 1,196 out of 13,856

Due list available: Bihar & HR blocks June ’10 to May ‘11 Bihar districts Cumulative State average = 42 % 13,294 out of 31,736 < 40% 40% to 60% 61% to 80% > 80% HR Blocks Cumulative HR blocks average = 52 % 1,770 out of 3,386

UP districts Cumulative State Average = 29% Hub-cutter available: 20,234 out of 70,851 Availability of hub-cutter: UP & HR blocks June ’10 to May ‘11 < 40% 40% to 60% 60% to 80% > 80% HR Blocks Average = 20% Hub-cutter available: 2,513 out of 12,660

By ICDS UP districts - cumulative State Average = 34.2% ICDS found present: 24,249 out of 64,653 Source: RI monitoring data, GoUP and NPSP (Apr’10 to Mar’11) By ASHA < 20% 20% to 40% 40% to 60% > 60% Mobilization of beneficiaries at monitored RI session sites, Uttar Pradesh April ’10-March ‘11 UP districts - cumulative State Average = 63.5% ASHA found present: 44,981 out of 64,653

Efforts to strengthen RI

Risk scoring: Karnataka, 2011 Criteria for risk categorisation (Karnataka): A summed scored index is computed on following criteria-  Estimated unimmunized for OPV3 in (coverage assumed at DLHS-3 levels)  WPV importations in previous years since 2002  Bordering WPV importation districts  Clustering of compatibles in the past 3 years  AFP Surveillance quality: surveillance index &  Migratory population (<5 yr children) Suggested additional criteria for states: Measles outbreak data Vacancy status of service providers VDPV data Hard-to-reach areas (Score 7-16) (Score 4-6) (Score 1-3)

Nearest RI session site for each HtH team day area identified Mapping RI sites in Polio SIA plan: Karnataka, 2011 RI session information added to polio SIA microplan Planning for Migrants/ high-risk populations

Percent validated migrant sites included in RI micro plan, India  Emergency Preparedness and Response Plan, 2011 emphasizes mapping migratory / mobile populations to cover them in both SIA & RI  Mapping & validation of migrant sites is ongoing in states  Following mapping, sites are being incorporated in RI plan  Final data is being compiled from UP, Bihar, Maharastra, Gujarat Data being compiled RI microplans should be updated every 6 months to ensure the inclusion of shifting migrant populations

Harmonization of Polio SIA & RI Microplan District: Bulandshahr, Uttar Pradesh Every polio SIA team carries this plan and must inform parents of when and where RI sessions are held SIA component RI component Village visited by SIA team

Brick Kilns VillageDistance from PHC Owner & manager of Kiln ANM 4 monthly drives Special RI session for Brick Kilns in Meerut, UP Special initiatives must to be sustained & incorporated in regular RI microplan

Improving and expanding RI monitoring  In 2011, more than 9,000 session sites and 90,000 children monitored per month in 3 high priority states  RI monitoring expanding to other states: West Bengal, Karnataka, Rajasthan, Punjab, Orissa, Delhi, Assam RI monitoring: June 2010 – May 2011 State Sessions monitored Children surveyed 0 to 11 months12 to 23 months Bihar 36,362200,01587,474 Jharkhand 5,15824,30312,998 UP 83,890500,719170,100 TOTAL 125,410725,037270,572

Use of data for action  RI monitoring systematically shared with District and Block health officials –DTFs pre/post polio SIA –Quarterly DIO review meetings  Jharkhand: –RI Cell meetings held bi-monthly chaired by Director Health –Development Partners attend the meeting –2 DIOs (one from better & one from weaker district) are invited by rotation  Bihar: –At the PHC/Block Level by FVs (every day) –At the District level by SMOs (every week) during District Control Room meetings –At the State Level (both weekly & monthly)  Other states are instituting RI Cell Meetings

Initiatives in cold chain and vaccine management Strengthening  Human Resource –Recruitment of National vaccine Logistics manager –Cold chain Consultants in state of UP, Jharkhand and Orissa –Regional Vaccine Logistics mangers in Orissa –221 state trainers, 762 district trainers and 6586 CC handlers trained  Infrastructure strengthening (Dec ’10 – July ’11) –27 WIC, 8 WIF, 4650 ILR, 6070 DF supplied –300 combo solar equipment supplied to 16 states –Temperature monitoring devices installed in 9 State vaccine stores –National Cold Chain and Vaccine management Resource Center at NIHFW initiated  National Cold chain MIS developed by SHTO-Pune  Reviews and Monitoring –National partners and experts subgroup meeting in Jan 2011 – CCOs review in April 2011

Improving AEFI surveillance  National AEFI guidelines revised in 2010  25,000 copies disseminated to all the states  Training package with revised AEFI guidelines prepared, workshops conducted in several states to date  50,000 copies of SOPs on AEFI operational guidelines for BMOs in print  Post Marketing Surveillance (PMS) network in Maharashtra  Training on causality assessment is scheduled for September/ October

New vaccine introduction  Hepatitis B vaccine expansion –Ongoing in 15 states/UTs –Expansion to all remaining areas  Pentavalent (DPT-HepB-Hib) –Introduction to TN and Kerala  Measles 2 nd dose in RI –Given with 1st DPT booster (16-24 months) in 21 states –MCUP in phases in 14 states –MCV2 in RI for districts that have completed MCUP 6 m back

Continued challenges

Involvement of Govt in RI monitoring: HR blocks of Jharkhand, June ’10 – May ‘11 n=number of sessions monitored HR Blocks monitored (2 Blocks) HR Blocks not monitored (28 Blocks)

Involvement of Govt in RI monitoring: HR blocks of Bihar, June ’10 – May ‘11 n=number of sessions monitored Jun10 to May11 HR Blocks monitored (3 blocks) HR Blocks not monitored (38 blocks)

Involvement of Govt in RI monitoring: HR blocks of UP, June ’10 – May ‘11 HR Blocks monitored (39 blocks) HR Blocks not monitored (27 blocks) Utilisation of Govt manpower for RI monitoring – still scope for improvement n=number of sessions monitored Jun10 to May11

Way forward  States are to convene quarterly review meeting of DIOs on RI with participation from GoI and partners  Continued RI-polio convergence: –Migrant & mobile mapping –Updating RI microplan with polio microplans –Polio SIA newborn tracking for RI – link with MC tracking  Intensifying RI monitoring: –All states to initiate monitoring –Adapt GoI strategy and tools to local context –Ensure feedback and use of data for programme decisions  RIMS to be universally used for RI data uploading and analysis for local action

Thank you

Additional slides