1. STRATEGIES AND PROGRESS
IMMUNIZATION

2. SITUATIONAL ANALYSIS
Evaluated coverage of 43.5% by NFHS 3 and 62.4% by UNICEF CES fully immunized children
20 lac more children fully immunized in one year

3. Immunization coverages increased in traditionally low performing states (NFHS 2-3)
Immunization coverages decrease from % in high performing states-(NFHS 2 to 3)

4. GENERIC INTERVENTIONS
Introduction of new vaccines based on disease specific mortality and morbidity indicators – JE, Hep B
System Strengthening :
Activity based funding to strengthen service delivery
Alternate vaccine delivery to ensure reach into villages
Alternate Vaccinators to ensure sessions are held
ASHA/Link workers used for Social Mobilization to ensure demand creation in community.
Strengthening supportive supervision by support for POL
Half yearly meeting at State with districts to ensure monitoring.
Capacity Building: Trainings at all levels for all aspects of immunization service delivery
Monitoring and supervision of the programme at service delivery level
Demand generation: Social Mobilization
Injection Safety: AD syringes and waste disposal guidelines for immunization sessions

5. STRATEGIES TO INCREASE IMMUNISATION IN LOW PERFORMING STATES
Service delivery improvement
Catchup Campaigns – Immunization + other interventions (Vit A, Deworming etc)
UP, Bihar, Chhattisgarh, Jharkhand, NE States
External quality assurance mechanism for health workers training
Bihar
Quality Assurance Network for training of Health Workers
Rajasthan
Outsourcing immunizations to NGOs in underserved areas
Arunachal Pradesh
Incentives to health worker/ families
Jharkhand, Orissa
Improving vaccine, cold chain and logistics management
Mobile Cold-Chain Workshop in Rajasthan
Rajasthan
Annual Maintenance Contract for cold chain
Bihar
Vaccine and logistics management assessment
Orissa
Programme monitoring and supervision
District level CES
Bihar, Gujrat
Partner supported monitoring
UP, Bihar, Rajasthan, Jharkhand, Orissa
Supportive supervision
Jharkhand, MP
Divisional level reviews UP

6. STRATEGIES TO INCREASE IMMUNISATION IN HIGH PERFORMING STATES
Strengthening service delivery
PPP with medical college & youth organizations
Karnataka, Mizoram
Establishing support groups
Maharashtra
Engagement with PRI to mobilize beneficiaries
Kerala
Incentives for health workers
Kerala, Karnataka
Operationalization of additional static and mobile clinics
Mizoram, Delhi
Private Medical practitioners involvements, Outsourcing immunization to NGOs in underserved areas
Maharashtra, Goa, Kerala, Delhi
Strengthening vaccine, cold chain and logistics management
Emergency vaccine procurement fund, Vaccine stock management systems
Tamil Nadu, Maharashtra
Strengthening programme monitoring and supervision
State task force/operational core group for monitoring
Kerala, Karnataka
District level supervision
Punjab
Close monitoring, cluster and internal evaluation, and supportive supervision of low performing areas
Kerala, Karnataka, AP (with Medical Colleges), Tamil Nadu, Maharashtra

7. PROGRESS JE Hep B New vaccines introduced in UIP Hep B in 10 states
Highest Priority District
High Risk Districts
Medium Risk Districts JE
Hep B
New vaccines introduced in UIP
Hep B in 10 states
JE in endemic districts
11 Districts in 2006
27 districts in 2007
24 districts in 2008
Validation of elimination of Maternal and neonatal tetanus in
15 States -Andhra Pradesh, Kerala, Tamil Nadu, Karnataka, Maharashtra, West Bengal, Haryana, Goa, Sikkim, Punjab, Chandigarh, Pondicherry, Lakshadweep, HP, and Gujarat
Routine Immunization monitoring systems (RIMS) introduced in all districts and being used by nearly 180 districts
Catch-up rounds and Immunization weeks in low performing states
Training of more than 90,000 ANMs and other health workers

8. IMMUNISATION: KEY ISSUES
Shortage of vaccines and cold chain equipment
Inconsistent delivery of vaccines to outreach session sites.
Operational issues :
Immunization sessions not being held regularly
HR shortages at all levels
Inadequate mobility of health workers and supervisors at district & state levels
Urban areas - inadequate health infrastructure, multiple agencies, poor coordination.

9. IMMUNISATION: WAY FORWARD
Introduction of new vaccines based on disease specific mortality and morbidity indicators/ NTAGI inputs
HepB-DPT-HiB Pentavalent
2nd Dose of measles and Rubella in select states
JE in remaining 42 districts
System Strengthening :
Operationalization of RIMS in all districts.
Activity based funding to strengthen service delivery
Alternate vaccine delivery to ensure reach into villages
Alternate Vaccinators to ensure sessions are held
Strengthening Supportive supervision
Half yearly meeting at State with districts to ensure monitoring.
Support for POL to assist active supervision
Demand generation through social mobilization
3. Streamline procurement and supply chain
4. Capacity Building: Training of the remainder of >100,000 health workers & managers
5. Survey of more states for MNT elimination validation
6. Mid term evaluation of the program against the milestones stated in the multi year plan