Post on 09-Apr-2018
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Routine Immunization
Dr SD KhapardeDeputy Commissioner (I.D &Imm)
Ministry of Health & Family WelfareGovernment of India
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Province/states: 35
s r c s:
Projected Infants (2007): ~ 27 million
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Child Health Pro rammes
1978- Ex anded Pro ramme of immunization EPI
1984- Universal Immunization Programme (UIP) Forprevention of deaths due to 6 VPDs
1985- Oral Rehydration Therapy Programme for prevention ofdeaths due to diarrhoea
1990- UIP and ORT universalized in all districts
1992- CSSM1997- RCH-1
2005- NRHM and RCH II
The focus is a DistrictDistrict Action planning
ec veness o po cy
coordination at District
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NATIONAL GOALS & MDG
2007 2010 2015Current
Infant MR 45
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IT ATI NAL ANALY I
. .
immunized children
54.5
.
1.5%
42 43.5
20 lac more
fullyimmunized
in one year
5
NFHS 2 NFHS 3 CES 2005 CES 2006
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Immunization coverages increased in traditionally low performing states(NFHS 2-3)
14.6
17.7 18.519.1
20.5 21.222.2
25.7 26.90-9%
10-19%
20-29%
30-39%
NFHS 2 FI data
2.6 2.74.5
6.97.9 8.1
9 9.210
-
50-59%
60-69%
HARYANA
UTTAR
PRADESH
MANIPUR
NAGALAND
RUNACHAL
PRADESH
ORISSA
TRIPURA
AJASTHAN
JAMMU&
KASHMIR
ASSAM
MADHYA
PRADESH
EGHALAYA
ARANCHAL
TBENGAL
BIHAR
SIKKIM
HARKHAND
TTISGARH
Immunization coverages decrease from 4-19.6% in high performing states-(NFHS 2
A M
U
TT
W
E JCH
0MAHARASHTRA MIZORAM
ANDHRA
PRADESH PUNJAB
HIMACHAL
PRADESH TAMIL NADU GUJARAT DELHI KARNATAKA KERALA GOA
--12
-9.2-8 -7.8
-6.6
-5 -4.4-4
-10
NFHS 2 FI data
6-19.6
- . .
-20
50-59%
60-69%70-79%
80-89%
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Immunization s ecific Initiatives
Improving service delivery yr nges roug ou e coun ry
Alternate vaccinators in areas with no ANM and in urban areas
.
Increased services through catch Up rounds
Monthly Village Health & sanitation Days ASHAs for tracking the children and mobilizing the community
Additional ANMs active in Immunization
Session Monitoring in poor performing states
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states -
Hepatitis-B implementation expanded to 10.
Policy decisions undertaken
o ntro uce vacc ne n t e
Second opportunity for measles and measlescampa gns
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STRATEGIES TO INCREASE IMMUNISATION IN
Service delivery improvement
Catchup Campaigns Immunization + other interventions (Vit A, Deworming UP, Bihar, Chhattisgarh,etc) Jharkhand, NE States
External quality assurance mechanism for health workers training Bihar
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
Vaccine and logistics management assessment Orissa
Programme monitoring and supervision
District level CES Bihar, Gujrat
Partner supported monitoring UP, Bihar, Rajasthan,Jharkhand, Orissa
9
Supportive supervision Jharkhand, MP
Divisional level reviews UP
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STRATEGIES TO INCREASE IMMUNISATION IN
Strengthening service delivery
PPP with medical college & youth organizations Karnataka, Mizoram
Establishing support groups Maharashtra
En a ement with PRI to mobilize beneficiaries Kerala
Incentives for health workers Kerala, Karnataka
Operationalization of additional static and mobile clinics Mizoram, Delhi
r va e e ca prac oners nvo vemen s, u sourc ng
immunization to NGOs in underserved areas
a aras ra, oa, era a,
Delhi
Strengthening vaccine, cold chain and logistics management
Emergency vaccine procurement fund, Vaccine stockmanagement systems
Tamil Nadu, Maharashtra
Strengthening programme monitoring and supervisionState task force/operational core group for monitoring Kerala, Karnataka
District level supervision Punjab
10
ose mon tor ng, c uster an nterna eva uat on, an
supportive supervision of low performing areas
era a, arnata a, w t
Medical Colleges), TamilNadu, Maharashtra
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PROGRESS
JE Hep B
Hep B in 10 states JE in endemic districts
11 Districts in 2006 27 districts in 2007 24 districts in 2008
Highest Priority DistrictHigh Risk DistrictsMedium Risk Districts
Validation of elimination of Maternal andneonatal 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 monitorin s stems RIMS introduced in all districts and bein used b
11
nearly 180 districts
Catch-up rounds and Immunization weeks in low performing states
Training of more than 90,000 ANMs and other health workers
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IMM NI ATI N: KEY I E
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 - inade uate health infrastructure,multiple agencies, poor coordination.
12
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IMMUNISATION: WAY FORWARD
1. Introduction of new vaccines based on disease specific mortality and morbidity
HepB-DPT-HiB Pentavalent
2nd Dose of measles and Rubella in select states
JE in remaining 42 districts
2. System Strengthening :
Operationalization of RIMS in all districts.
Activity based funding to strengthen service delivery Alternate vaccine delivery to ensure reach into villages
Strengthening Supportive supervision
Half yearly meeting at State with districts to ensure monitoring. upport or to ass st act ve superv s on
Demand generation through social mobilization
3. Streamline procurement and supply chain
13
4. Capacity Building: Training of the remainder of >100,000 health workers & managers
5. Survey of more states for MNT elimination validation
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CoverageinChildImmunization
15
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1state
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7states
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IMMUNIZATION MONITORING
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State
Block
Session Site
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