Emergency Preparedness and Response Planning – risk analysis, actions taken in HR areas &

preparedness status for mop ups : West Bengal

24th Meeting of India Expert Advisory Group on PolioNew Delhi 15-16 March 2012

Dr Rashmi Kamal,IAS

Addl State Mission Director, NRHM & Jt Secy to Govt of West Bengal

Outline of the presentation

• Risk assessment

• Sustaining high population immunity in HRAs– SIAs– Routine Immunization

• Status of AFP Surveillance

• Preparedness for responding to importations

Risk assessment

Location of wild polio cases (2002 to 2011)

WPV cases HR districts

Risk assessment in West Bengal

HR districts

HR Gram Panchayats/ wards identified in each district

Sub district risk assessment(based on past epidemiology & performance)

9 districts 36 blocks/ urban areas

Howrah

Identification of High Risk Areas, WB

~ 5,200 Migrant sites

Migrant sites High risk areas in settled population

~ 10,122 HR areas in settled population

= 10 Migrant site = 10 HR site

Progress on Emergency Preparedness & Response Plan

• EPRG constituted – Two EPRG meetings held since December to assess progress

• RRT members selected and trained

• High Risk districts allocated to RRT members

• EPRP prepared and implemented

Dr Soumitra Roy

Dr Kalyan Mukherjee

Dr Amabasu DasDr J K Mehta

Dr Prasanta Biswas

Dr Dipankar Maji

Dr Pramit Ghosh

Dr S S Basu

• Sustaining high population immunity in HRAs

–SIAs

–Routine Immunization

Intensive Government Oversight• Regular video conferences by Principal Secretary for polio SIAs

with DMs /Mayors & Chair persons of urban bodies and Health / ICDS officials

• Senior state officials assigned to HR districts for monitoring

• District, sub divisional and block task forces to review preparedness & supervise operations

• Daily evening review meetings at districts & block PHCsDistrict Magistrate Howrah monitoring

activityUrban area task force meeting in

progress at Maheshtala

Intensification of underserved strategy

•Endorsement from religious institutions

•Compilation of appeals for teams working in HRAs

•Announcement from mosques

•Advocacy in religious gatherings

•Inauguration by religious leaders

•Sensitization of Hajis before and after return from Haj pilgrimage

•Rally by Madarsa students

Polio advocacy at Urs

Sensitization of Hajis

Rally by madarsa students

Special initiatives to reduce missed children in HR districts of West Bengal

Health camps : Murshidabad

0

20

40

60

80

100

120

Dec-10 Jan 272011

Feb 52011

Feb 272011

Mar 272011

Apr 242011

May 292011

June 262011

Aug 282011

Sept 252011

Nov 132011

Jan 152012

Impact of health camps : Khargram

Remaining houses with reluctance to vaccination

Clinic booths: Howrah

4000

4200

4400

4600

4800

5000

May 2011 June 2011 Aug 2011 Sept 2011 Nov 2011 Jan 2012

Children vaccinated

Sick children vaccinated at clinic booths

123 clinic booths

Partner supported Social Mobilization / Advocacy

• 1600 Field volunteers and supervisors from 23 NGOs deployed by Unicef in 6 HR district

• Social Mapping is being done in HR areas for planning appropriate area specific intervention

• Sensitization meetings with all PRI members and urban councilors– 24 Pgs South – Howrah

• SIA inauguration and advocacy by Cricketers– Kolkata Knight Riders – West Indies team

• Ganga sagar Mela • Urs in different Mazars • Eid congregations • Other religious festivals

Special immunization plans for Congregations

Vaccination at Ganga sagar mela

Vaccination at Urs

~ 20,000 children vaccinated at various congregations in 2012

Social mobilization to overcome refusals

0

4000

8000

12000

Howrah Kolkata 24 Pgs South

Feb-11 Feb-12

Number of houses with reluctance to vaccination: 2011 vs 2012

South Bengal districts

0

600

1200

1800

UttarDinajpur Maldah Murshidabad Bardhaman Birbhum

Feb-11 Feb-12

North Bengal districts

Vaccination of children in transit

0

10000

20000

30000

Murshidabad How rah Kolkata 24 Pgs North 24 Pgs South

Feb-11 Feb-12

Children vaccinated at transit points: 2011 vs 2012

> 500,000 children vaccinated in transit

during each campaign in the state

Other special initiatives to improve coverage•Targeted X-P conversion : Doctors from Medical colleges visit reluctant families (X houses) with medicines immediately after the round.

•Distribution of Motivational items from booths

•ICDS feeding on booth dayMedical college doctors visiting an X house

ICDS feeding on booth day

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Apr-10 Jul-10 Aug-10 Jan-11 Feb-11 Mar-11 Apr-May-11

29-May-11

Jun-11 Aug-11 Sep-11 Nov-11 Jan-12

MURSHIDABAD

KOLKATA

Trend in remaining X houses – Kolkata & Murshidabad

Outcome : Reduction in remaining X houses

Percent unvaccinated children End-of-round survey

Southern districts, West Bengal

Per

cent

Per

cent

N= 7,525 6,665 8,193 11,933

N= 6,556 7,574 7,686

11,027

7,065

Northern districts, West Bengal

1,371 4,490 2,996 4,020 3,515

11,787

10,320 6,461 6,651 7,996

12,602 11,343 11,816 10,919 17,450

6,890 8,924

Strengthening Routine immunization

• Merger with SIA microplans in process– Identification of new RI/VHND sites through

SIA microplan– Incorporating RI session plan in SIA

microplan– Identification of newborns during SIA and

their inclusion in RI

• Training of MOs and Cold chain handlers • Quarterly review of RI performance at

state level

RI sessions planned vs held – West Bengal May 2011 – January 2012

95% 95% 96% 97% 97% 97% 100% 96% 96%

5% 5% 4% 3% 3% 3% 0% 4% 4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

May'11(193) Jun (114) Jul (329) Aug (222) Sep (58) Oct (115) Nov (99) Dec (296) Jan'12(156)

Session held Session not held

Reason for session not held (N=57)

Source: Session RI Monitoring data (May 2011-January 2012)

State N = 1,582

65% 67%73% 74%

86%79% 78% 75% 74%

27%28%

24% 23%

13%19% 21% 22% 22%

8% 5% 3% 3% 1% 2% 1% 3% 4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

May'11(611) Jun (450) Jul (1,259) Aug (898) Sep (248) Oct (438) Nov (393) Dec (1,228) Jan'12 (698)

Fully Immunized Partially Immunized Unimmunized

Immunization status of monitored children, West Bengal, May 2011 - January 2012

37%

10%

37%

2%

10%4%

Reasons for children not being fully immunized

N= 1,629

State N (children 12 to 23 months of age)= 6,223

Not aware of need

Fear of AEFI

Unaware of session site

Beneficiary not available

Programmatic Reason

Other Reasons

• Status of AFP Surveillance

7.18 87%

Non-polio AFP rate Stool collection rate

Status of AFP Surveillance - 2011

IndiaLess than 60%60% to 69%70% to 79%80% and aboveNo AFP case

* data as on 3 March 2012

AFP Surveillance is sensitive enough to

pick any transmission in the state

• Preparedness for responding to importations

Preparedness for responding to importation• Prepared to hold first mop up within 7 days of detection of

transmission, as demonstrated in the past.

Day 6

Mop up conducted

Day 4

•National level partners meeting•Media plan operationalized•Vaccine arrived in district

Day 3

•State & District Task Force Meetings•14 additional SMOs arrive in districts•IEC plan developed•Marker pens & other logistics procured

Day 2

•Field Investigation (NCDC/NPSP/UNICEF)•National Technical Group Meeting •Decision on mop up

Day 1

Chief Minister & Chief Secretary WB

informed by GoI

Day 0

WPV notified

Day5

Vaccine & other logistics reach blocks

7 Feb 2011 13 Feb 2011

Preparedness for responding to importation

• Logistics plan• Running rate contract exists for marker pens – supplies

expected to districts within 7 days of placing order

• Printing of formats have been decentralized to districts – may be done in 5 days

• Vaccine distribution to block PHCs (including hard to reach areas) within 4 days of receipt at state

• Communication plan• Running rate contract exists for printing of banners/posters and

delivery to districts

• UNICEF is ready with the prototype IEC materials, will be updated in minimum time

Preparedness for responding to importation

• Cold chain• Adequate vaccine carriers available in High risk blocks and

urban areas• Repair of cold chain equipments has been decentralized to

district level to minimize delay

• Microplanning• Microplans of all high priority planning units are reviewed and

rationalized before each round

• Manpower & training• Training of all high priority teams will be conducted within 6

days of notification

Preparedness for responding to importation

• EPRG & RRT – EPRG is meeting from time to time to assess ongoing

activities for increasing / sustaining population immunity and maintaining sensitive AFP surveillance

– can be activated within 24 hours

• District, Sub division and Block / Urban area task force – will meet as soon as campaign is decided.

Highest level ofpolitical commitmentto keep West Bengal polio free

Thank You