Académique Documents
Professionnel Documents
Culture Documents
in Bihar, MP and UP
Diagnostic findings
November 2012
ITSU - PHFI
Content
ITSU - PHFI 2
Memorandum
implement activities
to strengthen Indias
UIP/RI programme
ITSU - PHFI 3
Criteria for
shortlisting districts
for deep-dive
Combination of
Combination of
districts which
are near and far
from regional
warehouse
Districts from
different regional
warehouses in the
State
ITSU - PHFI
Madhya Pradesh
Uttar Pradesh
Patna
Bhopal
Gwalior
Lucknow
Varanasi
Agra
Bhagalpur
Purnia
Faizabad
Allahabad
Jamui
Saharsa
Guna
Tikamgarh
Shravasti
Allahabad
Etah
State/ Regional
Divisional
District
Block
Jamui-Sadar
Giddhor
Salkhua
Simri Bakhtiyarpur
Aron
Beenaganj
Niwari
Jatara
Hariharpurrani
Ikauna
Koraon
Mauiama
Aliganj
Jalesar
ITSU - PHFI 5
Bihar
Suppliers
Partners
ITSU - PHFI 6
Technician, Tikamgarh)
Dr K K Srivastav (MOIC, Aron)
Dr B S Raghuvanshi (Cold Chain and RI Ic)
Uttar Pradesh
Dr Vedprakash (GM Immunization, NRHM)
Mr Amit Kumar Ghosh (MD, NRHM)
Dr Bharat Ram (AD, UIP)
Dr Poornimal Verma (JD, EPI)
Mr Shashank (Assistant cold chain officer,
Lucknow)
Mr Nigam (Store keeper State)
Mr Ramesh Gupta (State Refrigerator Mechanic)
Mr O P Kueeil (Admin officer, Nadarganj)
Dr D K Dubey (Additional Director, Varanasi
division)
Mr Gupta (Operator/ Cold-chain handler,
Varanasi regional store)
Dr Padmakar Singh (CMO Allahabad)
Capt Ashutosh Srivastav (DIO, Allahabad)
Mr P K Anuragi (Cold chain handler, Allahabad
district store)
Mr
Rajkumar
(Refrigerator
Allahabad district store)
Mechanic,
Mr G N Yadav (DHNTC)
Dr M L Verma (BMP, Hariharpurrani)
Mrs Lalita Devi (LHV/ Cold-chain
handler, Hariharpurrani)
Mr Ramanand Prajapati (Record keeper)
Dr Rajat Singh (BMO, Ikuana)
Mr R K Tyagi (AD, Faizabad)
Mr Jagdish Malhotra (Refrigerator Mechanic,
Faizabad)
Mr Vinay Kumar (WIC attendant, Faizabad)
Dr Chitranshi (Joint Director)
Dr V Pandey (Joint Director)
Dr Padmakar Singh (CMO, Allahabad)
Mr Harish Singh (Cold-chain
Allahabad division)
Ms Sonal Rai (DHNTC)
Dr U B Singh (MOIC, Suraon)
Mr Pankaj Singh
Officer, Suraon)
(Health
handler,
Education
PHC)
Dr Ashok Singh (Store-keeper, Agra warehouse)
Mr Rakesh Kumar (Cold-chain incharge, Agra
warehouse)
Dr Manju Sharma (CMO, Agra)
CMO, Etah
Cold-chain handler, Etah
Store-keeper, Etah
Cold-chain technician/ store-keeper, Aliganj
Dr Rajesh Sharma (MOIC, Aliganj)
Dr R P Gupta (CMO, Sharawasti)
Dr Ashok Kumar Sant (DIO, Sharawasti)
Dr Praveen (Chief Pharmacist, Shrawasti)
Officer, Muaiyama)
Prema Devi (LHV)
10 ANM/AWW/ASHAs
ITSU - PHFI 7
Content
ITSU - PHFI 8
Madhya Pradesh
Uttar Pradesh
Instances of ANM not
taking vaccine despite
vaccine being available at
PHC due to lower
anticipated demand at
session (especially in UP)
Data not
noted
NA
* For Bihar: Apr 2011-Mar 2012 from all 4 blocks visited; For MP: Aug 2011-Aug 2012 (except for Beenaganj & Aron, it is Aug 2011-Mar 2012); MP TT stock-out data
is for Aron, Jatara and Niwari blocks only; For UP, Apr 2011-Mar 2012 for Hariharpurrani & Ikuana, Oct 2011-Oct 2012 for Jalesar, Feb 2011-Jul 2012 for Aliganj, May
2011-Apr 2012 for Mauiama and Oct 2011-Mar 2012 for Koraon
SOURCE: Block stock registers
ITSU - PHFI 9
Content
ITSU - PHFI 10
DPT
Assumptions
Ideal supply
calculated as total
supply in the year
to be distributed
equally in 6 bimonthly intervals
Total supply
includes opening
stock in April
and delivery
from suppliers
and GMSDs
SOURCE: PHI
TT
ITSU - PHFI 12
BCG
TT
Hep-B
Assumptions
Ideal supply
calculated as total
supply in the year
to be distributed
equally in 6 bimonthly intervals
Total supply
includes opening
stock in April
and delivery
from suppliers
and GMSDs
SOURCE: PHI
ITSU - PHFI 13
DPT
TT
Measles
Assumptions
Ideal supply
calculated as total
supply in the year
to be distributed
equally in 6 bimonthly intervals
Total supply
includes opening
stock in April
and delivery
from suppliers
and GMSDs
SOURCE: PHI
ITSU - PHFI 14
TT
25%
7%
ITSU - PHFI 15
A Hep-B supplied to Agra, Lucknow and Gwalior were 60-70% short of order
placed by Centre
Lucknow
63%
SOURCE: UIP Programme division; Stock registers at Agra, Lucknow and Gwalio
Agra
63%
77%
ITSU - PHFI 16
Supply chain
structure
Safety/ buffer
stock
Basis of
distribution
Pick-ups
by blocks
Description
Examples
ITSU - PHFI 17
Bihar
(42 sessions)
UNICEF study
(5 states*, 2010)
Target population:
Number of
beneficiaries as
provided by State
Coverage as per
UNICEF Coverage
Evaluation Survey
Wastage: 25%
Buffer: 25%
Data not
noted
* Includes Uttar Pradesh, Assam, Maharashtra, Tamil Nadu and Himachal Pradesh
SOURCE: Tally sheets of ANMs; Vaccine Wastage Assessment, April 2010 (UNICEF);
ITSU - PHFI 18
Cold storage
capacity
Description
Examples
Delay in
installation
Quality and
maintenance of
equipment
Store
Store location
location
small,
inconvenient or inappropriate
ITSU - PHFI 19
Key assumptions
WIF
Storage guidelines:
tOPV in WIF only
DPT and TT in WIC only
BCG and Measles in WIC,
however can be stored in
WIF if lack of space in
WIC
Key assumptions
Purnia has
PURNIA
division:
1 WIC with capacity of 1.21.5 lakh vial
1 WIF with capacity of 1.5-2
lakh vial
Storage capacity at Bhagalpur:
2 WIC with capacity of 22.5 lakh vial each
1 DF with capacity of 0.05
lakh vial
Monthly demand (as per State)
estimated based on
BCG: Number of sessions
planned
Other vaccines: Number of
live births; 100% coverage;
33% wastage; 25% buffer
Storage guidelines:
tOPV in WIF only
DPT and TT in WIC only
BCG and Measles in WIC,
however can be stored in
WIF if lack of space in WIC
BHAGALPUR
capacity to store
two months
vaccine
requirement for
the division
(ideally should be
able to store upto
3 months
requirement)
Bhagalpur does
not WIF/DF
capacity to store
even one months
tOPV requirement
for the division
ITSU - PHFI 21
Feb
Mar
Apr
May
Jun
Jul
BCG
17%
(63d)
tOPV
69%
(162d)
DPT
38%
(60d)
TT
Measles
AugSep
37%
(58d)
Oct
Nov
Dec
Jan
2012
46%
(80d)
31%
(72d)
54%
(162d)
8%
(54d)
84%
(85d)
16%
(53d)
100%
(80d)
* Time between date of issuing purchase order and deadline for supplying first lot
SOURCE: Procurement division
ITSU - PHFI 23
80%
(145d)
tOPV
100%
(150d)
DPT
46%
(240d)
TT
Measles
Feb
Mar
Apr
May
54%
(113d)
76%
(NA)
23%
(NA)
100%
(146d)
* Time between date of issuing purchase order and deadline for supplying first lot
SOURCE: Procurement division
ITSU - PHFI 24
Delivery schedule
needs to be tightly
defined. Currently it
allows 2 supply chain
issues to occur:
ITSU - PHFI 25
ITSU - PHFI 26
ITSU - PHFI 27
Place of immunization
Potential reasons
for high
dependence on
outreach
Largely rural
Demand
primarily
through
ASHA/AWW
mobilisation
People used to
being serviced
closer home
due to polio?
ITSU - PHFI 28
guidelines(1/2)
ANMs has
visited the
village once a
month though
micro-plan
requires her
to visit twice/
month
ANM has
visited these
villages twice in
2 months
whereas the
micro-plan
requires her
to visit it once
in two months
per guidelines(2/2)
ANM: Prema
Kumari
An ANM is planned to
conduct two sessions
in different villages
on same day
ITSU - PHFI 32
Insufficient
funds
AVD stipend not sufficient for long distance session sites, especially
ITSU - PHFI 33
ESTIMATES
Assumptions
Bhagalpur
Purnia
Annual: Rs 100,000
Monthly: Rs 8,333
Annual: Rs 100,000
Monthly: Rs 8,333
16
Rs 300
Rs 4,800
14
Rs 300
Rs 4,200
Rs 3,533
Rs 4,133
32,563 vials
Banka: 7,200 vials
Bhagalpur: 10,756 vials
Jamui: 6,232 vials
Munger: 4,820 vials
Lakhisarai: 3,555 vials
60,612 vials
Araria: 9.954 vials
Katihar: 10,882 vials
Kishangarh: 5,998 vials
Madhepura: 7,075 vials
Purnnia: 11,614 vials
Saharsa: 6,731 vials
Supaul: 7,908 vials
250 km
Rs 6
Rs 3,000
307 km
Rs 6
Rs 3,000
> Rs 6,000
> Rs 11,000
Fund available
Fund required
* Assumes all vaccines are available at the time when van goes for pick-up
SOURCE: Team analysis
ITSU - PHFI 34
Content
ITSU - PHFI 35
Hire and train cold chain staff where required; training must include technical (including distribution on basis
1
Manpower &
training
of past consumption/ current inventory) and financial aspects (i.e. funds available for various activities)
Team of 7 refrigerator mechanics currently placed in Patna must all be trained and relocated to divisions (to
help solve machine break-downs faster)
Hire buffer ANMs to cover for absent ANMs (so that no planned sessions are cancelled/postponed)
2 Lack of funds
Explore mobility support to ref mechanics and vaccine store keepers at district level for preventive
maintenance
MOIC must support ANMs in making micro-plans and improve session planning such that:
ANMs conduct vaccination sessions at villages/sites as per frequency recommended by guidelines based
3 Session planning
on injection load
No ANM conducts more than one session in a day
Micro-plan is planned on actual calendar dates so that holidays (and other foreseeable events i.e. polio
campaigns) are accounted for
Order and install new WIC capacity at Patna and WIF/DF at Bhagalpur
4 Cold chain
equipment
Cold chain in-charges be trained to record batch number of diluents, syringes received/distributed and vaccines
returned from outreach sessions
5 Data recording
All stock data must be entered in an online system .Visibility into stock information at higher level will help in
raising indents and at lower level will help in allocation of stock
ITSU - PHFI 36
Manpower &
training
2 Lack of funds
Hire and train cold chain staff where required; training must include technical (including distribution on basis
of past consumption/ current inventory and maintenance of safety stock) and financial aspects (i.e. funds
available for various activities)
Review AVD policy in Tikamgarh (one AVD per session) leading to low incentive for AVDs covering
far-away sessions to return vaccines at end of session
MOIC must support ANMs in making micro-plans and improve session planning such that:
ANMs conduct vaccination sessions at villages/sites as per frequency recommended by guidelines based
3 Session planning
on injection load
No ANM conducts more than one session in a day
Micro-plan is planned on actual calendar dates so that holidays (and other foreseeable events i.e. polio
campaigns) are accounted for
Identify space and build the Tikamgarh vaccine store in an appropriate area
4 Cold
space
storage
Cold chain in-charges be trained to record batch number of diluents, syringes received/distributed and vaccines
5 Data recording
All stock data must be entered in an online system .Visibility into stock information at higher level will help in
raising indents and at lower level will help in allocation of stock
ITSU - PHFI 37
Recommendations for UP
Key issues
Manpower &
training
Hire buffer ANMs to cover for absent ANMs (so that no planned sessions are cancelled/postponed)
NRHM to ensure timely dispersion of funds for issues identified (example, electricity bill, generator fuel,
vaccine van fuel)
2 Lack of funds
Explore mobility support to ref mechanics and vaccine store keepers at district level for preventive
maintenance
3 Session planning
MOIC must support ANMs in making micro-plans and improve session planning such that:
All villages are assigned to an ANM
ANMs conduct vaccination sessions at her villages as per frequency recommended by guidelines based
4 Cold chain
equipment
on injection load
No ANM conducts more than one session in a day
Micro-plan is planned on actual calendar dates so that holidays (and other foreseeable events i.e. polio
campaigns) are accounted for
5 Data recording
All stock data must be entered in an online system .Visibility into stock information at higher level will help in
raising indents and at lower level will help in allocation of stock
ITSU - PHFI 38
Backups
ITSU - PHFI 39
Giddhor
Jamui-Sadar
Saharsa district
Salkhua
Simbi Bakhtiyarpur
Vaccine
availabl
e
Jamui district
NA
NA
Vaccine available
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA: For Jamui-Sadar, register for calendar year 2011 was locked and store-keeper did not have key; For Simbi Bakhtiyarpur, store-keeper shared
session-wise vaccine distribution data for 4 months only
SOURCE: Block stock registers
ITSU - PHFI 40
Giddhor
Jamui district
Jamui-Sadar
Salkhua
Saharsa district
Simbi Bakhtiyarpur
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA: For Jamui-Sadar, register for calendar year 2011 was locked and store-keeper did not have key; For Simbi Bakhtiyarpur, store-keeper shared
session-wise vaccine distribution data for 4 months only
SOURCE: Block stock registers
ITSU - PHFI 41
Jamui-Sadar
Saharsa district
Jamui district
Giddhor
Jamui-Sadar
Salkhua
Simbi Bakhtiyarpur
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA: For Jamui-Sadar, register for calendar year 2011 was locked and store-keeper did not have key; For Simbi Bakhtiyarpur, store-keeper shared
session-wise vaccine distribution data for 4 months only
SOURCE: Block stock registers
ITSU - PHFI 42
Salkhua
Jamui district
Jamui-Sadar
Salkhua
Vaccineav
ailable
Giddhor
Saharsa district
Simbi Bakhtiyarpur
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA: For Jamui-Sadar, register for calendar year 2011 was locked and store-keeper did not have key; For Simbi Bakhtiyarpur, store-keeper shared
session-wise vaccine distribution data for 4 months only
SOURCE: Block stock registers
ITSU - PHFI 43
Saharsa district
Jamui district
Jamui-Sadar
Salkhua
Vaccineavail
able
Giddhor
Simbi Bakhtiyarpur
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA: For Jamui-Sadar, register for calendar year 2011 was locked and store-keeper did not have key; For Simbi Bakhtiyarpur, store-keeper shared
session-wise vaccine distribution data for 4 months only
SOURCE: Block stock registers
ITSU - PHFI 44
Etah district
Jalesar
Aliganj
Shrawasti district
Allahabad district
Ikuana
Hariharpurrani
Mauiama
Koraon
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
ITSU - PHFI 45
SOURCE: Block stock registers
Aliganj
Shrawasti district
Allahabad district
Ikuana
Hariharpurrani
Mauiama
Koraon
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
ITSU - PHFI 46
SOURCE: Block stock registers
Aliganj
Shrawasti district
Allahabad district
Ikuana
Hariharpurrani
Mauiama
Koraon
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
ITSU - PHFI 47
SOURCE: Block stock registers
Etah district
Jalesar
Aliganj
Shrawasti district
Allahabad district
Ikuana
Hariharpurrani
Mauiama
Koraon
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
ITSU - PHFI 48
SOURCE: Block stock registers
Etah district
Jalesar
Aliganj
Shrawasti district
Allahabad district
Ikuana
Hariharpurrani
Mauiama
Koraon
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
ITSU - PHFI 49
SOURCE: Block stock registers