Trainers Guide for Immunization Handbook for Health Workers...2 | Facilitators’ Guide:...

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 1

FACILITATORS’ GUIDE:

Immunization Guide for Block Programme Managers

Ministry of Health & Family WelfareGovernment of India

New Delhi

2012

2 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)

Published by: Department of Health and Family Welfare, Ministry of Health and Family Welfare Government of India, 2012

Address: Nirman Bhawan, Maulana Azad Road, New Delhi, 110011, India

Email: [email protected]: www.mohfw.nic.in

Your suggestions for improving or enhancing the Facilitators’ Guide for the Immunization Guide for Block Programme Managers are always welcome and encouraged.


Table of Contents

Introduction ...............................................................................................................................................................................7

Immunization training of health workers: an Overview ............................................................................................8

Programme for Immunization Training of Health Workers .......................................................................................9

Role and Responsibilities of a Facilitator ...................................................................................................................... 11

Training preparation check-list ........................................................................................................................................ 12

List of Equipment and Supplies required during training ...................................................................................... 14

Conducting Training Sessions .......................................................................................................................................... 16

Annex 1: Registration Form for Participants ................................................................................................................ 34

Annex 2: Sample Certifi cate .............................................................................................................................................. 35

Annex 3: Training Workshop Reporting Format ......................................................................................................... 36

Annex 4: Checklist for monitoring Quality of Immunization Training ............................................................... 37

Handout 1: Pre and post test Questionnaire ............................................................................................................... 38

Handout 2: Agenda for Immunization Training of Health Workers ..................................................................... 40

Handout 3: VPD Quiz ............................................................................................................................................................ 41

Handout 4: Temperature Chart......................................................................................................................................... 42

Handout 5: To calculate downtime, response time and sickness rate .............................................................. 43

Handout 6: Priority issue of vaccines to session sites ............................................................................................... 44

Handout 7: Sub-center Micro plan .................................................................................................................................. 45

Handout 8: Monitoring Chart ........................................................................................................................................... 46

Handout 9: Supervision checklists ................................................................................................................................. 47

Handout 10: Feedback from Participants Form.......................................................................................................... 49

Answers to Handout 1: Pre and Post Test Questionnaire ........................................................................................ 50

Answers to Handout 5: Sub-center Micro plan .......................................................................................................... 50

Answers to Handout 6: Coverage Monitoring Chart ................................................................................................ 50

Answers to Handout 7 ......................................................................................................................................................... 51

Answers to Handout 8 ......................................................................................................................................................... 52


Abbreviations

Abbreviation Extended form

ADS Auto disable syringes

AEFI Adverse Eff ects Following Immunization

ANC Antenatal checkup

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AVD Alternate Vaccine Delivery

AWW Anganwadi worker

CES Coverage Evaluation Survey

CHC Community Health Center

DH District Hospital

DHQ District headquarter

DLHS District Level Household Survey

DIO District Immunization Offi cers

DPMU District Program Management Unit

DPT Diphtheria Pertussis Tetanus Vaccine

DT Diphtheria Tetanus

GoI Government of India

HMIS Health Management Information System

ILR Ice-Lined Refrigerator

JE Japanese Encephalitis

MCH Maternal and Child Health

MCHN Maternal and Child Health and Nutrition

MCP Mother and Child Protection

MCV Measles containing Vaccine

M& E Monitoring and Evaluation

NFHS National Family Health Survey

NRHM National Rural Health Mission

OPV Oral Polio Vaccine

ORS Oral Rehydration Solution

PCM Paracetamol

PHC Primary Health Center

PNC Postnatal checkup


Abbreviation Extended form

RI Routine Immunization

SC Sub center

SC/ST Scheduled Caste/Tribe

SDH Sub divisional Hospital

TT Tetanus Toxoid Vaccine

VHND Village Health and Nutrition Day

VPD Vaccine preventable disease

VVM Vaccine Vial Monitor

WHO World Health Organization

UIP Universal Immunization Programme

VVM Vaccine Vial Monitor


The purpose of this Facilitators’ Guide is to assist the facilitators in conducting the training for Block Programme Managers to improve their immunization skills and practices. This guide is meant to accompany Immunization Guide for Block Programme Managers. The training aims to improve the knowledge and skills of Block Programme Managers in managing immunization program at block level. The training has two components: classroom training and fi eld visit to session site.

As a facilitator, you must read through the Immunization Guide for Block Programme Managers and the Facilitator’s Guide in great detail before conducting the training.

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 7Introduction


Duration 3 days

Participants All managers (non-clinical) posted at PHC/Block/Sub-district

Batch size Approximately 20 Block Programme Managers per batch

Facilitators District Immunization Offi cer /District Programme Manager / ANMTC trainer / Pediatrician/ CHC Medical Offi cer

Facilitators per batch 4 facilitators. Each facilitates a group of 5 participants throughout the training course.

Venue District Hospital and ANM Training Center (ANMTC)/ First Referral Unit/ Community Health Center (CHC)

Methodology Group discussions, Exercises, Demonstration and Return Demonstration, Hands-on-practice, Role play, Field Visit, Film show

8 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Immunization training of Block Health Managers: Overview


Time Sessions Methods

Day-I0900-0930 Registration

0930-0945 Pre test Brainstorming

0945-1000 Introduction of participants Interaction

1000-1015 Participants’ expectations and Training overview Brainstorming, Discussion

1015-1100 Importance of Immunization and Responsibilities of Block Programme Managers in RI

Discussion, Brainstorming,

1100-1115 Tea

1115-1215 Vaccines and Immunization Program VPD Quiz, Discussion

1215-1315 National Immunization Schedule and FAQs Reading Handbook and Discussion

1315-1415 Lunch

1415-1615 Cold chain and Logistics management Demonstration, Discussion, Reading Handbook and Guide

1615-1630 Tea

1630-1715 Ensuring Safe injections Demonstration, practice

1715-1730 Evaluation of the day

Day-II0900-0915 Warm up and Re cap Discussion

0915-1100 Micro planning for Immunization Group discussion, exercise

1100-1115 Tea Lecture discussion

1115-1200 Records, Reports and use of data for action Group Discussion and presentations

1200-1315 Monitoring and Supervision

1315-1400 Lunch

1400-1415 Monitoring and Supervision continued Brainstorming, reading guide

1415-1545 Advocacy and Communication Discussion, reading handbook

1545-1600 Tea

1600-1730 Immunization Program Review and Preparing Block Action Plan (unit7)

1730-1800 Film on Immunization

1800-1815 Preparation for the fi eld visit and Evaluation of the day

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 9Programme for Immunization Training of Block Programme Managers


Time Sessions Methods

Day-III0900-1300 Field visit and debriefi ng from Field visit Field visit, Mock review meeting

1300-1400 Lunch

1400-1600 Workplan preparation and presentation Group work, presentation

1600-1615 Tea

1615-1645 Post-test and Participants’ feedback Brainstorming

1645-1700 Distribution of certifi cates and conclusion Discussion


To eff ectively carry out your roles, positive attitude is required at all times. As a facilitator:

You Guide:

• Explain the learning objectives of each session.

• Encourage participants to ask questions and make comments.

• Clarify any information that the participants fi nd diffi cult to understand.

• Look available, interested and ready to help

• Use examples from your own experience, and ask HWs for examples from their experience.

• Lead group activities, such as group discussions, exercises, and role plays, to ensure that learning objectives are met.

• Model good communication skills, speak clearly and vary the pitch and speed of your voice.

• Give guidance and feedback as needed during sessions.

• Ensure every aspect is considered

You Motivate:

• Praise / Compliment each participant for comments, participation and contributions

• Always summarize, or ask a participant to summarize, what was discussed in the exercise

• Demonstrate enthusiasm for subject matter, the course and for participants’ work

• Prepare in advance and use appropriate energizers

• Encourage participants to explore how the skills they are learning can help them to improve their immunization work.

• Keep the group on track

• Keep the atmosphere constructive

• Ensure each contribution is given fair consideration

You Manage:

• Ensure that all participants have access to supplies and materials when they need them.

• Make sure that there are no major obstacles to learning (such as too much noise or not enough light or insuffi cient work space).

• Monitor the progress of each participant.

• Record conclusions and agreements

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 11Role and Responsibilities of a Facilitator


Two Months before

• Select a training venue which has

• Classroom to accommodate 24 people; well ventilated with power back-up.

• Facilities for stay and food of the participants.

• Select facilitators who have been trained at state level and are available for full duration of the training (4 facilitators for a batch of 20 participants for 3 days)

• Prepare a training calendar after taking into consideration the following:

• The training load

• Availability of training days

• Availability of training venues

• Availability of facilitators

• Other training courses for Health Workers

• Select participants from compiled list of Block Programme Managers to be trained.

• Prepare and send a letter of invitation from the CMO to the Medical offi cers of PHCs/CHCs, to depute the Block Programme Managers during the scheduled dates for training at the specifi c venue.

• Make arrangements for facilitators’ and participants’ travel and TA/DA by ensuring the availability of funds.

• Arrange for all equipment and supplies required during training as mentioned in next section.

• Prepare and print adequate participant certifi cates (see Annex 2)

One Month before

• Call a meeting of facilitators to fi nalize the agenda and decide on role of each facilitator.

• Select 4 fi eld sites to be visited on third day of training which should be immunization session day.

One Week before

• Get confi rmation of the fi eld visit sites from the concerned offi cials.

• Arrange for vehicles / transport for the fi eld visit.

• Ensure that all the training supplies are available.

• Identify support staff that will assist in the training.

One Day before

• Check that the classroom is prepared. Arrange the seating around 4 round tables. Test that mike, LCD/OHP, generator are in good working order.

• Put up the workshop banner in the classroom

• Confi rm lodging facilities and tea/meal service during the training based on the number of

12 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Training preparation check-list


participants.

• Decide time and place for the group photograph on fi rst day and confi rm arrangements with the photographer

• Meet the facilitators and review the schedule for the fi rst day, including the time and site of registration, opening ceremony, and the scheduled training course sessions.

Day 1 and 2 of the training

• Conduct training course. Take a group photograph before the end of fi rst day.

• Observe the facilitators to ensure that they follow the training steps, allotted time and methodologies as mentioned in the facilitators’ guide.

• Conduct the facilitator meeting daily and give specifi c and constructive feedback to facilitators, as needed. Review sessions scheduled for next day.

• Confi rm the scheduled fi eld visit and reconfi rm travel arrangements for all groups.

• Prepare training certifi cates by writing the names of the participants who complete the training.

Day 3 of the training

• Conduct the fi eld visit

• Conduct the training course

• Take care of all remaining administrative work.

• Supervise the packing up of all training materials. Check that the training course location is left clean and in good condition.

One week after

• Write the report of training course (Annex 3).

Six months after

• Conduct on-the-job performance evaluation of trainees (Annex 5)


FURNITURE

Large table (for training materials)

4 tables (each for 5-6 persons)

24 chairs

Wall Clock (for timing sessions)

EQUIPMENT

LCD Projector and White Screen

Blackboard /white board

Flipchart stand

Photocopier

Mike/Microphone

SUPPLIES

Whiteboard Markers/ Chalk

Flipchart pad

Adhesive Tape

FACILITATOR MATERIALS

Facilitators’ Guide

CD with fi lm (Immunization)

Registration Form (Annex 1)

VIPP cards/ Post card size chart paper pieces

Copies of all Handouts

Cold chain equipment

• vaccine carrier

• ice packs

Other Equipment

• AD syringes (0.1 ml and 0.5 ml)

• Disposable Syringes (5ml) for reconstitution.

• Hub Cutters

14 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)List of Equipment and Supplies required during training


• Black and Red plastic bags

Vaccines

• Vaccine vials with VVM in diff erent stages

Records and Reports

• Immunization card

• Tracking bag

• Immunization / MCH registers

• Due list of benefi ciaries cum Tally sheet

• Temperature chart

• HMIS Monthly Report format (fi lled)

Certifi cates (Annex 2)

PARTICIPANT MATERIALS (one for each participant)

Folder/Bag containing:

• Immunization Handbook for HWs

• Immunization Guide for Block Programme Managers

• Pencil

• Pen

• Notepad

• Name tag

• TA/DA form

• Handouts

Group photograph

Certifi cate

TRAINING MATERIALS (one for each of 4 groups)

Calculators

Erasers

Sharpeners


DAY-1

1. Registration

Session objective:

• Prepare list of participants and their contact details.

• Distribute training materials to the participants

Time: 30 minutes

Training Aids:

• Immunization Guide for block programme managers

• Participants’ stationery

• Registration Form (Annex 1)

Steps:

• Distribute copies of the Immunization Handbook and Guide to all participants.

• Provide bag/folder, writing pad /notebook, pen, pencil, etc to all participants.

• Register participants (Annex 1)

• Make note of the number of nominated participants who have not attended.

2. Pre testing

Session objective:

• Test participants’ knowledge prior to the training

• Identify areas that require greater attention during the training

Time: 15 minutes

Method:

Brainstorming

Training Aids:

• Pre-test questionnaires (Handout 1)

16 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Conducting Training Sessions


Steps:

• Distribute Pre test questionnaires (Handout 1) to be fi lled by the participants.

• Collect all the fi lled-in tests at the end of the stipulated 15 minutes.

• Assign a facilitator to check the tests and calculate the percentage of correct answers to each question by the end of the day.

• Display the scoring chart in the classroom.

• Identify weak areas (with less than 50% correct responses) which need to be emphasized during the training.

3. Introduction of Participants

Session objective:

• Introduce participants and facilitators to each other.

• Create a friendly and comfortable environment in the classroom.

Time: 15 minutes

Method:

Interaction

Steps:

• Facilitators introduce themselves.

• Ask each participant to introduce briefl y by saying her/his name, place of work and years of experience. Also, one personal thing such as a hobby or interest they have outside of work.

4. Participants’ expectations and Training overview

Session objectives:

• Identify the expectations of the participants.

• Explain the agenda and methodology of training.

• Write ground rules for the training on a fl ip chart.

Time: 15 minutes

Method:

Brainstorming

Discussion

Ground Rules of Training

• Active participation and informality are encouraged

• All points of view are acceptable and respected

• Start on time and end on time

• Mobile phones in silent mode

• Respect the direction of the course coordinator

• No-one will monopolize the training

• No cross-talking between participants

• Do not interrupt others when they speak. Allow them to complete


Training Aids:

• VIPP cards/post card sized chart papers cut into rectangles.

• Agenda (Handout 2).

• Flipcharts and Marker pens.

Steps:

• Distribute 2 blank cards to each participant.

• Ask the participants to write on each card, one topic they expect to learn during this training.

• Collect and read aloud each card one by one. If the topic will be covered in the training, paste the card on a Flipchart under “Topics Covered”. If not, paste it under “Topics Not Covered” and explain why.

• Explain the agenda and methodology of training.

• Ask participants to suggest ground rules for the training and write on a fl ip chart.

5. Importance of Immunization and Responsibilities of Block Programme Managers in Routine Immunization

Learning objectives: By the end of the session, participants will be able to:

• Explain why immunization is important and reasons for low immunization coverage

• List the responsibilities of Block Programme Managers in Immunization

Time: 45 minutes

Method:

Discussion

Brainstorming

Training Aids:

• Immunization Handbook (Unit 1)

• Immunization Guide for Block Programme Managers (Unit 1)

Steps:

• Introduce the hand books and their contents.

• Discuss the importance of full immunization

• Inform district/ local data on Immunization coverage.

“Responsibilities of BPMs in RI”

• Microplanning

• Preparing Action plan

• Cold chain and logistics management

• Monitoring and Supervision


• Ask reasons for low immunization coverage and list on fl ip chart.

• Ask participants the following questions and write the responses on a fl ip chart

• Which health functionaries are involved in immunization?

• What are their major roles and responsibilities in immunization?

• What role you can play in managing immunization program?

• Facilitator groups the responses under various heads as planning etc. and adds more from the handbooks if missed.

6. Vaccines and Immunization Programme

Learning objectives:

By the end of the session, participants will be able to:

• List diseases that are preventable by immunization under the UIP.

• Describe their mode of spread and how they can be recognized and prevented

• Describe how diff erent types of vaccines work to provide immunity

• Explain the various initiatives undertaken by Government of India to strengthen the Immunization Programme

Time: 60 minutes

Method:

Discussion

VPD Quiz

Training Aids:


• VPD Quiz (Handout 3)

Steps:

• Ask the participants to name the VPDs. (5 mts)

• Distribute the Handout 3 with suspect case defi nition of each VPD written in column-A and Mode of spread in column C and ask each participant to fi ll in the columns B and D for Name of VPD and Name of Vaccine. (20 mts)

• Summarize about each VPD to the participants (5 mts)

• Ask participants in small groups to read unit 2 of Immunization guide for health managers. (10 mts)

• Ask one trainee from each group to present in the plenary and discuss (20 mts)


7. National Immunization Schedule and FAQs



• List vaccines, timings, dosage and routes in the National Immunization Schedule.

• Answer frequently asked questions regarding the National Immunization Schedule.

Time: 60 minutes

Method:

Reading Immunization guide for BPM

Discussion

Training Aids:

• Immunization Handbook (Unit 3)

Steps:

• Form 4 groups of 5 participants and one facilitator in each group.

• In each group, open unit-3 of the handbook and ask the participants to read (one at a time) the National Immunization Schedule and FAQs.

• Explain to clarify their doubts and ensure that each participant thoroughly understands the answer to each FAQ.

8. Cold chain and Logistics Management



• Defi ne and describe the importance of Cold chain.

• Describe which vaccines are sensitive to heat /light and freezing.

• Guide and supervise the Vaccine and Cold Chain Handler at the ILR points to properly store and transport vaccines and other related logistics

• Monitor preventive maintenance of colds chain equipment

• Ensure regular, adequate and proper supply of vaccines and other related logistics to ILR points

• Supervise and ensure systematic distribution of vaccine and logistics to all sites during immunization session days.

Time: 120 minutes


Method:

Brainstorming

Discussion

Demonstration

Reading Handbook

Training Aids:


• Vaccine vials with VVM

• Hard frozen Ice-packs to demonstrate conditioning of ice-packs

• Vaccine carriers

• Handouts 4, 5 and 6

Steps:

• Ask participants to defi ne cold chain system and explain the responsibilities of cold chain handler and vaccinator in cold chain maintenance. (Imm guide)-10 mts

• Ask the participants to open the HW handbook unit-4 and discuss Table 4.1 on the Vaccine sensitivities – 10 mts

• Organize 4 sites for demonstration in the class room, each with one facilitator. Ask each group to visit all sites by rotation to see and discuss (40 mts):

• Demonstrate the vaccine vials with VVM on the label and cap of the vials. Ask them to explain the discard point. Demonstrate how to check T series and HepB vials for freezing. Demonstrate ice-packs, conditioning of ice-packs, vaccine carrier and packing of vaccine carrier.

• Demonstrate correct placement of vaccines in the ILR; ice-packs in DF and reading the temperature in the ILR correctly. (Imm. Guide)

• Explain stock management through Min-Max inventory control chart. (Imm. Guide)

• Explain elements of well maintained cold chain room (Imm. Guide)

• Show the Temperature monitoring chart (Handout 4) and discuss the importance of twice daily recording of temperature and power breakdowns (even on holidays and weekends) along with signatures. (10 mts)

• Ask participants in small groups to read from Immunization Guide the Inventorization of equipment, preventive maintenance, Repair and Planning for emergencies. One trainee from each group to present in the plenary (20 mts)

• Ask participants to complete

• Handout 5 to calculate downtime, response time and sickness rate (10 mts).

• Handout 6 on priority issue of vaccines to session sites (10 mts)

• Summarize the session and inform participants regarding observation points during fi eld visit. (10 mts)


9. Ensuring Safe Injections



• Explain the importance and advantages of safe injection practices.

• Demonstrate how to use AD Syringes.

• Demonstrate safe disposal of immunization waste

Time: 45 minutes

Method:

Brainstorming

Demonstration

Return demonstration

Discussion

Training Aids:

• Immunization Guide for BPM (Unit 5)

• AD syringes (0.1 ml and 0.5 ml)

• Reconstitution (mixing) Syringes (5ml)

• Hub Cutters

• Black and Red plastic bags

Steps:

• Ask participants about the risks due to unsafe injections and ways to improve injection safety including advantages of AD syringe. List their responses on a fl ip chart.

• In each small group, ask a participant to demonstrate how to use an AD syringe.

• Show a syringe to the participants and ask them to point out the hub of the syringe. Emphasize that the hub-cutter is intended to cut the plastic hub of the syringe, rather than the needle. Show all the diff erent parts of the hub-cutter to the participants.

• Invite another participant to demonstrate how to use a hub-cutter. Explain each step as the participant demonstrates. Allow participants to practice cutting syringes using the hub-cutter.

• Ask participants to explain the Guidelines for Waste Disposal.


10. Evaluation of the day

Time: 45 minutes

Instructions

• Ask participants to provide feedback about all the sessions conducted that day. This could be done using the following method.

• Make some chairs positive and some chairs negative (either by grouping the chairs together or by sticking a + or a – sign on them). Participants must choose a chair to sit on and then say either a positive or negative thing about the day depending on the sign on the chair they choose. They can also suggest which ways training could be improved

• Remember negative comments are useful. Evaluations are not to make trainers “feel better or feel good about them”. They are an opportunity to improve quality.


DAY-2

11. Warm Up—Clap!

Time: 10 minutes

Steps:

• Seat /stand all participants in a circle. Tell the person on your right to say aloud “one”. The person to his or her right then says the next number, .i.e. “two.

• In this manner all members count out loud around the circle. However, each person whose number is a multiple of 3 (3, 6, 9, 12, etc.) must CLAP instead of saying the number. The next person continues the normal sequence of numbers.

• Example:

• The fi rst person starts with saying “1”

• The next one says “2”

• The third person, instead CLAPS

• The next person says “4”

• Anyone who fails to CLAP or who makes a mistake with the number that follows CLAP is disqualifi ed.

• The numbers must be said rapidly (5 seconds maximum); if a participant takes too long to say her/his number, s/he is disqualifi ed.

• The last two participants left are the winners.

12. Microplanning for Immunization



• Prepare a map and micro-plan of a Sub-center area.

• Describe preparations for conducting the immunization sessions.

• Guide health workers to prepare sub center micro plans including maps

• Compile sub center micro plans and help prepare plan for supervision, alternate vaccine delivery and day-wise logistic distribution plan.

• Prepare an updated map of the PHC (including AVD plan)

Time: 105 minutes


Method:

Reading Handbook

Group Exercise

Discussion

Training Aids:


• Micro-plan exercise (Handout 7)

Steps:

• In each group of 5 participants, facilitator to open unit-6 of the HW-Handbook.

• Explain the components of a micro plan, guidelines for session sites and number of sessions and steps in preparation of a sub-center micro plan (30 mts)

• Ask each participant to complete Handout 7 on microplan exercise. (15mts).

• Explain Urban area micro planning, Alternate Vaccine Delivery System and Alternate Vaccinators as (10 mts).

• In each group read sections on preparing, arranging and conducting immunization session. (10mts)

• In small groups ask participants to read Immunization guide unit-5, steps 1to 5, let one trainee from each group explain one step each. (40 mts)

13. Records, Reports and Use of data for Action



• List recording and reporting formats and describe their use.

• Fill the monthly progress report completely and accurately.

• Use the coverage monitoring chart for plotting drop-outs.

Time: 45 minutes

Method:

Reading Handbook

Demonstration

Group work and Presentations

Discussion


Training Aids:

• Immunization guide of BPM (unit 6)

• Immunization Card

• Tracking Bag

• MCH/Immunization register

• Due list cum Tally Sheet

• Coverage monitoring chart (Handout 6)

• Monthly Progress report (fi lled in)

Steps:

• Ask participants what are the various records and reports related to the immunization program. Write their responses on the blackboard/fl ipchart.

• To each of the 4 groups, assign one record or report and give the task of reading in detail (within 5 minutes) about their assigned record or report from the Immunization guide. They would then have to present to the plenary the data collected, uses, common problems and solutions associated with their assigned record or report.

• Tell participants that the selected speaker for the group would enact the role of the assigned record or report. For instance, the person who is to speak about the Immunization Card could say “Hello. I am the Immunization Card. I am given to every child or pregnant woman that receives a vaccine. I contain all kinds of useful data such as ….”

• Group 1: Immunization Card

• Group 2: Tracking Bag

• Group 3: MCH/Immunization register

• Group 4: Due list cum Tally Sheet

• Ensure that during the presentations, participants demonstrate how to use the specifi c record or report.

• Explain the Coverage Monitoring and demonstrate how to fi ll.

• Ask participants to complete Handout 6 by plotting the data on coverage monitoring chart.

• Demonstrate a fi lled in Monthly progress report ask the participants to point out if there are any errors. Then discuss the common issues faced in fi lling the reports.

14. Monitoring and Supervision



• Monitor the Routine Immunization activities at block level

• Conduct eff ective review meeting at block level.

• Follow the key steps for eff ective supportive supervision.


Time: 90 minutes

Method:

Reading Handbook


Discussion

Training Aids:


• Coverage monitoring chart (Handout 8)

• Monthly Progress report (fi lled in)

Steps:

• Ask participants what is monitoring, and diff erent monitoring methods and tools available. What immunization activities should be monitored by managers? Write their responses on the blackboard/fl ipchart. (10 mts)

• Ask participants in each group, to read section on monitoring and conducting a review and feedback meeting. (15 mts)

• Ask participants to defi ne supervision; explain diff erence between monitoring and supervision and diff erence between control and supportive supervision (10 mts).

• Ask four groups to read one step each for conducting supportive supervision and present in the plenary. (30 mts)

• Discuss common issues observed during monitoring and supervision. (10 mts)

• Each group to read and discuss formats related to reporting and supervision in Annexure. (15 mts).

15. Advocacy and Communication



• List the reasons for left-outs, drop-outs and fully immunized children

• Use eff ective IPC to deliver 4 key messages to caregivers.

• Describe the need for and methods to address demand side issues to improve immunization program

• Use various aspects of communication to improve the utilization of immunization services

• Eff ectively utilize communication materials and communication methods to improve immunization coverage

• Make an eff ective communication plan to improve immunization.

Time: 90 minutes


Method:

Brainstorming

Group Discussion and Presentation

Training Aids:

• Immunization Handbook for HWs(Unit 8)

Steps:

• Start the session by asking the participants defi nition of drop-outs and left-outs. (5 mts)

• Ask the participants “How community can support immunization program?” Write their responses on fl ip chart.

• Divide the participants into four groups

• Ask Group 1 to move to the far corner of the room to represent that they are living in a remote hamlet without any sub-center in their village. Outreach sessions are rarely held in their village. Explain that their children are one type of “left-outs”, i.e. they are hard to reach geographically and have diffi cult access to services. Ask them to briefl y state some of the reasons why their children do not get vaccinated. Also ask them to suggest some possible solutions (e.g. have more regular outreach sessions; support the mobility of the health worker, etc.)

• Now turn to Group 2 and explain that theirs is a large village which is easy to reach, but they have many children that have never begun vaccination. They therefore represent a second kind of “left-out.” Ask them to state some of the reasons why their children do not go for vaccination (e.g., social inaccessibility as scheduled castes or tribes, migrants, border populations, mistrust of immunization by minority populations, etc.). Ask them to suggest some possible solutions (e.g. counseling by ASHAs/link workers, involvement of community leaders, better tracking, etc.) and write their responses on a fl ip chart.

• Now turn to Group 3 and explain that their children started the vaccination schedule but have not completed it and no longer go to the session. Explain that their children are “drop-outs.” Ask them to state the reasons why their children dropped out. Ask them for some possible solutions (e.g. counseling and better tracking by ASHAs/AWWs etc)

• Explain to Group 4 that children in their village are fully immunized. Ask them why their children started and continue to go for vaccination. Write their responses on a fl ip chart. Possible factors for fully immunized children could be:

• Well informed about the value of immunization and schedule

• Husbands, mothers-in-law, other infl uential’s are supportive

• No signifi cant geographical or convenience barriers

• Have time available when services are off ered

• Available services are reliable and friendly

• Community leaders visit and encourage immunization

• Heard about many child deaths before the immunization program started

• Have not had or heard about bad experiences with immunization

• Health worker tracks all children


• Ask each group to present in the plenary and write their responses on a fl ip chart. (40 mts)

• Ask participants in small groups to read from unit 8 of Immunization Guide and one trainee from each group to present one step each in eff ective advocacy.(15 mts)

• Ask participants to read case study and facilitator to discuss the behaviour of HWs and the outcome in their work.(10 mts)

• Brief the participants on preparing a comprehensive communication plan (10 mts).

16. Immunization Program Review and Preparing Action Plan



• compile, collate, analyze and use data eff ectively for program management

• Periodically review the immunization program and initiate corrective measures.

• Coordinate a comprehensive annual review of the program.

• Develop a realistic work plan for the next year.

• Prepare a program budget for the next annual cycle.

Time: 90 minutes

Method:

Reading Handbook


Discussion

Training Aids:


Steps:

• Brief participants about importance of program review, processes and need for continuous improvement (10 mts)

• Conduct a role play of a typical review meeting while the participants give feedback about their fi ndings during the fi eld visit (45 mts)

• Read and discuss preparation of work-plan in small groups.(15 mts)

• Ask all groups to read steps for developing a budget plan. (15 mts)

• Tell them that they would have to make actual workplan for themselves following the fi eld visit on 3rd day. (5 mts)


17. Film on Immunization

Time: 20 minutes

Method:

Film on Improving Immunization Coverage

Training Aids:

• Film on immunization (CD)

• LCD Projector

Steps:

• Provide an overview of the fi lm, which is on how to plan and conduct a quality immunization session.

• Ask participants to note specifi c points such as conducting the session, IPC, tracking and inter-sectoral coordination.

• Show the fi lm

18. Preparation for the fi eld visit and Evaluation of the day

Time: 15 minutes

Steps:

• Brief the participants regarding the fi eld visit to 4 diff erent PHCs / Session sites on Day-2

• One facilitator asks each participant to provide feedback on the sessions conducted that day. First ask for positive feedback on what they liked followed by what could be improved.

• Another facilitator notes down the points on the fl ip chart.

• Finally, ask each participant to tell one new skill which they learnt during the fi rst day of the training. Note on the fl ip chart.


DAY-3

19. Field Visit and debriefi ng



• Explain the cold chain equipment & its maintenance at various levels in the district

• Describe the micro-plan, steps for conducting immunization session and the procedures followed for injection safety and waste disposal

• List the positive practices observed and the weaknesses identifi ed for improvement

Time: 4 hours (240 minutes)

Session Overview

• Visit PHC/CHC and the immunization session site (180 minutes)

• Discussion on observations of the fi eld visit in a review meeting (60 minutes)

Materials

• Supervision checklist (Handout 9)

• Flipcharts and Marker Pens

A. Visit PHC/CHC and the immunization session site (180 minutes)

• Ask the participants to observe, interact with staff and make observations based on the Supervision Checklist (Handout 8) for the PHC/CHC (60 minutes) and the Session site (60 minutes).

• Ask participants to keep their comments to a minimum. Remind them that they are not there to fi x anything, but to learn and observe. Ask them to be respectful of staff as they do their jobs and to thank the staff for letting them watch.

• Meet with the person in charge of the PHC/CHC and ask participants to give him the thank-you card. Mention one or two good practices observed by the group.

Return to the course venue

B. Discussion on observations of the fi eld visit (60 minutes)

• Ask the participants to organize a mock review meeting at the block level with all stakeholders.

• Discuss and list the positive as well as the negative fi eld visit observations during meeting.

• Conclude the meeting with summary of action points and way forward.


20. Workplan preparation and presentation



• Prepare a realistic workplan for their block/PHC based on the learning from the training course.

Time: 120 minutes

Steps:

• Prepare a realistic workplan based on the learning from the training course.

• Present the workplan in the plenary.

21. Post test and Participants’ feedback

Time: 30 minutes

Method:

Brainstorming

Training Aids:

• Post test questionnaires (Handout 1)

• Participants’ feedback form (Handout 10)

Steps:

• Distribute the post-test questionnaire (Handout 1) to all the participants. Ensure that participants do not consult their handbooks during the post-test.

• Collect the fi lled-in handouts at the end of the stipulated 15 minutes.

• Assign one of facilitators with the task of correcting the fi lled in tests and calculating the percentage of correct answers to each question.

• Plot (with colored tape or marker pens) the percentage of correct answers to each question on the Scoring Chart, below the pre-test results for each question.

• Display the Test Scoring Chart in the classroom. This will inform the participants about their scores before and after the training. Discuss results from the pre and post tests.

• Discuss each question and tell participants the correct answers.

• Distribute the Participants’ Feedback Form (Handout 10) and ask participants to complete it in 15 minutes. Explain, if required.

• Tell participants that their responses are anonymous and not to write their names on the form.

• Collect the forms and compile the information.


22. Distribution of certifi cates and conclusion

Time: 15 minutes

Method:

Discussion

Training Aids:

• Sample Certifi cates (Annex 2)

Steps:

• Thank participants for their active participation in the training

• Ask district dignitaries to distribute certifi cates to participants

23. Post training activitiesBy end of one week:

• Complete and submit Training Workshop Reporting Format within next one week. (Annex 3)

Monitoring of training:

• State –level offi cers /trainers should monitor the quality of the immunization training at the district level, using the Checklist for Monitoring Quality of Immunization Training (Annex 4).

34 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)34 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Annex-1

Registration Form for ParticipantsDate: __________ Training Site: ______________ District: _______ State: ________

Sl. No. Name Designation Place of work Signature

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 35Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 35Annex-2

Sample Certifi cate

CERTIFICATE

This is to certify that Ms/Mr______________of ___________

has successfully completed the Immunization Training for Block

Programme Managers held at ___________ on _____________

201___.

Training Coordinator Chief Medical Offi cer

36 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)36 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Annex-3

Training Workshop Reporting Format Submit to the State Training Coordinator after every training course

Name of Training Institution

Dates of Training course

Number of participants – Nominated

Number of participants – Attended

Field sites visited (tick all that apply)

CHC PHC District Hospital Immunization Session Other

Names of Facilitators and Designation

1.

2.

3.

4.

Training and other materials given to all the participants? (tick all that apply)

Immunization Guide for BPMs in local language

Handouts (from Facilitators’ Guide)

Certifi cates

Other (specify) ___________

Pre AND Post-test evaluation done? (tick one)

Yes No

Feedback from trainees sought? (tick one)

Yes No

Mention salient points:

Remarks on the training course indicating good experiences and problems/constraints faced (such as attendance of trainees, training material, release of funds, etc.)

Attach Registration Form (List of participants with designation, place of work and contact numbers)

Submitted by_________________________________ Date: _________________

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 37Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 37Annex-4

Checklist for monitoring Quality of Immunization Training

General Information

Name of Monitor

Designation and Organization

Dates of visit

Place of visit

Days visited: Check all that apply Day1 Day2 Day3

Training Arrangements

Training Calendar available Yes No

No. of participants: Less than 15 15-25 More than 25

1 facilitator per 5-7 participants Yes No

All facilitators TOT trained Yes No

Is the training residential Yes No

Training venue equipped with Water/Electricity/Mess facilities Yes No

Classrooms have seating facilities Yes No

Flipcharts/ Films / Equipment for demonstration available Yes No

All participants given Handbooks, Handouts and Certifi cates Yes No

Field visit organized to DH/CHC/PHC and RI Session Site Yes No

Training Implementation

Pre/post test done Yes No

Feedback taken from participants Yes No

Rate the Training sessions (in terms of adherence to the Facilitators’ Guide) Tick the appropriate box

Introduction and Responsibilities of BPMs in immunization Very Poor Poor Fair Good Excellent

Vaccines and Immunization Programme Very Poor Poor Fair Good Excellent

National Immunization Schedule and FAQs Very Poor Poor Fair Good Excellent

Cold Chain and Logistics management Very Poor Poor Fair Good Excellent

Ensuring Safe Injections Very Poor Poor Fair Good Excellent

Microplanning for Immunization Very Poor Poor Fair Good Excellent

Records, Reports and Use of Data for Action Very Poor Poor Fair Good Excellent

Monitoring and Supervision Very Poor Poor Fair Good Excellent

Advocacy and Communication Very Poor Poor Fair Good Excellent

Immunization Programme review and Preparing block action plan Very Poor Poor Fair Good Excellent

Facilitation Techniques (of each facilitator)

Training Skills 1_______ 2______ 3_______ 4_______ 5_____

Questions to promote discussion Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Encourages trainees to ask questions Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Paraphrasing and summarizing Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Eff ective mgmt of discussion Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Eff ective non-verbal communication Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Learning Climate

Engages participants’ interest Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Positive rapport with learners Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Visual Aids

Legible writing on fl ipchart Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Appropriate use of fl ipchart Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Timing

Adherence to time limits Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA

Overall remarks and suggestions to improve the quality of training:

38 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)38 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Handout-1

Pre and post test Questionnaire Name: Date:

1. A fully immunized child is one who has received BCG, DPT/ Polio -1 & 2, Measles and Vit -A before the fi rst birthday.

True

False 2. Each infant will need four injections in their fi rst year of life to be fully immunized True

False 3. If a child comes for vaccination for the fi rst time at 16 months of age, the vaccines

that should be given are: BCG, DPT/OPV-1, Measles and Vit –A. True

False 4. A child received BCG, DPT1 and OPV1 at the age of 1 and half months. Then, comes

again after a gap of 6 months. You will start the immunization with DPT-1 again. True

False 5 Fill in the blanks:

Vaccine Route Site DoseBCG ______________ ______________ ______________DPT ______________ ______________ ______________Hepatitis B ______________ ______________ ______________Measles ______________ ______________ ______________

6. The fi rst dose of Vit-A solution is given with Measles at 9 months of age. a. Up to what age, Vit –A is given? ____________b. What is the interval between two doses of Vit –A? ____________c. How many doses of Vit –A are given including fi rst dose? ____________d. How much Vit A solution is given to a child above 1yr of age? ____________

7. Which vaccines should NEVER be frozen?a. BCG b. DPT c. OPV d. Measles e. Hepatitis B f. TT

a b c d e f

8. What do you do with T-series vaccines (DPT, DT, TT, Hep B) that are frozen?a. Warm them and use them as quickly as possibleb. Keep them in the cold chainc. Discard and report

a b c

9. Diluent supplied with the vaccine should be stored in ILR at least 24 hrs before use to ensure that vaccine and diluent are at the same temperature when reconstituted.

True False

10. In a village located 6km away from your sub center, with a population of less than 1000. How many minimum sessions/yr need to be organized to fully immunize all infants?

6 3 5 4

11. How many vials of Measles vaccine will you carry to immunize 15 infants in a village? 2 3 4 5

12. Reconstituted BCG and Measles vaccines should be discarded after how many hours? 1 2 3 4

13. Should you give immunization to a benefi ciary who has lost his/her card? Yes No


14. How can you track drop out children?a. Counter foil of Immunization cardb. Tickler box/ bagc. Immunization registerd. All of the above

a b c d

15. How will you dispose off AD syringes after use? a. Cut needle in hub cutter and collect syringe in Red bag and send to PHC for disinfection and disposal.b. Throw in general waste/ Black bag.c. Burn it in open air.d. Bury it in a pit.

a

b c d

16. What will you do if a child comes to you with mild fever, pain and swelling at the site of injection?a. Refer to MO PHCb. Give Paracetamol, ask to apply cold cloth at injection site and reassurec. Do nothing

a b c

17. Which of the following AEFIs need to be reported immediately and investigated?a. Death b. Hospitalization c. Anaphylaxisd. All of the above

a b c d

18. If a child comes with abscess after immunization what will you do?a. Do nothingb. Reassure parents and refer to PHC & include in monthly report.c. Give Paracetamol

a b c

19. Drop out children are those who have never received any immunization True False

20. If a child comes with mild fever and diarrhea, should you give immunization? Yes No


Agenda for Immunization Training of Block Programme Managers

Time Sessions Facilitator

Day-I0900-0930 Registration0930-0945 Pre test0945-1000 Introduction of participants 1000-1015 Participants’ expectations and Training overview 1015-1100 Importance of Immunization and Responsibilities of Block Programme

Managers in RI 1100-1115 Tea1115-1215 Vaccines and Immunization Program 1215-1315 National Immunization Schedule and FAQs1315-1415 Lunch1415-1615 Cold chain and Logistics management 1615-1630 Tea1630-1715 Ensuring Safe injections1715-1730 Evaluation of the day

Day-II0900-0915 Warm up and Re cap0915-1100 Micro planning for Immunization1100-1115 Tea 1115-1200 Records, Reports and use of data for action1200-1315 Monitoring and Supervision1315-1400 Lunch1400-1415 Monitoring and Supervision continued1415-1545 Advocacy and Communication 1545-1600 Tea1600-1730 Immunization Program Review and Preparing Block Action Plan (unit7)1730-1800 Film on Immunization1800-1815 Preparation for the fi eld visit and Evaluation of the day

Day-III0900-1300 Field visit and debriefi ng from Field visit1300-1400 Lunch1400-1600 Workplan preparation and presentation1600-1615 Tea1615-1645 Post-test and Participants’ feedback1645-1700 Distribution of certifi cates and conclusion

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 41Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 41Handout-3

VPD QuizFill columns B and D in the Table below:

A B C D

History of fever and rash and any one of the following; cough, running nose, red eyes with in 3 months

Coughing or sneezing

Sudden onset of weakness and fl oppiness in any part of the body in a child less than 15 years of age or paralysis in a person of any age in whom polio is suspected.

Contact with faecal matter due to poor hygiene

Sore throat, mild fever and grey patch or patches in the throat.


History of normal suck and cry during fi rst two days of life, onset of illness between 3 and 28 days of life, inability to suck followed by stiff ness of neck and body and/or Jerking of muscles.

Unclean cutting and dressing of the umbilical cord

A child with fever and / or cough for more than 2 weeks, with loss of weight / no weight gain. History of contact with a suspected or confi rmed case of pulmonary tuberculosis.

Cough or sneeze droplets of infected persons

History of repeated and violent coughing with any one of the following: Cough persisting for 2 or more weeks, fi ts of coughing, cough followed by vomiting, typical whoop in older infants.


Clinical signs and symptoms include fever, headache, nausea, vomiting, jaundice (yellowish eyes), light or grey stools.

Contact with Infected blood and body fl uids

Acute onset of fever with change in mental status (such as confusion, disorientation or coma) and /or seizures.

By mosquitoes


Temperature ChartMonth: ____________ PHC: ___________District: _______ State: ___________

Date Temperature Power Breaks Duration and time

Remarks Signature

10 am 4 pm1.2.3.4.5.6.7.8.9.

10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.26.27.28.29.30.31.


To calculate downtime, response time and sickness rateBased on the information given below, write the down time for all equipments and response time for repairing each of the equipments.

Name of the Equipment

Date of Becoming Sick

Date of Reporting of Sickness

Date of Attending

the equipment

by CCT

Date equipment

become functional

Down time (days)

Response time (days)

ILR-1 2.6.09 20.6.09 25.06.09 25.7.09

ILR-2 10.6.09 15.06.09 26.06.09 20.07.09

DF-1 15.6.09 16.06.09 19.06.09 24.06.09

DF-2 20.6.09 26.06.09 30.06.09 10.07.09

DF-3 01.06.09 08.06.09 13.06.09 25.06.09

DF-4 28.6.09 30.06.09 1.07.09 10.07.09

In a district, 35 of the 40 electrical cold chain equipments are in working condition and 5 are under repair. Ten items have been condemned but are lying in the store. Calculate the sickness rate of the district –


Priority issue of vaccines to session sites On 6th May 2009 you have stock of DPT vaccines in your ILR as under:

Lot No Received from Date of receipt

Quantity Date of expiry

VVM status

1. District 01.03.09 2 vials 30.09.09 Usable but Darker

2. District 15.03.09 5 vials 31.08.09 Usable3. District 11.04.09 10 vials 31.08.09 Usable4. Block PHC 20.04.09 3 vials 31.06.09 Usable5. Out reach session returned un opened

(fi rst time)28.04.09 1 vial 30.06.09 Usable

You are required to issue 5 vials on 6th May and 7 vials on 13th May 2009 to sub-centers. Which vaccines will you issue on 6th and 13th, respectively?

Answer:

Date Lot no. No. of Vials Lot no. No. of Vials Lot no. No. of Vials Total vials

6th May 200913th May 2009

Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 45Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012) | 45Handout-7Su

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46 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)46 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)Handout-8M

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Supervision checklists CHECKLIST FOR FIELD VISIT TO PHC/CHC

Name of Block/Planning Unit : ______________________________________ Name of CHC/PHC : __________________________________

Date of Visit : ___/___/_____ Population covered : _________________________ Name of Supervisor: _________________________

PROGRAMME MANAGEMENT (Consult Facility in-charge and records)

1 Components of the Facility’s RI Microplan available

• Map of Catchment area (indicating sub-centers and distances from vaccine storage point) Yes No

• Estimation of Benefi ciaries (village/ area wise) for current year Yes No

• Estimation of Logistics – Vaccines, Syringes, Immunization Cards etc. (village/area wise) Yes No

• ANM roster / Immunization Calendar Yes No

• Day-wise Plan for Supervisor fi eld visits Yes No

2 ANM Roster / Immunization Calendar displayed at the facility Yes No

3 Coverage Monitoring Chart/Drop out Chart (BCG-Measles or DPT 1-3) displayed at the facility Yes No

4 Meeting conducted with RI component with Health/ICDS/ PRI in last calendar month (verify minutes) Yes No

5 Supervisory visits by District level Government Health offi cials in the last calendar month Yes No

COLD CHAIN (Observe in Cold Chain Room)

6 ILRs and DFs

• Placed on wooden blocks and at least 10 cm away from walls and surrounding equipment Yes No

• Each equipment is connected through functional Voltage Stabilizer Yes No

• Functional thermometer placed inside every ILR and DF Yes No

• No frost OR frost less than 5mm on inside walls of every ILR Yes No

7 Temperature Log Books

• Twice daily monitoring of temperature in respective log books Yes No

• Record of power failures/cuts (if any) and Record of Defrosting ILRs & DFs Yes No

• Periodic checks of Temperature Log Books by Facility in-charge (see evidence of signatures) Yes No

8 Ice Lined Refrigerator (ILRs)

• Cabinet Temperature between +2 to +8OC Yes No

• All vaccine vials correctly arranged inside labeled cartons (expiry date, batch) Yes No

• No T-series or Hepatitis B vaccine vials placed in the bottom of ILR Yes No

• Diluents placed in ILR, at least 24 hours before distribution (observe and/or consult) Yes No

9 Deep Freezer (DF)

• Cabinet Temperature of DFs between -15 to -25OC Yes No

• Correct placement of ice packs inside DF (in crisscross manner, while freezing) Yes No

• No RI vaccines stored inside DFs (including reconstituted vaccines) Yes No

SUPPLIES AND STOCKS (Physically count for 1 or 2 vaccines and consult stock register)

10 Vaccines and Diluents Actual count Record Actual count Record

BCG/OPV/DPT/DT/TT/HepB/Measles vaccine (in vials)

BCG/Measles Diluent (amps.)

11 Records of vaccines and diluents distributed (from vaccine issue register) correlates with Stock Register Yes No

12 All sessions conducted in last calendar month issued at least one vial of each antigen Yes No

13 Records for ADS and Reconstitution syringes available and updated Yes No

IMMUNIZATION SESSIONS (Consult Microplan, Vaccine Issue Register and MPR)

14 Imm. Sessions (for last calendar month) Planned (P) Conducted (C) % conducted (C/P X 100)

% sessions conducted more than 80%

Yes No NA

15 Doses administered (Cumulative for last 3 months)

DPT1 (D1) DPT3 (D3) % Dropout ([D1-D3]/D1 X 100)

Dropout Rates less than 10%

Yes No

REPORTS (Consult MPR in UIP Format)

16 Any AEFI reported or Zero Report in last 3 calendar months Yes No

17 Any VPD reported or Zero Report in last 3 calendar months Yes No

INJECTION SAFETY (Observe)

18 Immunization waste chemically disinfected Yes No

19 Disposal pit used for disposal of disinfected sharps (cut needles, broken vials & ampoules) Yes No NA


CHECKLIST FOR FIELD VISIT TO SESSION SITE

Name of ANM: _________________________________________________Name of Subcentre : ____________________________________

Name of CHC/PHC : _______________________________________________________ District: ___________________________________

Date of Visit : ___/___/_____ Time of visit: ________ Name and designation of Supervisor: ________________________________________

PROGRAMME MANAGEMENT (Consult Facility in-charge and records)

1 Session Site Sub Center Anganwadi Center Other

2 Present at Site (tick all that apply) If ANM is absent, do not fi ll this format ANM AWW ASHA/Link Worker Mobilizer Other

3 Is the session site as per RI micro plan? Yes No

4 What immunization-related IEC material is displayed at site?(tick all that apply) Banner Wall writing Tinplate Poster Other

5 Is a vaccine carrier with 4 ice packs available? Yes No

6 What is the condition of icepacks in the vaccine carrier? Hard Frozen Semi Frozen Fully Melted

7 Are all vaccine vials & diluents placed in plastic zipper bag in vaccine carrier? Yes No

8 Availability of vaccines and logistics (Tick)

BCG Measles DT Functional hub cutter

BCG Diluent Measles Diluent Vitamin A Tracking Bag

tOPV JE Blank Immunization Cards 0.1 ml AD Syringes

DPT JE Diluent Red Disposal Bags 0.5 ml AD Syringes

HepB TT Black Disposal Bags Disposable Syringes

9 Is any expired vaccine found? Yes No (if yes, which vaccine ………………)

10 Is any vial of DPT, DT, TT and/or Hepatitis B found frozen? Yes No

11 Is the VVM on tOPV in usable stage (Stage 1 or 2)? Yes No

12 Is the time of reconstitution mentioned on both BCG & Measles vial(s)? Yes No NA

13 Does ANM/AWW/ASHA/Link Worker have a due list of benefi ciaries for this day? Yes No

14 Is the DPT vaccine administered on outer mid thigh (antero-lateral aspect)? Yes No NA

15 Is Vit A being given with a plastic spoon to benefi ciaries receiving measles? Yes No NA

16 Are all AD and Disposable syringes cut with hub cutter immediately after use?

Yes No NA

17 Are new immunization cards being fi lled and issued for all new benefi ciaries?

Yes No NA

18 Are updated counterfoils from previous sessions of this session site available?

Yes No

19 Is the ANM noting each vaccination correctly and completely in the tally sheet?

Yes No NA

20 Is the ANM giving the 4 key messages to the mother/care-giver? Yes No

21 Is the vaccine carrier brought by….?(tick only one) Hired Person Supervisor ANM Other

22 Is the vaccine carrier distributed from the PHC/Urban Planning Unit today? Yes No

23 What is the ANM sending back at end of session?(tick all that apply) Vaccine vials Used Syringes Unused syringes Report

24 Has a Supervisor/MO visited sessions in ANM’s area in last 1 month? Yes No

25 What made the mother come here for immunization today? (tick all that apply)

Mother 1 ANM AWW ASHA/link worker Other

26 Mother 2 ANM AWW ASHA/link worker Other


Feedback from Participants FormDates__________________ Location ______________________State________________District______________

Please rate the following aspects of the training course by putting the mark.

Strongly Agree

Agree Disagree Strongly Disagree

Training venue was adequate for this training

Boarding and lodging facilities were comfortable

Refreshment and meals were satisfactory

Training content was helpful in carrying out routine tasks

Training methodologies were suitable for the content

There was opportunity for active participant involvement

Handbook and other handouts were helpful

Field visit provided practical information

There was enough time to cover all material

Objectives of the training were met

Please rate your knowledge in the following topics after this training course by putting the mark.

Excellent Good Fair Poor

Introduction and Responsibilities of BPMs in immunization

Vaccines and Immunization Programme

National Immunization Schedule and FAQs

Cold Chain and Logistics management

Ensuring Safe Injections

Microplanning for Immunization

Records, Reports and Use of Data for Action

Monitoring and Supervision

Advocacy and Communication

Immunization Programme review and Preparing block action plan

Please provide suggestions for improving the content and methodology of training

Additional Comments


Answers to the Handout: 1 Pre and Post Test Questionnaire1. False2. False3. False4. False5 Fill in the blanks:

Vaccine Route Site DoseBCG Intradermal Left upper arm 0.1 mlDPT Intramuscular Outer mid-thigh 0.5 mlHepatitis B Intramuscular Outer mid-thigh 0.5 mlMeasles Subcutaneous Right upper arm 0.5 ml

6. a. 5 yrs; b. 6 mths; c. 9 doses; d. 2ml / 2lakh IU7. (b, e and f )8. c9. True10. 411. 412. 413. Yes14. d15. a16. b17. d18. b19. False20. Yes

Answers to the Handout: 5Name of the Equipment

Date of Becoming Sick

Date of Reporting of Sickness

Date of Attending

the equipment

by CCT

Date equipment

become functional

Down time (days)

Response time (days)

ILR-1 2.6.09 20.6.09 25.06.09 25.7.09 53 5

ILR-2 10.6.09 15.06.09 26.06.09 20.07.09 40 11

DF-1 15.6.09 16.06.09 19.06.09 24.06.09 9 3

DF-2 20.6.09 26.06.09 30.06.09 10.07.09 20 4

DF-3 01.06.09 08.06.09 13.06.09 25.06.09 24 5

DF-4 28.6.09 30.06.09 1.07.09 10.07.09 12 1

Answers to the Handout: 6Date Lot no. No. of Vials Lot no. No. of Vials Lot no. No. of Vials Total vials

6th May 2009 5 1 1 2 4 2 513th May 2009 4 1 2 5 3 1 7


Ans

wer

s to

Han

dout

7: S

ub-c

ente

r Mic

ro p

lan

Esti

mat

ion

of B

enefi

cia

ries

Esti

mat

ion

of V

acci

nes

an

d L

og

isti

cs

Sl No.

Vill

age

Total PopulationA

nn

ual

Ta

rget

Mo

nth

ly

Targ

etB

enefi

cia

ries

per

mo

nth

for

each

vac

cin

e &

V

itam

in A

Vac

cin

e vi

als

& V

itam

in A

per

mo

nth

Syri

ng

es p

er

mo

nth

PW

Infants

PW

Infants

TT

BCG

DPT

OPV

Hepatitis B

Measles

JE

Vitamin A

TT

BCG

DPT

OPV

Hepatitis B

Measles

JE

Vitamin A (in ml)

ADS 0.1 ml

ADS 0.5 ml

Recons-titution

ab

cd

ef

gh

ij

kl

mn

op

qr

st

uv

w

Formula


Based on actual headcount x 2


Column a ÷ 12

Column b ÷ 12

Column c x 2

Column d x 1

Column d x 5

Column d x 4

Column d x 3

Column d x 2

Column d x 1

Column d x 9

(Column e x 1.33) ÷10

(Column f x 1.33) ÷ 10

(Column g x 1.33) ÷10

(Column h x 1.33) ÷ 10

(Column i x 1.33) ÷ 10

(Column j x 1.33) ÷ 5

(Column k x 1.33) ÷ 5

{(column d x 1 ml) + (column d x 8) x 2 ml)} x 1.11

Column f X 1.11

(Columns e + g + i + j + k) X 1.11

(Columns m +q+s) X 1.11

1Ra

mpu

r (SC

)20

0066

606

512

525

2015

105

452

14

22

32

100

675

7

2C

hand

pur

1700

5651

55

105

2520

1510

545

21

42

23

210

06

737

3Ra

nap

ur14

0046

424

48

420

1612

84

362

13

22

32

805

587

4Ka

roth

i18

0060

545

510

525

2015

105

452

14

22

32

100

673

7

5M

anaa

v10

0034

303

36

315

129

63

271

12

12

21

604

445

AN

M W

ork

Pla

n/ R

ost

er

Sl

No.

Vill

age

Dis

tan

ce

(km

s) fr

om

IL

R p

oin

tA

WW

ASH

AIn

ject

ion

s

per

mo

nth

Sess

ion

s re

qu

ired

p

er m

on

th

Mo

nth

1M

on

th 2

Mo

nth

3

Wed

Sat

Wed

Sat

Wed

Sat

12

34

12

34

12

34

12

34

12

34

12

34

1Ra

mpu

r (SC

)1

722

xx

2Ch

andp

ur3.

570

2x

x

3Ra

nap

ur2

562

x

4Ka

roth

i3

702

xx

5M

anaa

v6

421

x

52 | Facilitators’ Guide: Immunization Guide for Block Programme Managers (2012)A

nsw

ers

to H

ando

ut 8

: Cov

erag

e M

onito

ring

Cha

rt

Cum

ulat

ive

Mon

thly

Tar

get

Cove

rage

Mon

itori

ng C

hart

for D

PT1

and

DPT

330

x 1

2 =

360

30 x

11

= 3

30

30 x

10

= 3

00

30 x

9 =

270

30 x

8 =

240

30 x

7 =

210

30 x

6 =

180

30 x

5 =

150

30 x

4 =

120

30 x

3 =

90

30 x

2 =

60

30 x

1=

30

30 x

0 =

0

Fill

in a

t the

end

of

each

mon

thAp

rCu

m

Tot.

May

Cum

To

t.Ju

nCu

m

Tot.

Jul

Cum

To

t.Au

gCu

m

Tot.

Sep

Cum

To

t.Oc

tCu

m

Tot.

Nov

Cum

To

t.De

cCu

m

Tot.

Jan

Cum

To

t.Fe

bCu

m

Tot.

Mar

Cum

To

t.

Tota

l im

mun

ized

DPT

125

2526

5125

7628

104

2112

525

150

Tota

l im

mun

ized

DPT

320

2021

4124

6523

8824

112

2413

6

Dro

p o

ut n

umb

er (D

O)

(DPT

1-D

PT3)

5

10

11

16

13

14

Dro

p

out

%

(DO

/D

PT1)

*100

2020

1415

109

L

egen

d

DPT

1 co

vera

ge

∆ D

PT3

cove

rage

Trainers Guide for Immunization Handbook for Health Workers...2 | Facilitators’ Guide:...

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