Forms and Tools for Measles SIA (2)

8/14/2019 Forms and Tools for Measles SIA (2)

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Name of UC MO: Name and Designation

Mobile no. of UC MO: Mobile no. of UC Superv

Vaccine and Logistics distribution center:

EPI Fixed center 1: EPI Fixed center 2:

Skilled person: Name and mobile number Skilled person:

Team Assistant: Name and designation Team Assistant:

Skilled person: Name and mobile number Skilled person: Name and mobile numbeTeam Assistant: Name and designation Team Assistant: Name and designation

Social Mobilizer 1 Name and designation Social Mobilizer 1 Name and designation












School(s) with tentative target

school name (M:target, P:target)

School(s) with tentative target School(s) with tentative target

Day 2Areas with tentative target:

area name (M:target, P:target)

Areas with tentative target:


Day 7



Days

Areas with tentative target:area name (M:target, P:target)

Areas with tentative target:area name (M:target, P:target)

Day 1

Outreach Team 1 Outreach Team 2















Union Council Vaccination Session Microplan

Measles - Polio SIA, Pakistan 2013

School(s) with tentative target

school name (M:target, P:target)


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Date: ___________________

_______________________________________

1 _____________________________________

_______________________________________ 2 _____________________________________

UC: ____________________ Tehsil: __________________________ District: __________________

Site/Location:

Summery daily report

Full Name and signature of the UC MO:

Full Name and signature of the UC Supervisor:

Measles - Polio SIA, Pakistan 2013

Tally Sheet(To be used on Fixed vaccination centers, Outreach vaccination centers and Schools)

Name of Skilled person:

Name of social mobilizers:

Name of team assistant

_________________________________________________________________________

OPV (0 to below 5 years) Measles (06 months to below 10 years)

Total: Total:

Vaccine Place of vaccination Total children vaccinated Vial received Vial used Vial r

OPVHome

Outreach/Fixed site

Measles Outreach/Fixed site

Pentavalent Fixed site

PCV10 Fixed site

BCG Fixed site

TT Fixed site


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Days TeamTentative target

(Polio)

OPV required

(doses)

OPV required

(20 doses vial)

Tentative target

(Measles)

Vaccine

required

(doses)

A B C D E F G

Sum of tentative

Polio targets of allareas and schools by

day from UC

microplanning sheet

Column C x 1.167 Round up Column D/20

Sum of tentative

measles targets of allareas and schools by

day from UC

microplanning sheet

Column F x

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Outreach

Team 1Outreach

Team 2

Outreach

Team 3

Outreach

Team 1Outreach

Team 2

OutreachTeam 3

Outreach

Team 1Outreach

Team 2

Outreach

Team 3

Outreach

Team 1Outreach

Team 2

Outreach

Team 3

OutreachTeam 1

Outreach

Team 2

Outreach

Team 3

Outreach

Team 1Outreach

Team 2

Outreach

Team 3

Outreach

Team 1

OutreachTeam 2

Outreach

Team 3

Outreach

Team 1Outreach

Team 2

Outreach

Team 3

Outreach

Team 1

Day 4

Day 5

Day 6

Day 7

Measles - Polio SIA, Pakistan 2013Union Council Vaccine and Logistics Microplan

Day 1

Day 2

Day 3

Day 8


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Outreach

Team 2

Outreach

Team 3

Outreach

Team 1

Outreach

Team 2

Outreach

Team 3

Tentative total target

in the catchment area

TOTAL

Day 9

Fixed center

Day 10


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Vaccine

required

(10 dose vial)

Diluent

required

(ampoule)

AD Syringe

(0.5 ml)

Reconsitution

Syringe (5 ml)Safety Box

H I J K L

Round up

Column G/10

Equal to

Column H

Equal toColumn H x

10

Equal to

Column H

Roundup((Column J +

Column

K)/100)


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Sl no. Indicator Target Observation

1Proportion of districts with operational fund available

at least 2 weeks before the campaign.

100%

2Proportion of districts with required quantity ofvaccines and injection equipments available at least 1

week before the campaign.

100%

3

Proportion of district campaign preparation committee

headed by DCO held preparatory meeting at least 10

days before the campaign.

100%

4


meeting minutes shared with the provincial steering

committee within 2 days of the meeting.

100%

5


meeting issues clear action plan with timeline and

responsibility for pre-campaign monitoring.

100%

6

Proportion of UC microplan submitted to the district at

least one week before the campaign of which at least

30% plan are reviewed and validated by the district

level staff.

100%

Measles - Polio SIA, Pakistan 2013Monitoring Preparation of the Measles SIA


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Information source

EDO (Health)/DHO

EDO (Health)/DHO

DCO

Provincial Program

Manager EPI

DCO

EDO (Health)/DHO/Dist

EPI Coordinator


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13/16

Name of Observer:___________________________ Designation:______________________________

District: ____________ Province: ___________

1

2

3

4

A. SITE ORGANIZATION

1

2

3

B. SESSION CONDUCTION & INJECTION PRACTICE

4

5

6

7

8

9

10

11

12

13

C. INJECTION SAFETY

14

15

16

17

18

D. AEFI MANAGEMENT

19

20

E. COLD CHAIN

21

22

23

24

25

Team has contact number of the AEFI focal person in the UC and district

Vaccines are stored in standard vaccine carrier with four ice packs

Diluents are kept in vaccine carrier

Both OPV and measles vaccines are given at the center

2 drops of OPV is given to each


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Name of the Observer:_______________________ Designation:____________________ Office:_________________

Village/Mahalla:________________________ Union Council/valley:__________________ Tehsil:________________

District:______________________________ Province/Area:__________

Area type: Urban/Rural Hard to Reach/High-risk population: Yes/No Date:_____/______/2013

(circle as appropriate) (circle as appropriate)

H1

H2

H3

H4

H5

H6

H7

H8

H9

H10

Note:

2. If any serious AEFI is found, immediately notify local authority.

3. Officials of the partner agencies and federal and provincial govt deparments will submit copy of this RCA to the WHO Islamabad

office within 3 days marking "attention: MO-EPI". All others would submit it to the respective DHO office.

Total

1.Please write down name and full address of the missed children/women on the back of the page and share those with local authorit

Measles - Polio SIA, Pakistan 2013Rapid Convenience Assessment (RCA)

All supervisors and independent observers should conduct at least one RCA daily in areas where the campaign has already taken pla

Take cluster in an area where vaccination is already completed. Purposively select area which is suspected to be missed. Do not tak

cluster in an area adjacent to an outreach or fixed vaccination center.

Start in a central location, and pick a direction at random. Begin with the first house facing you. Select and record vaccination status

measles of all target-age children in 10 households. If a household has more than one eligible child, collect data from all.

Send unvaccinated children to the nearest outreach or fixed site. If more than 2 children are found unvaccinated, inform the superviso

or local authority and request to plan a mop-up in that area.

If any AEFI is found, direct the guardian to take the child to a health facility.

HHNumber

Specific Address

HH number or Elder's name

Total number of

children aged


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Forms and Tools for Measles SIA (2)

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