An Update

India’s Immunization Programme

Immunization Division, MOHFW, Govt. of India

Overview of Universal Immunization Programme (UIP)
 One

of the largest, ongoing public health interventions in the country  Centrally sponsored programme under National Rural health Mission - NRHM (2005-12)  Programme targeted ~ 26 million infants and 30 million pregnant women in 2009-10  All the vaccines are procured by central government with 100% domestic funding
Immunization Division, MOHFW, Govt. of India

Full Immunization Coverage (DLHS-3)
Coverage
Low (<50%) Medium (50-70%)

States/UT
Uttar Pradesh , Meghalaya , Madhya Pradesh , Tripura , Arunachal Pradesh , Bihar , Manipur and Rajasthan Mizoram , Assam , Jharkhand , Gujarat , Chhattisgarh , Haryana , Orissa , Jammu & Kashmir , Uttarakhand , Andhra Pradesh , Delhi , D & NH and Maharashtra Chandigarh, West Bengal, Karnataka, Sikkim, Kerala, Punjab, Pondicherry, Himachal Pradesh, Tamil Nadu, Lakshadweep, A & N Islands, Daman & Diu and Goa

High (>70%)

Immunization Division, MOHFW, Govt. of India

Measles Second Opportunity

Applying the 80% MCV1 coverage cut-off and applying DLHS-3 survey data there are ▪ 14 states qualify for catch-up campaign in 9 mo-10 yrs age group ▪ 21 states qualify for MCV2 through routine immunization
 4 states viz. Delhi, Goa, Poducherry & Sikkim already introduced 2nd dose

Operational guidelines for Measles catch-up campaign developed State planning for second opportunity of Measles started
Immunization Division, MOHFW, Govt. of India

Measles Coverage (DLHS-3)
India : 69.6%
2nd Dose of RI

Immunization Division, MOHFW, Govt. of India

Polio cases, India
Most recent virus 28 May 2010 Birbhum, WB

WPVs State Jamm u & Kashmir Maharashtra West Bengal Uttar Pradesh Bihar Haryana Total P1 1 1 3 0 0 0 5 P3 0 0 0 10 6 1 17 Total 1 1 3 10 6 1 22

* data as on 25 June 2010

Why is Polio Transmission Persisting?
 Remaining

gaps in SIA quality in high-risk areas  High-risk populations missed during SIAs, especially migrant populations  Low routine OPV3 immunization coverage  Poor sanitation and Hygiene  Convergence of these risk factors in high-risk blocks

Cold Chain:
State Chhattisgarh H.P Manipur West Bengal WIC 2 1 1 4

Status of Preparedness of WIC/WIF sites for installation
WIF Status as per record 1 1 1 Site Not Identified; 1 WIC lying for 3 yrs Site NOT Identified Site NOT Identified Sites Identified, Civil work NOT started

•All the states were informed of these installation in Nov’09 •Other states need to expedite the civil work so that WIC/WIF installation can be completed by end of July’10

Cold Chain: Key issues
High sickness rate, response time and break down period of cold chain equipments.  Temperature monitoring of vaccines requires strengthening
 Ø Cold chain management is poor in some places

(including private practices), particularly for temperature recording and risk of freezing the freeze-sensitive vaccines.

There is need to assess adequacy of trained manpower with essential qualifications at every level.  Disposal of condemn equipments – occupying un-necessary space. Needs to be dispose off

Immunization training of Health workers
State / UT s Andhra Pr Arunachal Pr Assam Bihar Chattisgarh Haryana J & K Kerala Madhya Orissa Punjab Rajasthan Sikkim West Bengal Total Pr Maharashtra Annual Target 6728 319 1567 5558 2266 1211 574 3297 7077 13057 4587 933 4758 200 7855 69397 Trained in 2009 - 10 19413 0 0 0 5638 0 483 2687 5937 8131 2408 150 0 0 0 13795 41763
D&N HAVELI MAHARASHTRA HIMACHAL PRADESH PUNJAB UTTARANCHAL HARYANA SIKKIM RAJ ASTHAN UTTAR PRADE SH BIHAR ARUNACHAL PR.

< 30% 30% - 50 %
JAMMU & KAS HMIR

50 % - 80 % > 80 % Completed

GUJARAT

MADHYA PRADESH

ASSAM NAG ALAND MEG HALAYA MANIPUR TRIPURA JHARKHAND MIZORAM WEST BENGAL

CHHATTISGARH ORIS SA

ANDHRA PRADESH GOA KARNATAKA A&N ISLANDS PONDICHERRY TAMIL NADU LAK SHADW EEPKERALA

Uttar Pradesh 6700

Rest of the states have completed the training or achieved 90%
(As on 1 June 10) Immunization in 2007-08; ~175,000 out of 220,000 HW Trainings startedDivision, MOHFW, Govt. of India

of Total training load

Immunization Training of Medical Officers
TOTs conducted for 1500 trainers from all states during 2009-10.  MO-Training started and ~11500 out of 62000 (18%) MOs trained so far.  Slow / No progress in 22 states.  Monitoring needs MOHFW, Govt. of India Immunization Division,

JAMMU & KAS HMIR HIMACHAL PRADESH PUNJAB UTTARANCHAL HARYANA RAJ ASTHAN GUJARAT MADHYA PRADESH D&N HAVELI MAHARASHTRA GOA KARNATAKA PONDICHERRY TAMIL NADU LAK SHADW EEPKERALA

Not Started < 30% 30 % - 50% 50 % -80% > 80%

SIKKIM BIHAR

ARUNACHAL PR.

UTTAR PRADE SH

ASSAM NAG ALAND MEG HALAYA MANIPUR TRIPURA JHARKHAND MIZORAM WEST BENGAL

CHHATTISGARH ORIS SA

ANDHRA PRADESH

A&N ISLANDS

As on 1 June10

New Vaccine Introduction

Hepatitis B Ø Already in 10 states and selected cities and districts of the country Ø Expansion of Hepatitis B vaccine in the remaining states of country in phased manner is under consideration Ø Service delivery issues -Birth dose of Hep B not being given within 24 hours
ØReluctance to use due to concerns about AEFI and vaccine wastage (Punjab & Tamil Nadu) Immunization Division, MOHFW, Govt. of India

Hepatitis B States Hepatitis B Pilot Districts

Hepatitis B Pilot Cities

Reported Coverage 200910-Issues

Immunization Division, MOHFW, Govt. of India

Reported Coverage 200910-Issues

Immunization Division, MOHFW, Govt. of India

Name Based Tracking of Pregnant Mothers & Children – ANCs & Immunisation
Ministry of Health & Family Welfare

Objective
• Name-based tracking of
– pregnant women - for ANCs, Delivery & PNCs – children - for immunisation

• To facilitate
– Closer monitoring of regular check-ups of pregnant women and reduce avoidable complications – Complete immunisation of children

• For closer monitoring of mortality indicators (IMR and MMR)

Coverage
• Pregnant Women
– All pregnant women since 1st April, 2009 – In the first instance from 1st December, 2009 – Emphasis on ALL pregnancies
• Irrespective of whether ANCs are done by public or private health provider

• Children
– All Births since 1st April, 2009 – In the first instance from 1st December, 2009 – Emphasis on all births – public or private

Data to be captured

Pregnant Women
      

INFANTS

Location Details
Ø State, District, Block,

Location Details
Ø State, District, Block,

Identification details
Ø Name, DOB, Phone No,

Address

Health Provider details
Ø HSC, ANM, ASHA, Linked

JSY, caste

Identification details
Ø Name, DOB, Phone

Address

ANC details

facility for delivery

Ø LMP, ANC dates, TT, IFA,

Health Provider details

No, JSY, caste

Pregnancy Outcome PNC Details - dates Infant details
benefits

Anemia, complications

Ø Place, delivery date, JSY

Immunization details
Ø Dates for BCG, OPV,

Ø HSC, ANM, ASHA

DPT, Hepatitis, Measles, Vit A

16 digit Identity Code
1 2 Digits (Nos) 01-02 (2) 03-04 (2) 05-07 (3) 08-09 (2) 10-10 (1) 11-12 (2) 3 10 2 11 2 2 3 12 1 1 4 13 3 1 14 5 6 15 1 6 7 16 1 0 0 8 0 0 1 9 Item State Code District Code Block PHC/CHC Code Health Sub-Centre Code Pregnant Woman – Code 1; Child – Code 2 Year Code Last 2 digits for the year is to be given, for example, for the year 2009, “09” will be entered and so on Description /Remarks As per Census codes As per Census codes As per Census codes given to Block HQ To be serially given by Block HQ.

13-16 (4)

To be given serially to each From 1st April each year, the codes will be mother / child from 1st December, given afresh starting from 0001. 2009 starting from 5000

Progress made so far…
Based on recent observations during field tours
States

Ø Ø Ø

Status Mother & Child tracking registers printed; •Data entry in registers started, •Computerization to be done

Chhattisgarh

Orissa

Standardized Formats for data collection •Data entry at blocks in standardized excel sheets developed by state

West Bengal

Standardized formats for data collection •Data entry started at block levels in excel sheets designed at blocks; lack of uniformity

Uttarakhand

Standardized formats for data collection •Data entry started at block levels in excel sheets designed at blocks

Issues in the field
 Special
Ø To Ø To Ø To Ø To

software required for this process
generate beneficiary list maintain uniformity avoid duplication of beneficiaries access data for supervision/monitoring Ø To calculate coverage

 Data

entry at block level being done by Block Accounts Assistant; no data entry operator
Ø Huge volume of data coming monthly

Name Based Information Tracking System -NHSRC
 Name

Based Information Tracking System (NBITS) being developed by NHSRC and piloted in MP  This would address some of the issues raised

Ø Ø Ø Ø Ø

Thank you

Immunization Division, MOHFW, Govt. of India