Intensification of Routine Immunization(IRI) in India

Coverage Improvement Plans for 2012-13

SEPIOSwasthya Bhavan

GoWB

• August 2011 - High Level Ministerial Meeting (HLMM) on “Intensification of Routine Immunization”.

• September 2011 - All SEAR countries endorsed 2012 as the “Year of Intensification of Routine Immunization”.

• GoI has declared 2012-13 as “Year of Intensification of Routine Immunization”.

• Strategy for IRI discussed within Imm. Division of Ministry, with Partners and also during focused review meetings held with priority states.

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

UTTAR PRADESH

KARNATAKA

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.HARYANA

KERALA

UTTARANCHAL

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

FI: 61%• OPV3: 70.4%• DPT3: 71.5%• Measles: 74.1%

Proportion of Fully immunized (FI) children

DLHS-2Below 4040 to 5050 to 6060 to 70Above 70

India State

FI: 62%• OPV3: 68%• DPT3: 68%• Measles: 71%

CES 2006CES 2006 CES 2009CES 2009

FI coverage: CES 2009 vs CES 2006

-30

-20

-10

0

10

20

30

AN AP AC AS BI CH CG DN DD DL GO GU HA HP JK JH KA KE LD MP MH MN ME MZ NA OR PD PB RJ SI TN TR UP UA WB

Delhi: - 14 %Haryana: -3 %

Punjab: +8 %

Rajasthan: +6 %

Bihar: +11 % UP: +4 %

MP: - 11 %

12 low performing states improved, However, 17 states declined

Jharkhand: +7 %

Maharastra: +6 %

WB: - 5 %

Assam: +20 %

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KAR NATAKA

UTTAR PRADESH

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.HARYANA

KER ALA

UTTARANC HAL

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

DELHI

D&N HAVELI

PONDICHERRY

LAKSHADW EEP

0 – 10%

10 – 20% 20 - 28%

Source: DLHS 3 2007-08

System weakness in tracking and following children:Percentage difference between BCG and MCV1 coverage

Prioritization: • DTP3 : important indicator • > 90% DPT3 at national level• > 80% at least, at district level

• CES-2009(India):– FIC%:61%– DPT3%: 71%– 14 states under national average.– Others(includes WB): Low performing pockets

for focused attention.

• Prioritization of districts also based on – % of fully immunized children (as per DLHS-3 survey).

• in WB: 6 districts identified for special focus 2yrs back. – Districts with < 50% FI children prioritized for focused

interventions to improve coverage. • In WB lowest FIC% of 54% (DLHS-3) was UDP.

• Prioritization of blocks in all districts based on risk analysis

Purpose of IRI

• To improve immunization coverage in all the districts of the country.

• State and district wise realistic targets to improve immunization coverage.

D. Strategies for IRI

Proposed activities1. National and State level advocacy2. Strengthening communication and social mobilization3. Regular program reviews at all levels4. Development of Coverage Improvement Plans5. Institutional Capacity Building6. Vaccine and logistics management7. Cold chain strengthening and maintenance8. Teeka Express9. Immunization Weeks10.Strengthening RI monitoring and supervision11.Strengthening partnership with all stakeholders12. Institutionalizing AEFI and VPD surveillance13.Operational Research studies planned during 2012-13

National and State level advocacy

Proposed actions:• 2012-13 as the “Year of Intensification of RI”.

• Interdepartmental coordination. • State and District level Task force

• State level launch of the Year of IRI.

Strengthening communication and social mobilization • Focus on components and strategies for addressing

– left outs, – drop outs and– increasing community participation in immunization.

• Social mobilization activities :activate wider networks and groups to include:

– ICDS,– Education,– Panchayati Raj Institutions,– Professional bodies, – Women Self Help Group, – NGOs etc.

Regular program reviews at all levels

Review meetings – – to track progress, identify problems and analyze

issues and address them. – quarterly at national/state level– and monthly at district and block levels

Development of Coverage Improvement Plans

• States and districts- to conduct risk analysis to identify and prioritize

high risk blocks,- gap analysis to identify bottlenecks in HRA,

- review and update the micro-plans of these areas and

- strengthen monitoring of session sites and community.

• Institutional Capacity Building : Vacancy etc

• Vaccine and logistics/CC managementEVM guideline & post EVM follow up

• Planning and strengthening AVD

Linkage with rational micro-plan

• Strengthening partnership with all stakeholdersICDS, PRI, Urban local bodies, NGO/SHG, Education dept. Unicef, WHO-NPSP, Professional bodies etc.

Strengthening RI monitoring and supervision

• All levels• Use standard monitoring formats.• Immediate feedback & record in Inspection book.• Compilation, convergence and Analysis of Data - from RI monitoring, - HMIS, - surveillance and - coverage surveys

Institutionalizing AEFI and VPD surveillance

• Present AEFI/VPD reporting status poor.• District AEFI committee to be operational.• Capacity building of AEFI committee members will be

undertaken.• DMCHO should be the nodal person.• Timely report of minor & serious AEFI including FIR, PIR

& DIR .• DMCHO would be held responsible personally for

AEFI/VPD surveillance

Operational Research studies planned during 2012-13

1. Evaluation of MO training in immunization;

2. Cold chain assessments;

3. Studies on vaccine freezing and

4. Injection safety studies

G. Indicators to be monitored at each level

District Opening Balance as on

01.04.2011

Release Expenditures Refund to State

HQ

Closing Balance as on

31.03.12

% of Exp

Bankura 8510342 1365966 5472324 0 4403984 55.41

Birbhum 4231934 4298991 4428646 0 4102279 51.91

Burdwan 7425758 9325489 4633056 0 12118191 27.66

Cooch Behar 3341892 3899054 3513469 0 3727477 48.52

Dakshin Dinajpur 3086269 2021732 2983082 0 2124919 58.40

Darjeeling 3769466 94001 718103 0 3145364 18.59

Hoohgly 6799026 10975099 4046517 0 13727608 22.77

Howrah 5173267 5574703 2575496 0 8172474 23.96

Jalpaiguri 5013342 4571702 3239656 0 6345388 33.80

Kolkata 0 1054521 358184 27900 668437 33.97

Malda 4995504 3837213 1143647 0 7689070 12.95

Murshidabad 8456624 6428354 7531952 0 7353026 50.60

Nadia 5870861 3693203 3232666 0 6331398 33.80

North 24 Pgs 13078896 4826482 4935126 0 12970252 27.56

Paschim Medinipur 10082909 4105521 10105900 0 4082530 71.23

Purba Medinipur 8144388 4063575 2685606 0 9522357 22.00

Purulia 2719249 6787407 4602941 0 4903715 48.42

Souuth 24 Pgs 13005613 8853237 5766205 0 16092645 26.38

Uttar Dinajpur 2876085 3906084 3889201 0 2892968 57.34

Darjeeling (DGHC) 551266 0 0 0 551266 0.00

Grand Total 117132691 89682334 75861777 27900 130925348 36.68

DPT3 target (increase of 15% from DLHS-3)State target >80%

Can we do this?

A declining trend in the state

Thank you