Emergency Preparedness and Response Planning – risk analysis, actions taken in HR areas & preparedness status for mop ups : West Bengal 24 th Meeting of India Expert Advisory Group on Polio New Delhi March 2012 Dr Rashmi Kamal,IAS Addl State Mission Director, NRHM & Jt Secy to Govt of West Bengal

Outline of the presentation Risk assessment Sustaining high population immunity in HRAs –SIAs –Routine Immunization Status of AFP Surveillance Preparedness for responding to importations

Risk assessment

Location of wild polio cases (2002 to 2011) WPV cases HR districts Risk assessment in West Bengal HR districts

HR Gram Panchayats/ wards identified in each district Sub district risk assessment (based on past epidemiology & performance) 9 districts36 blocks/ urban areas Howrah

Identification of High Risk Areas, WB ~ 5,200 Migrant sites Migrant sites High risk areas in settled population ~ 10,122 HR areas in settled population = 10 Migrant site = 10 HR site

Progress on Emergency Preparedness & Response Plan EPRG constituted – Two EPRG meetings held since December to assess progress RRT members selected and trained High Risk districts allocated to RRT members EPRP prepared and implemented Dr Soumitra Roy Dr Kalyan Mukherjee Dr Amabasu Das Dr J K Mehta Dr Prasanta Biswas Dr Dipankar Maji Dr Pramit Ghosh Dr S S Basu

Sustaining high population immunity in HRAs –SIAs –Routine Immunization

Intensive Government Oversight Regular video conferences by Principal Secretary for polio SIAs with DMs /Mayors & Chair persons of urban bodies and Health / ICDS officials Senior state officials assigned to HR districts for monitoring District, sub divisional and block task forces to review preparedness & supervise operations Daily evening review meetings at districts & block PHCs District Magistrate Howrah monitoring activity Urban area task force meeting in progress at Maheshtala

Intensification of underserved strategy Endorsement from religious institutions Compilation of appeals for teams working in HRAs Announcement from mosques Advocacy in religious gatherings Inauguration by religious leaders Sensitization of Hajis before and after return from Haj pilgrimage Rally by Madarsa students Polio advocacy at Urs Sensitization of Hajis Rally by madarsa students

Special initiatives to reduce missed children in HR districts of West Bengal Health camps : Murshidabad Impact of health camps : Khargram Remaining houses with reluctance to vaccination Clinic booths: Howrah Sick children vaccinated at clinic booths 123 clinic booths

Partner supported Social Mobilization / Advocacy 1600 Field volunteers and supervisors from 23 NGOs deployed by Unicef in 6 HR district Social Mapping is being done in HR areas for planning appropriate area specific intervention Sensitization meetings with all PRI members and urban councilors –24 Pgs South –Howrah SIA inauguration and advocacy by Cricketers –Kolkata Knight Riders –West Indies team

Ganga sagar Mela Urs in different Mazars Eid congregations Other religious festivals Special immunization plans for Congregations Vaccination at Ganga sagar mela Vaccination at Urs ~ 20,000 children vaccinated at various congregations in 2012

Social mobilization to overcome refusals Number of houses with reluctance to vaccination: 2011 vs 2012 South Bengal districts North Bengal districts

Vaccination of children in transit Children vaccinated at transit points: 2011 vs 2012 > 500,000 children vaccinated in transit during each campaign in the state

Other special initiatives to improve coverage Targeted X-P conversion : Doctors from Medical colleges visit reluctant families (X houses) with medicines immediately after the round. Distribution of Motivational items from booths ICDS feeding on booth day Medical college doctors visiting an X house ICDS feeding on booth day Trend in remaining X houses – Kolkata & Murshidabad Outcome : Reduction in remaining X houses

Percent unvaccinated children End-of-round survey Southern districts, West Bengal Percent N= 7,5256,6658,19311,933 N=6,5567,5747,686 11,027 7,065 Northern districts, West Bengal 1,3714,4902,9964,0203,515 11,787 10,320 6,461 6,651 7,996 12,60211,34311,81610,91917,450 6,8908,924

Strengthening Routine immunization Merger with SIA microplans in process –Identification of new RI/VHND sites through SIA microplan –Incorporating RI session plan in SIA microplan –Identification of newborns during SIA and their inclusion in RI Training of MOs and Cold chain handlers Quarterly review of RI performance at state level

RI sessions planned vs held – West Bengal May 2011 – January 2012 Reason for session not held (N=57) Source: Session RI Monitoring data (May 2011-January 2012) State N = 1,582

Immunization status of monitored children, West Bengal, May January 2012 Reasons for children not being fully immunized N= 1,629 State N (children 12 to 23 months of age)= 6,223 Not aware of need Fear of AEFI Unaware of session site Beneficiary not available Programmatic Reason Other Reasons

Status of AFP Surveillance

% Non-polio AFP rateStool collection rate Status of AFP Surveillance * data as on 3 March 2012 AFP Surveillance is sensitive enough to pick any transmission in the state

Preparedness for responding to importations

Preparedness for responding to importation Prepared to hold first mop up within 7 days of detection of transmission, as demonstrated in the past. Day 6 Mop up conducted Day 4 National level partners meeting Media plan operationalized Vaccine arrived in district Day 3 State & District Task Force Meetings 14 additional SMOs arrive in districts IEC plan developed Marker pens & other logistics procured Day 2 Field Investigation (NCDC/NPSP/UNICEF) National Technical Group Meeting Decision on mop up Day 1 Chief Minister & Chief Secretary WB informed by GoI Day 0 WPV notified Day5 Vaccine & other logistics reach blocks 7 Feb Feb 2011

Preparedness for responding to importation Logistics plan Running rate contract exists for marker pens – supplies expected to districts within 7 days of placing order Printing of formats have been decentralized to districts – may be done in 5 days Vaccine distribution to block PHCs (including hard to reach areas) within 4 days of receipt at state Communication plan Running rate contract exists for printing of banners/posters and delivery to districts UNICEF is ready with the prototype IEC materials, will be updated in minimum time

Preparedness for responding to importation Cold chain Adequate vaccine carriers available in High risk blocks and urban areas Repair of cold chain equipments has been decentralized to district level to minimize delay Microplanning Microplans of all high priority planning units are reviewed and rationalized before each round Manpower & training Training of all high priority teams will be conducted within 6 days of notification

Preparedness for responding to importation EPRG & RRT –EPRG is meeting from time to time to assess ongoing activities for increasing / sustaining population immunity and maintaining sensitive AFP surveillance –can be activated within 24 hours District, Sub division and Block / Urban area task force –will meet as soon as campaign is decided.

Highest level of political commitment to keep West Bengal polio free Thank You