1. Routine Immunizationcurrent status & low coverage areas identificationStrategy & way forward SEPIO meeting 18-20 May 2011 Dr Pradeep Haldar, MoHFW, GoI

2. Presentation Outline

Routine immunization Current Status

Evidence from the field

Low RI coverage area - Identification

Way forward

3. Routine Immunization in India Proportion of Fully immunized children (12 23 months) CES 2009: FI 61 % Source:http://www.mohfw.nic.in 4. Challenges: Access & Utilisation Source: DLHS-3 Data 5. Improved access but declining utilisation Source: DLHS-2 and DLHS-3 6. Assessing utilisation and access of services DLHS 2 versus DLHS 3 Full Immunization ImprovedUtilisation Improvement Decline Access Improvement Andhra Pr, Assam, Goa, HP, Karnataka, Kerala, Lakshadweep, Mizoram, Orissa, Punjab, Uttarakhand, WB Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh, D&D, Jharkhand Decline A & N Islands, Chandigarh, Delhi,Gujarat,Haryana, J&K, Manipur, Meghalaya, Tripura 7. Analysis of gaps

Low Access :

• Immunization session sites are not included in microplan

• Session not attended by ANM leave, post vacant, not going to the site

Poor utilisation:

• Irregular sessions, variable quality of services

• Non-availability of vaccine/logistics

• Poor messaging and communication

• Low community confidence in services

8. DLHS-2 v/s DLHS 3 Full Immunization Declined Utilization Improvement Decline Access Improvement Tamil Nadu Decline D& NH, Poducherry, Maharashtra, 9. BCG (HIMS 10-11 Vs CES-09) 10. BCG (HIMS 10-11 Vs CES-09) 11. DPT (HIMS 10-11 Vs CES-09) 12. DPT (HIMS 10-11 Vs CES-09) 13. Measles (HIMS 10-11 Vs CES-09) 14. Measles (HIMS 10-11 Vs CES-09) 15. Vaccine Supply Vs HIMS 10-11 16. Vaccine Supply Vs HIMS 10-11Cont 17. Findings from RI Monitoring 18. % RI session held UP, Bihar and Jharkhand (Year - 2010) n=number of sessions monitored 15 to 25% sessions not held / not held as per microplanDue to absence of ANM and/or vaccine, logistics 19. Availability of vaccine & diluent at RI sessionsJanuary December 2010 n=number of RI session found conducted 20. % availability of all Vaccines on sessions sites (Year 2010 & 1 stQuarter 2011) JBSAJachha Bachha Suraksha Abhiyan -UP JBSA started form August10 UP districts Cumulative Jan11 Mar11: State Average- 83% Sessions held- 17,573 Data not available =80% Not monitored UP districts CumulativeJan10 - Dec10 : 80% Sessions held- 59,811AEFI of Mohanlal Ganj (Lucknow) 21. Availability of all UIP vaccines and diluent at RI sessions, Bihar - 2010 Year 2010: Total 30,604 RI sessions monitored 22. %Sessions where all RI vaccines and AD syringes were available, Jan-Dec 2010, Jharkhand State average 2010: 69.8% Source:RI session monitoring data N = 5692 RI session found held 23. Full immunization status and BCG-measles drop out rates, 2010 Uttar Pradesh FIC (Fully immunized coverage) BCG-measles drop out rate n= 1,76,634 children 12 to 23 month of age 24. Full immunization status and BCG-measles drop out rates, Bihar, Jan-Mar 2011 FIC (Fully immunized coverage) BCG-measles drop out rate n = 20,872 children 12 to 23 month of age 25. Jharkhand: Monitoring community coverage gaps: % Fully immunized children, children 12-23 months By district, Year 2010 State average : 76.1% Source:RI h-t-h monitoring data N = 12485 Children 12-23 month Percent fully immunized 26. Improving access and utilisation of RI: Lessons from pulse polio activities (1)

Social mobilization in Polio to increase utilisation;

• Messages tailored for specific audience

• Use of local resources (community members, local leaders, and influential people)

• Religious sites and gatherings for message delivery

Strengthen linkages with pulse polio teams activities:

• Polio microplans to include RI session site information (where, when and by whom)

• Teams provide RI card to families during the house-to-house visits and share information on RI sessions

27. Improving access and utilisation of RI: Lessons from pulse polio activities (2)

Strong inter-sectoral coordination (health, education and ICDS):

• Pooling of human resources, venue, vehicles and leadership prior and during rounds

• ANM and ASHA (Health), AWW (of ICDS), School teachers (education) works together.

• Evening briefings attended by MOI/Cs, CDPOs, BEO and community members for better planning

Replicating and extending coordination in support of RI:

• RI monitoring feedback during coordination meetings

• Preparing joint strategies to strengthen RI at different levels

28. Low coverage area Identification

populations known to have a disproportionate share of the disease burden;

un-immunized or under-immunized children in urban and peri-urban areas;

populations in places where sanitation is poor;

populations inhabiting difficult or mountainous terrain, marshy areas, islands

refugees, internally displaced persons, migrant workers and other transient populations;

politically and or socially marginalized populations or minority groups;

religious groups that oppose vaccination.

Communities at international borders and Intra-State administrative borders.

29. Identification and prioritizationlow coverage areas

URBAN Strategy

Rural Strategy

• First priority to the villages/habitations which are never (rarely) reached

• Then the villages / habitations in which immunization was planned but not held during previous 3-4 months.

• Villages where RI is normally done but coverage is low

• Convergence of Microplan for uncovered areas

30. Way forward

Experience from Polio SIAs to be used for RI improvement

• Improved access and utilization

• Updating micro-plans

• Social mobilization

Expand RI monitoring to other states and locations

31. Thank you