IPPI MICRO-PLANNING 2020

PHC / UHP / Mpty: _______________________

Block: ________________________________

HUD / Corporation: _______________________

ANNING 2020

___________

__________

____________
 CONTENT

1) PHC / UPHC / Mpty Profile

2) High risk / Migratory site Survey data with map

3) Planning Forms – 1, 2 & 3

4) PHC / UPHC / Mpty Maps

(a) Map of PHC / UPHC / Mpty area showing HRAs (Settled & Migrant sites), location of Polio booth & Route of Vaccine
distribution
(b) Supervisors Area Map Allocation
(c) Spot map of transit sites

5) Form 4 A - Booth planning template

6) Form 4 B - House to House planning Form

7) Form 4 C - Template for Transit Point Planning

8) Form 4 D - Planning of mobile team activity for migratory & High risk sites

9) Form 5 - Miking Format

10) Form 6 - Check list for Preparing / Reviewing Microplans

of Vaccine
IPPI - Jan, 2020
6. No. of Villages/Ward:

2. Estimated Populations (including Migratory): 7. No. of HSC:

Urban __________ Rural ____________ Migratory_____________ Total___________ 8. Total Booths:

3. Children < 5 Years (including Migratory)

9. Total Transit Teams

Urban __________ Rural ____________ Migratory_____________ Total___________

10.Total Mobile Teams:

4. No. of Households
11. Total h-t-h teams:

Urban __________ Rural ____________ Migratory_____________ Total___________

5. Details of settled High risk & Migratory area / sites 12. No. of Vaccinators: Health Dept:

Other Dept:
Slums with
Brick kilns Constructio Settled
Type of sites → migration Nomads (2) Others (5*) Total Volunteers:
(3) n site (4) HRA **
(1)
Total:

No. of sites / Areas

Population 14. No. of Supervisors:

No. of Households
No. of Children <5 yrs

No. of sites / Areas included

in IPPI Microplan

No. of sites / Areas included

in RI Microplan Signature o
% of <5 yr Children in the Migrant / settled HRA Population:_____________

* Others: Occupational migrants include Agriculture/ Poultry/Animal husbandry/Circus/Quarries / Fishing communities who migrate with families during season

Settled HRAs: 6 - Urban Slums; 6 A - Hard to Reach Area; 6 B - VPD Outbreak Areas;6 C - Unserved/Vacant sub centres;6 D - Underserved/Vaccin
Hesitancy/Refusal Area; 6E - Others
 HRA Booths:

HRA Transit:

HRA Mobile:

HRA h-t-h
teams:
 Signature of MO

served/Vaccine
 Name of HSC

Total
IPPI - Jan, 2020

Urban / Rural

Estimated number of children

below 5 years

No. of Vaccination Booths

HUD / Corp: _____________________

required
Booth activity

No. of Team Members required

Estimated houses in the area

Block:

( from the last IPPI round )

No. of Teams required

No. of Team members

required
House-to-House activity

No. of transit points

No. of team members required

Transit points

No. of sites to be covered

No. of Mobile team members

Mobile teams

required
Form 1

No. of Supervisors required

____________________PHC / UPHC / Mpty:________________
IPPI - Jan, 2020

Name of PHC / UPHC / Mpty:____________________________ Name of Block:________________________

Name of HUD / Corp.:_________________________________

Migratory HR Areas
Migrants residing in slum Nomads Brick kilns Construction sites
Address of Area

No. of Households

No. of Households

No. of Households

No. of Households
No. of under 5 yrs

No. of under 5 yrs

No. of under 5 yrs

Number of Sites

Number of Sites

Number of Sites

Number of Sites
S.No.

Children

Children

Children
 Total 0 0 0 0 0 0 0 0 0 0 0

*Type of HRA Code : Settled HRA

1 - Slum with migration 6 - Urban Slums
2 - Nomads 6 A - Hard to Reach Area
3 - Brick Kiln 6 B - VPD Outbreak Areas
4 - Construction Sites 6 C - Unserved/Vacant sub centres
5 - Others 6 D - Underserved/Vaccine Hesitancy/Refusal Area
6 E - Others
 n sites
No. of under 5 yrs
Children

Number of Sites

No. of Households

Others*
No. of under 5 yrs
Children

Number of Sites

No. of Households
HR Areas

No. of under 5 yrs

Settled HR Areas**

Children
Date:____/_____/______
0 0 0 0 0 0 0

Signature of MO
 Name of HSC
IPPI - Jan, 2020

Urban / Rural

Estimated population

Estimated number of Children

Resident

(Non HRA)
population

below 5 Years

Number of Areas

Estimated population
(HRA)

Estimated number of Children

below 5 Years
Settled population

Number of sites

Estimated population
HUD / Corp.: ____________________

Migratory
population

Estimated number of Children

below 5 Years

Total Estimated population

(Resident Non HRA + HRA + Migrants)

Total Estimated children

below 5 years
(Resident Non HRA + HRA + Migrants)

Vaccination Booths Required

Booth Team Members required

Booth activity

Supervisors required

Number of transit teams

Transit team members required

Manpower Planning Form

Transit points

Supervisors required

Estimated houses in the area

(from the last SIA round)

Teams required

Team members required

Resident
population

Supervisors required
H to H activity for

Teams required

Team members required

risk population

Supervisors required
Migratory & High
H to H activity for

No. of sites covered by mobile

teams
Mo
Block:_______________________ PHC / UPHC / Mpty:____________
Migratory / Settled High R
Total
 Teams required

Mobile Team Members Required

Mobile teams
d High Risk strategy
Supervisors required

Total Number of Vaccinators**

(Booth + Transit + Mobile team members)

Total Number of Supervisors**

Form 1B-HRA

_________________________________
 IIPPI

Name of PHC / UPHC / Mpty

Total
- Jan, 2020

Urban / Rural

Total Estimated population

(Resident + Migrants)

Total Estimated children

below 5 years
(Resident + Migrant)

Total OPV doses required

for each round

Total OPV vials required

HUD / Corp.: ______________________

for each round

Required as per
micro plan

Available

Shortage
Vaccine Carrier

Required as per
micro plan
Cold Box

Available

Required as per
micro plan
ILRs
Vaccine and Cold Chain Planning Form

Available in
functioning condition
Required as per
micro plan
Deep

Available in
Freezers

functioning condition

Required for vaccine

carriers and cold boxes
Ice Packs

Available for vaccine

varriers and cold boxes

Comments(Availability of power
Block:_______________________

supply,stabilizers,
thermometers, etc)
Form 2
Total
Name of PHC / UPHC / Mpty
IPPI - Jan, 2020

Supervisor's Checklist
(7A)
Supervisor's Tally Sheet
(7B)
Supervisor's Reporting
Format (9A)
Logistics

Vaccinator's Booth Tally

Sheet (8A)
Vaccinator's H-t-h Tally
HUD / Corp : _____________________

Sheet (8B)

Vaccinator's X Sheets (8C)

Chalk

Janker Pen

Total Vehicles Required

Vechicles available

Additional Vehicles
Needed
& Logistics

Specify type
Transport for Vaccine

Additional Vehicles
Needed
Teams
Mobile

Specify type
Logistics and Transport Planning Form

Transport for

Number of Supervisors

Supervisors using own

transport
Additional Vehicles
Needed
Supervision
Transport for

Specify type
Form 3

Comments
Block:________________________
IPPI - Jan, 2020 LEGEND

PHC
SUB CENTRE

VILLAGE

ROAD

POLIO BOOTH
P
RAILWAY LINE

RIVER

LAKE / POND

SCHOOL S
TEMPLE

MOSQUE

CHURCH

SETTLED HRA#: SHADE THE AREA

WITH ORANGE / RED COLOUR

MIGRANT SITES*

# Settled HRAs: Slum/ Hilly Terrain / Hard to reach areas / Low immunization coverage areas / Field Huts / Sri Lankan Refugees, etc. SHOW ROUTE OF VACCINE
* Migrant Site: M1- Slums with migration, M2- Nomads, M3- Brick DISTRIBUTION USING ARROW
kilns, M4- Construction site, M5- Others JanKS
Signature of MO
Supervisor's Area Allocation Map
LEGEND
PHC

SUB CENTRE

VILLAGES

ROAD

POLIO BOOTH
P
RAILWAY LINE

RIVER

LAKE / POND

SCHOOL S
TEMPLE

MOSQUE

CHURCH

SETTLED HRA SHADE THE AREA

WITH ORANGE COLOUR

MIGRATORY SITES

OTHER
Signature of MO
 Spot Map of Transit Sites in PHC / UPHC / Mpty Area
PHC/UPHC/Mpty:_____________________________ Block:_________________________________

Signature of MO
Signature of MO
IPPI - Jan, 2020
Booth Planning Template
HUD / Corp.: ______________________________ Block:______________________________

PHC / UPHC / Mpty:__________________________ Name of Supervisor: ______________________________

Is this
Booth booth
Booth Location with address If yes, type of HRA Name of Team Members Designation
No. located in
HRA?

Slum with Migration /

Nomads / Brick kiln/
Yes / No
Construction site /
Others/ Settled HRA

Slum with Migration /

Nomads / Brick kiln/
Yes / No
Construction site /
Others/ Settled HRA

Slum with Migration /

Nomads / Brick kiln/
Yes / No
Construction site /
Others/ Settled HRA

Slum with Migration /

Nomads / Brick kiln/
Yes / No
Construction site /
Others/ Settled HRA

Slum with Migration /

Nomads / Brick kiln/
Yes / No
Construction site /
Others/ Settled HRA
 Slum with Migration /
Nomads / Brick kiln/
Yes / No
Construction site /
Others/ Settled HRA
______________

_______________

Name of Local Influencer/s

IPPI - Jan, 2020

House to House (H-to-H) Planning Form

HUD / Corp._____________________________ Block: _________________________________ PHC / UPHC / Mpty:_

Name & Mobile No of Supervisor_________________ Name and Mobile No of MOIC: __________________________

(1) Name of vaccinator H-to-H 1 st day H-to-H 2 nd day
Team No (Monday) (Tuesday)
Name and description of the area to be
covered
Designation Is this an identified HRA? Yes/ No Yes/ No

Slum with Migration / Nomads Slum with migration / nomads

If yes, type of HRA / Brick kiln/ Construction site / / Brick kiln/ Construction site /
Others/ Settled HRA Others/ Settled HRA

Mobile No Name & address of first house owner with

landJanks
Special landJanks in the area & detailed
route description (via)
(2) Name of vaccinator Name & address of last house owner with
landJanks

Meeting point before afternoon activity

Designation
No of houses in the area

Mobile No
Name and mobile no of the influencer/s

Area specific Routine Immunization information

Name of HSC

Name of V.H.N.

Location of site where RI session is held

Day of RI

Name of Local Mobilizer / ASHA / Link Worker supporting RI session

Name of AWW supporting RI session

Signature of Supervisor
 Form 4 B
Form
C / UPHC / Mpty:_____________________________

____________________

Addl. Days if required

Yes/ No Yes/ No

Slum with migration / nomads

Slum with migration / nomads / Brick kiln/
/ Brick kiln/ Construction site /
Construction site / Others/ Settled HRA
Others/ Settled HRA
Signature of Medical Officer
 Template for Transit Point Planning Form 4 C
HUD / Corp._____________________________ Block:_____________________________ PHC / UPHC / Mpty:___________________________

Team No Name and Addresss of Transit Point Shift 1 Shift 2 Shift 3

Timing

Name of
Team Members

Timing

Name of
Team Members

Timing

Name of
Team Members

Timing

Name of
Team Members

Timing

Name of
Team Members

Timing

Name of
Team Members

Note : Teams should preferably work in shifts. Starting time and ending time should be indicated in the row of Timing of the shift

Signature of the Supervisor Signature of the Medical Officer

IPPI - Jan, 2020
Planning of Mobile Team Activity for Migratory & High Risk Sites

HUD / Corp.______________________ Block:_____________________________

PHC / UPHC / Mpty:______________

Medical Officer (Name & Tel No): ____________________ Supervisor (Name & Tel No): ______________________
Site 1 Site 2 Site 3 Site 4
Timing of visit

Address of area
Is this Settled (S) / Migrant
M/S M/S M/S M/S
(M) HRA
Day 1 Slum with migration / Nomad / Slum with migration / Slum with migration / Nomad / Slum with migration /
Brick Kiln / Construct Site Nomad / Brick Kiln / Brick Kiln / Construct Site Nomad / Brick Kiln /
Type of site /Other Construct Site /Other /Other Construct Site /Other
Is this site linked to RI
session site Yes / No Yes / No Yes / No Yes / No
Site specific Routine Immunization Information
Name of HSC
Name of VHN
Nearest RI session site
Day / week of RI session

Supporting Mobilizer / Link worker/ ASHA

AWW for the area
Timing of visit

Address of area
Is this Settled (S) / Migrant
M/S M/S M/S M/S
(M) HRA
Slum with migration / Nomad / Slum with migration / Slum with migration / Nomad / Slum with migration /
Day 2
Brick Kiln / Construct Site Nomad / Brick Kiln / Brick Kiln / Construct Site Nomad / Brick Kiln /
Type of site /Other Construct Site /Other /Other Construct Site /Other
Is this site linked to RI
session site Yes / No Yes / No Yes / No Yes / No
Site specific Routine
Immunization Information
Site specific Routine Immunization Information
Name of HSC
Name of VHN
Nearest RI session site
Day / week of RI session

Supporting Mobilizer / Link worker/ ASHA

AWW for the area
Timing of visit

Address of area
Is this Settled (S) / Migrant
M/S M/S M/S M/S
(M) HRA
Slum with migration / Nomad / Slum with migration / Slum with migration / Nomad / Slum with migration /
Day 3 Brick Kiln / Construct Site Nomad / Brick Kiln / Brick Kiln / Construct Site Nomad / Brick Kiln /
Type of site /Other Construct Site /Other /Other Construct Site /Other
Is this site linked to RI
session site Yes / No Yes / No Yes / No Yes / No
Site specific Routine
Immunization Information
Site specific Routine Immunization Information
Name of HSC
Name of VHN
Nearest RI session site
Day / week of RI session

Supporting Mobilizer / Link worker/ ASHA

AWW for the area
Note: Each site should be visited at least twice during the IPPI. Starting time and ending time should be indicated in the row of “Timing of visit”.
 Form 4 D

_______________________

Site 4

M/S

with migration /
d / Brick Kiln /
uct Site /Other

Yes / No

M/S

with migration /
d / Brick Kiln /
uct Site /Other

Yes / No

M/S

with migration /
d / Brick Kiln /
uct Site /Other

Yes / No
IPPI - Jan, 2020 MIKING FORMAT Form 5

Block:_____________________________ PHC / UPHC / Mpty:______________________

Date

Type Of Vehicle Description of Area to be Covered

Time

Name of Person
Monitoring Miking

Time

Name of Person
Monitoring Miking

Time

Name of Person
Monitoring Miking
Signature of Medical Officer
IPPI - Jan, 2020
Check List for Preparing / Reviewing Microplans
HUD / Corp._____________________________ Block:_____________________________ PHC / UPHC / Mpty:___

Micro Planning Check List Yes No

Has data and feedback from of past rounds been analyzed for corrective actions in
this round ?

Are booth locations identified and mapped ?

Have reliable and motivated vaccinators been identified and assigned booths?

Well defined day-wise area allocation to h-t-h teams with boundaries done ?

At least one female vaccinator from the local community available in each team ?

Are ICDS and ASHA workers part of vaccination teams in their areas ?

Is the daily workload distribution of house to house teams reasonable (in terms of
houses and geography) ?

Have microplans been developed for development of transit sites and Mobile teams?

Are young and energetic vaccinators deployed as a part of these teams?

Are Supervisors identified and assiged booth / house to house / transit / mobile
teams ?

Is there an orientation plan for vaccinators and supervisors ?

High Risk / Migrant Sites

Are slums, periurban areas, Nomads, brick kilns, construction sites, recently
developed townships included in microplans ?
Whether High risk and hard to reach areas identified and special plans developed to
cover these areas ?
Whether these sites are validated?

Maps
Map of planning unit / block / urban area with essential information marked prepared

Supervisor's map with day-wise demarcation of area to be covered by each team

Team wise maps with demarcation of area to be covered daily by each vaccinator team
 Form 6
ing / Reviewing Microplans
________ PHC / UPHC / Mpty:___________________________

Vaccine, Cold Chain & Other Logistics Yes No

Calculated correctly total OPV doses and vials required each round

Cold chain equipment identified (required, available, functioning)

Plan for freezing of ice packs / identification of ice pack freezing sites

Vaccine distribution centers / dropping points identified and daywise distribution plan
developed

Plan for procurement of logistics and other supplies - marker pens, chalk / tally sheets
etc

Transport

Inventory of available and required vehicles

Firm arrangements made for the procurement / Hiring of vehicles

Transport arranged for supply of vaccine and logistics

Transport arranged for mobile teams

Independent mobility / transport arranged for each supervisor

Daily vehicle movement / route chart prepared for each vehicle for vaccine
delivery/supervision

Social Mobilization

IEC plan through mike announcements, inter-personal communication and cable TV

Plans for briefing media (District and state level)

Schedule
Plan for District Coordination Meeting

Schedule for district level officials to visit blocks to oversee preparations and monitor
implementation

Work plan with time-line, activities/task, time to be completed and person responsible

Signature of MO