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Immunization- what can affectperformance
Lessons for Policy
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A ntigen wise Dist. Coverage and comparison with last year (Cumulative since A pril 07, 08)
9 1 . 1
6
7 8 . 1 9
7 6 . 5
7
7 7 . 4
3
7 0 . 0
6
1 0 6 . 7 2
6 8 . 4
5 8 1 . 3 9
8 3 . 4
4
7 2 . 4
7
0.00
20.0040.00
60.00
80.00
100.00
120.00
BCG D T3 O V3 Measles Fully mmuni ed
2007- 2008 2008- 2009
District 1
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Dropout up to the month of arch 0 and comparison with last year (Cumulative since A pril 08)
0
8
8
0
8
000
00
000
00
000
00
C
easles D D D
easles
2007- 2008 2008-2009
District 1
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5.31
10.79
16.7
27.98
33.35
37.76
34.7138.08
40.84
46.81
54.92
64.50
5.31
10.69
16.4422.44
28.4133.07
36.0839.98
43.89 49.81
57.46
66.47
8.33
16.67
25.00
33.33
41.66
50.00
58.33
66.66
75.00
83.33
91.66100.00
0
20
40
60
80
100
April May June July August Se ptember October November ecember January February March
PERCENT
GE
PT 3 OPV 3 ELA
DIS TR ICT COVER GE DPT3 & OPV3(APR IL-08 TO ARCH -0 )
SNID with mOPV decreasedOPV coverage & shortage of DPT vaccine decreased DPT coverage
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YE A WIS E COM P A IS O OF RI C OV E RA E District
294962925730070TT( W)
284762944330430MEASLES
28 1 6129989311 03OPV-3
3 0030 1 2531 090DP T-3
324283374934474BCG08-007-080 -07VA CCIN E
Shortage of DP vaccine decreases the coverageLack of quality in reporting system
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9596
2956432889
36999
54031
62055
1385618811
2399427631 28766
31519 33819
45312
53213
13750
20625
27500
3437541250
48125
55000
61875
68750
7562582500
4895
1495019872
2481928220
45203
4382 8966
38745
6875
0
15000
30000
45000
60000
75000
90000
A p r i l M a
y J u n
e J u l
y A u
g S e
p t O c t
N o v
D e c
J a n u a r
y
F e b r u
a r y M a r c h
N O
O F C H I L D R
E N
DPT-1 DPT-3 ELA
Drop out : 8842 children(14.25%)
DR O P OU : DP - O DP - 3(A PRIL-08 O MA RC H -0 ) Dist
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COM P A RIS O N OF RI C OV E RA E
9 5
. 5
8 4
. 2
8 4
. 1
8 3
. 5
7 7
. 0
6 4
. 5 0
6 6
. 4 7
7 5
. 0
6 9
. 6
9 1
. 8
0
20
40
60
80
100
BCG D P 3 O PV 3 Meas les TT( P
P E R C E N
A
E
2007-2008 2008-2009
69 vacant Sub-Center from April to JulyPresently 18 Sub-centers are vacantShortage of DPT vaccine from September
to December
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S O CK P O SI IO N OF VA CCIN E & LO IS ICS( District on 3 0.0 .0 )
Vaccine (doses)/Logistics (pcs)
OpeningBalance
Receive Distribution ClosingBalance
BCG 19000 60000 17000 62000
DPT 27000 100000 26000 101000
OPV 66620 100000 34120 132500
Hep-B 50320 36000 36000 50320
Measles 0 35000 16500 18500
DT 14000 60000 18500 55500
TT 42000 120000 26000 1365000.1 ml ADS 3400 6400 4800 5000
0. 5 ml ADS 776900 0 0 776900
5 ml DS 9300 12000 2300 19000
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District S A U S OF 0. ml A DSIN 008- 00
RECEIVING DATE QUANTITY RECIEVD (pcs)
O pening balance as on 1.4.2008 6000
15.7.2008 8000
6.11.08 91007.1.09 2600
10.2.09 5200
TOTAL 30900
B C coverage during 008- 00 : 7 7 8A NM s are using Insulin syringes for B C vaccination
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BCG
40000
0
30000
0 0
20000
30000
0
10000
30000
00
5000
10000
15000
20000
25000
30000
35000
40000
45000
A
' 0 8
a ' 0 8
J
e ' 0 8
J
' 0 8
A
' 0 8
e
' 0 8
c ' 0 8
N o v
' 0 8
e c
' 0 8
J a
' 0 9
e
' 0 9
Vacc i e Rece ive d a a i s o h R e q i e m e ie 09
o h R e q i e m e
119 0
District 3
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DPT
30000
0
46000
0 0 0 0
18500
87000
60000
00
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
A
' 0 8
a ' 0 8
J
e ' 0 8
J
' 0 8
A
' 0 8
e
' 0 8
c ' 0 8
N o v
' 0 8
D e c
' 0 8
J a
' 0 9
e
' 0 9
o h R e q i e m e
47840
Vacc i e Rece ive d a a i s o h R e q i e m e ie 09
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OPV
0 0
120000175000
062100
093000
692000782000
00
100000
200000
300000
400000
500000
600000
700000
800000
900000
A
p r ' 0 8
M a y ' 0 8
J u n e ' 0 8
J u l y ' 0 8
A u g ' 0 8
S e p ' 0 8
O
c t ' 0 8
N o v ' 0 8
D e c ' 0 8
J a n ' 0 9
F e b ' 0 9
Month ly Re qu ire m ent
47840
Vacc ine Rece ive d aga in s t M o n th ly Re q u ire m ent till Feb 09
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Measles
10000
0 0 0
29500
0
29000
0 0
5000
00
5000
10000
15000
20000
25000
30000
35000
A p r '
0 8
M a y
' 0 8
J u n e
' 0 8
J u
l y ' 0 8
A u g
' 0 8
S e p
' 0 8
O
c t ' 0 8
N o v
' 0 8
D e c
' 0 8
J a n
' 0 9
F e
b ' 0 9
Mont h ly Re q u ire m ent
11960
Vacc ine Rece ive d aga inst Mont h ly Re q u ire m ent till Feb 09
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Specific issue District
Child tracking system very poor.O utreach session plan very poor.Communication is difficult in 4 village Lochanpur
.P ( 6 km road only V an)H uge Shortage of V accine .A NM working is less ( Session start late, closesearly, session planned but not held etc).
Political ProblemStaff Change
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SP E CIF IC ISS U E S - L O W C OV E RA EDistrict
Low awa r ss l l Poo r dr op ou t tr a ckiHome v isit by ANM s pe rsist en tly low
Re sist an ce peop leLack of coo r dina tion be tween Hea lt & ICDSHa r d to r ea c a r ea/ Dist an t village f r om Sub-Cen te r
r equen t tr an s fer of A NM s and long vacancy
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Possible Reasons for LowPerformance
Way to Solve
Sub-centre vacant . Advocacy with Dist . Secondly use thenearby SCs ANM in other days .
No proper planning . Plan made after WBSISCsintervention .
Less session held . Regular monitoring .
Poor tracking system . Use of Social Mobilizers by using
Tickler Bag .
Hard to reach area . Special plan for Hard to reach area .
Poor monitoring from Upper level . Advocacy with Dist . & Block .
Vaccine shortage . Beyond hand .
Less involvement of otherstakeholders (Like GP, ICDS, etc .)
Regular meeting with stakeholders .
Resistant people . Social mobilization in villages .
Migration to other places . Beyond hand .
District 3
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S/C Session M onitoring on 3 . .0 District
A ll ype Vaccine kept in IC E Pack
Vaccine supply same day from B P H Cfor S/C clinic and outreach session
Reconstitute ime written on vial
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O utreach session monitoring District on 4. .0
A D Syringes open B efore use
O utreach session held at. ?
A fter M otivation
wo IC E pack kept inImmunization tray
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Acknow ledgemen ts
P r e s en ta tion s in May 2009 by District Ex tende rs of WBSISC
WBSISC P r oje ct Manage r Kolka ta Med ica l Co llege- Depa rtmen t of
Commun ity Med icine
CMO H of cove r ed d istrictsUNICEF s uppo rt to WBSISC
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