Five Year Plan on Immunization Program of Neelakantha

Municipality
6.1 Introduction:
National Immunization Program (NIP) of Nepal (launched as Expanded Program on Immunization in
2034 BS) is a priority 1 program contributing to reduction in morbidity and mortality associated with
vaccine preventable diseases. Since FY 2069/70 (2012/13), Nepal has initiated and implemented a
unique initiative known as ‗full immunization program ‘. This program addresses issues of social
inequity in immunization as every child regardless of social or geographical aspect within an
administrative boundary are meant to be fully immunized under this program. Over the years, Nepal
has witnessed participation of all stakeholders at all levels to achieve full immunization.
As of end of FY 2074/75, a total of 80% palikas, and 56 out of 77 districts have been declared as
‗fully immunized ‘. Currently, the program provides vaccination against 11 vaccine preventable
diseases. Recently, since 2018, fractional dose of Inactivated Polio Vaccine and Rota virus vaccine
have been introduced in the program.

National Immunization Program

Vision:
Nepal: A country free of vaccine-preventable diseases.

Mission:
To provide every child and mother high-quality, safe and affordable vaccines and immunization
services from the National Immunization Program in an equitable manner.

Goal
Reduction of morbidity, mortality and disability associated with vaccine preventable diseases.

Strategic Objectives
Objective 1 Reach every child for full immunization;
Objective 2 Accelerate, achieve and sustain vaccine preventable diseases control, elimination and
eradication;
Objective 3 Strengthen immunization supply chain and vaccine management system for quality
immunization services;
Objective 4 Ensure financial sustainability for immunization program;
Objective 5 Promote innovation, research and social mobilization activities to enhance best practices
National Immunization Schedule
S.N. Type of vaccine Number Schedule
of doses
1 BCG 1 At birth or on first contact with health institution
2 OPV 3 6, 10 and 14 weeks of age
3 DPT-HepB-Hib 3 6, 10 and 14 weeks of age
4 fIPV 2 6, 10 and 14 weeks of age (applicable from FY
2075/76; previously given as IPV at 14 weeks)
5 PCV 3 6, 10 weeks and 9 months of age
6 Measles-Rubella 2 First dose at 9 months and second dose at 15
months of age
7 JE 1 12 months of age
8 Td 2 Pregnant women: 2 doses of Td one month apart in
first pregnancy, and 1 dose in each subsequent
pregnancy
9 Rotavirus vaccine 2 6 and 10 weeks
Table 69: National Immunization Schedule

Literature review:
 Situation analysis of immunization was conducted by studying different national studies and
reviews. Annual health report (2074/75) on immunization was studied and compared with the
situation of Province 3 and Neelakantha municipality to identify areas for improvement.

Current Situation/ Situation analysis:

 In order to assess the immunization status of a region, basically there are 3 indicators:

1) Immunization coverage (no. of doses given/ target pop n X 100)

2) Vaccine Wastage [no. of surplus doses (procured- given)/procured X 100)]
3) Drop-out (comparing administration of 2 vaccines, e.g. BCG vs. MR1)

-National status:
 The comprehensive Multi-year Plan for Immunization (cMYP) 2012 - 16 ended in 2016 and
new cMYP 2017-21 is in place. The cMYP 2017-2021 provides a plan for five years to
achieve immunization related goals of the country.
 The objectives, strategies and activities set forth in the plan provide the framework required
to meet the goal of reducing infant and child mortality and morbidity associated with vaccine
preventable diseases (VPDs). Furthermore, this plan addresses new challenges and expands
the previous plan by providing guidelines for introduction of new vaccines, eradication,
elimination and control of targeted VPDs and strengthening of routine immunization.
 The tables below show the vaccination coverage, wastage rates and dropout rates in different
levels (national, provincial, district and municipal levels) in the years 2073-75BS.
National vaccination coverage by vaccine, FY 2076/77
Antigens % Achieved Antigens % Achieved
(2075/76) (2075/76)
BCG 91 fIPV1 82
DPT-HepB-Hib1 90 fIPV2 60
DPT-HepB-Hib2 88 PCV1 88
DPT-HepB-Hib3 86 PCV2 86
DPT-HepB-Hib3 including delayed 90 PCV3 81
dose given after 1 year of age Td2 and Td2 + 64
OPV1 88 MR 1st dose 84
OPV2 85 MR 2nd dose 73
OPV3 84 JE 81
OPV 3 including delayed dose 87
given after 1 year of age
National vaccination coverage

District Status: Dhading District

Indicators % Achieved
2074-75 2075-76 2076-77
Percentage of children fully immunized as per 71 66
NIP schedule
Percentage of children under one year immunized 59 57
with BCG
Percentage of children under one year immunized 75 71
with DPT-HepB-Hib3
Percentage of children aged 9-11 months 71 73
immunized with Measles/Rubella 1

Table 71: Vaccine coverage in Dhading District

Provincial status: Province 3

S.N. Antigens % Achieved % Achieved
(2074/75) (2075/76)
1 BCG 82 80
2 DPT-HepB-Hib3 73 71
3 MR 1st dose 74 71
4 MR 2nd dose 57 60
5 OPV 3 86.8 87.5
Table 72: Vaccine coverage in Province 3
Municipal status: Neelakantha Municipality
Fiscal BCG DPT- OPV 3 PCV 3 MR 1 MR 2 JE
year Hep-
Hib 3
2074/75 70.09% 79.27% 77.44% 70.67% 69.80% 71.69% 88.34%
2075/76 66.96% 80.77% 80.77% 82.78% 82.33% 80.38% 82.55%
2076/77 67.61% 54.92% 54.69% 53.68% 55.26% 57.41% 62.28%
Table 73: Vaccine coverage in Neelakantha Municipality

National Dropout Rate of vaccination

S.N. Antigens Dropout rate (in %)
2074/75 2075/76
1 BCG vs. MR1 11.7 8
2 DPT-HepB-Hib1 vs. 3 7.4 4.3
3 DPT-HepB-Hib1 vs. MR1 8 7.4
Table 74: National Vaccination dropout rate

Vaccine dropout rate at Neelakantha Municipality

S.N. Antigens Dropout rate (in %) 1
2074/75 2075/76 2076/77
1 BCG vs. MR1 0.41 -22.94 18.25
2 DPT-Hep-Hib1 vs. 3 8.63 7.48 19.17
3 DPT-Hep-Hib1 vs. MR1 19.56 5.69 18.67
Table 74: National Vaccination dropout rate

National Vaccine Wastage Rate

S.N. Antigens Wastage rate (in %)
2074/75 2075/76
1 BCG 77 81
2 DPT-HepB-Hib 21 23
3 OPV 22 23
4 PCV 11 14
6 MR 49 49
7 JE 44 46
8 IPV/fIPV 27
Table 76: National Vaccine wastage rate
Vaccine wastage rate at Neelakantha Municipality
S.N. Antigens Wastage rate (in %)
2074/75 2075/76 2076/77
1 BCG 10.96 15.27 22.08
2 DPT-HepB-Hib 6.26 7.93 10.34
3 OPV 4.88 6.74 10.59
4 PCV 7.28 6.76 8.11
6 MR 4.82 5.09 6.31
7 JE 11.62 6.37 12.54
Table 77: Vaccination wastage rate at Neelakantha municipality

6.2 Rationale for topic selection:

We selected the topic 'immunization' taking into the consideration the following reasons.
 Province 3 is declared as fully immunized province but Neelakantha municipality is still lagging
behind.
 Vaccine coverage in Neelakantha municipality is low as compared to national vaccine coverage.
 High vaccine wastage rate in Neelakantha municipality.
 Immunization plays crucial role in child‘s health and maternal health.
 Targets could not be fully achieved in spite of effective campaign from national level.