Accelerating Routine

Immunization
(Issue and Challenge)




UNICEF Bihar
24 September 2014

Neonatal Resuscitation: A Herculean Task
Schema of presentation
1. Key Milestones/ Policies and Guidelines: RI programme in India
2. National Immunization Schedule
3. Universal Immunisation Programme National perspective &
comparative analysis of UP, Bihar, Orissa, Assam and Jharkhand
4. Field Visit (Cold Chain Points/ RI Session Sites)


Immunization program in India KEY Milestones
Oldest (almost 30 yrs) and Largest Public Health Programme in the World

1978
Expanded
Program on
Immunization
(EPI)
BCG, DPT, OPV,
Typhoid
1985
Universal
Immunization
Program (UIP)
Measles added
1995
Pulse Polio
Immunizati
on Days
2005
NHRM
launched
MYP
2005-10
AEFI
guidelines
2010
MCUP In 14
states;
2
nd
dose of
Measles
added
2011
Last Polio Case
National
Vaccine Policy
Hepatitis B
universalized
Pentavalent
Vaccine
introduced
2012
Year of IRI;
Immunization
Weeks
2013
RMNCH+A Launched
2 doses for JE
Multi dose Open Vial
Policy
GAVI- Health
Strengthening
Support (GAVI-HSS)
National Immunization Schedule (NIS)
Infants Children
At birth BCG, OPV- 0 dose within
15 days of birth,
Hepatitis B- 0 dose
within 24hrs of birth

6 Weeks BCG (if not given at birth)
DPT- 1
st
dose
OPV- 1
st
dose
Hepatitis B- 1
st
dose


10 Weeks DPT- 2
nd
dose
OPV- 2
nd
dose
Hepatitis B- 2
nd
dose

14 weeks DPT- 3
rd
dose
OPV- 3
rd
dose
Hepatitis B- 3
rd
dose

9 months Measles 1
st
dose,

16-24 months DPT booster, Measles 2
nd
dose,
Vit-A 2
nd
dose, OPV booster,
JE in selected districts

2 to 5 years Vit-A 3
rd
to 9
th
doses at the
interval of 6 months (total of 7 doses)

5 years DPT booster

10 years T.T. booster

16 years T.T. booster

For Mother:

T. T. Pregnant women 2 doses in
4-6 weeks interval, one
dose if previously
vaccinated within 3 years.


Recent policies/guidelines and newer vaccines
1. Open vial policy
2. Immunization weeks to reached HRAs, 4 rounds per year on
regular basis
3. MNTE validation for remaining states by end 2015
4. Newer vaccine introductions
Pentavalent vaccine expansion to entire country
Rubella vaccine introduction
Measles elimination by 2020
End game polio strategy & introduction of IPV into routine
immunization in 2015
Introduction of Rota Virus vaccine




Site and Route of Vaccination
Drop-outs: Children who
receive one or more
vaccination, but do not return
for subsequent doses.
Left-outs: Children who do
not receive any vaccination
Left-outs and Drop-outs
Full Immunization Coverage (FIC)
Full Immunization : Child who received One dose of BCG, Three doses
of DPT and OPV each and One dose of Measles before one year of age)
Vaccination prevents an estimated
2.5 million deaths each year.
Proper Cold Chain and Vaccine management
System
Updated Microplan (Planning of immunization to reach
every infants )
Full Immunization Coverage (FIC)
64.5
65.6
63.7
69.1
69.9
55
62.3
68.8
45.2
48.1
52.7
0
10
20
30
40
50
60
70
80
2010-2011 2011-2012 2012-2013
Full Immunization
Full Immunization in the region
Bihar Jharkhand Odisha Uttar Pradesh
Odisha-13.8%
Immunization Dropout Rate (%)
35.5
36.3
45
54.8
34.4
30.9
37.7
51.9
30.1 30.1
31.2
47.3
0
10
20
30
40
50
60
Bihar Jharkhand Odisha Uttar Pradesh
Immunization dropout in the region, AHS
2010-2011 2011-2012 2012-2013

Equitable Access to Immunization is a core
component of the Right to Health.

69% of partially and un-
immunized children in 6 states:
Uttar Pradesh
Bihar
Madhya Pradesh,
Rajasthan
West Bengal
Gujarat
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
UTTAR PRADESH
KARNATAKA
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARANCHAL
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYA
NAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DLHS-2
Below 40
40 to 50
50 to 60
60 to 70
Above 70
India State
Fully immunized children
(12 23 months)
Coverage Evaluation Survey (CES) 2009
Snap shot Inequity Key drivers
>7 millions children not immunized in India

Full Immunization Coverage (FIC)
Huge Gaps



UTTAR PRADESH (52.7) UTTARAKHAND (79.6)
AHS 2012-13
Full Immunization- Bihar

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KISHANGANJ (26.6) MADHUBANI (82.8)
56.2
AHS 2012-13
AHS 2012-13
BIHAR:
Highest: -Madhubani-87.8%
Lowest: Kishanganj- 32.2%

High gap between high and
low coverage districts
ODISHA:
Highest: -Kendrapara-87.4%
Lowest: Malkangiri- 29.6%

Coverage in Southern Odisha is low
UTTAR PRADESH:
Highest: -Saharanpur-77.4%
Lowest: Shrawasti- 24.9%

Gap between highest coverage and
lowest coverage is three times
80.0 90.0 (0)
JHARKHAND:
Highest: -Lohardaga-88.1%
Lowest: Giridih-46.5%

High Gap (41.6%) between high and
low coverage districts
0 - 20%
21 - 40%
41 - 60%
61 - 80%
81 - 100%
Monitoring finding of WHO-UNICEF
Focused Action
0 5 10 15 20 25 30
Service not available
Vaccine not available
ANM absent
Long waiting time
Do not have time
Time not convenient
Place not convenient
Place too far
Not knowing where to go for immunization
Not knowing about vaccines
Did not feel need
Wrong advice by someone
fear of side effects
cannot afford vaccines
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2.1
6.2
3.9
2.1
6
8.9
3.8
2.1
10.8
26.3
28.2
3
8.1
12
11.8
Reasons for Unimmunized children
Source CES 2009
Demand side
issues
Supply side
issues
Why not immunized
Objectives
A. Strengthen vaccine logistics and cold chain management
1. Improve Human Resources to improve cold chain performance
2. Supportive Supervision to ensure quality implementation
3. Implement EVM improvement plans
4. Institutional Capacity building to strengthen the cold chain system
B. Increasing demand for RI through Innovations in BCC Strategies
1. Implement Multi pronged BCC strategy development and operational plans
2. Enhance Infrastructure and HR Capacity to develop and implement BCC strategies
3. Strengthen systems for effective inter personal communication and social mobilization
using Polio Social Mobilization Network (SMNet)
4. Develop and Broadcast immunisation messages through mass media
5. Promote advocacy with media for creating an enabling environment for increasing
demand for RI services

Evolution GAVI States Perf framework Reporting Deliverables Objectives
Reaching the Unreachable
Raising Awareness
Generating demand
Empowering the most at risk
Health
Routine Immunization
ORS ZINC
Water
Sanitation
hygiene
Nutrition
Infant Young
child feeding
Hard WORK
Hard WORK and Intelligent WORK
http://addsoftmail.com/bvlms/available_stock.aspx
BVLMS
Web based MIS application for vaccine and logistics management
(BVLMS)
1. To monitor the real time stock availability
2. Interpretations of stocks availability in terms of requirement
3. Helps in Rational Distribution of vaccine and logistics
4. Prevent over stocking of stocks at any location
5. Real time text message in the form of SMS alert to concern person regarding stock position.
6. Facilitate Batch no. and expiry date tracking
7. Auto Alert mechanism before approaching stock outs
8. Helps in wastage assessment and its control
9. Strengthening of EEFO (Earliest-Expiry-First-Out) and FIFO (First-In-First-Out) for stock
management
Cold Chain Point
VHSND Session Site

Media will make
India children be
immunized.


Thanks


Focused Action Initiated
1. H-H Survey by ASHA/AWW and 100% updation of Duelist
2. Special mobile teams to immunize the children and PW
3. Involvement of ICDS and Joint supportive supervision with Additional mobility support
for RI/VHND Supportive supervision
4. Introduction of BVLM to strengthen the system of vaccine & logistic management
5. Performance based incentives
6. Timeline with responsible person of each activity to be fixed
7. Regular follow up : DCR meeting, District Taskforce Meeting etc..