Immunization-NRHM

India’s Immunization Programme

An Update

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


Full Immunization Coverage (DLHS-3)


Coverage States/UT

Low(<50%)

Uttar Pradesh, Meghalaya, Madhya Pradesh, Tripura, Arunachal Pradesh, Bihar, Manipur and Rajasthan

Medium(50-70%)

Mizoram, Assam, Jharkhand, Gujarat, Chhattisgarh, Haryana, Orissa, Jammu & Kashmir, Uttarakhand, Andhra Pradesh, Delhi, D&NH and Maharashtra

High(>70%)

Chandigarh, West Bengal, Karnataka, Sikkim, Kerala, Punjab, Pondicherry, Himachal Pradesh, Tamil Nadu, Lakshadweep, A & N Islands, Daman & Diu and Goa

Measles Second OpportunityApplying 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 immunization4 states viz. Delhi, Goa, Poducherry & Sikkim already introduced 2nd dose

Operational guidelines for Measles catch-up campaign developedState planning for second opportunity of Measles started


Measles Coverage (DLHS-3)

Goa

Tam

il Nad

u

Himac

hal P

rade

sh

A & N

Isla

nds

Sikk

im

Laks

hadw

eep

Pond

icher

ry

Daman

& D

iu

Punj

ab

Andhr

a Pr

ades

h

Keral

a

Chand

igar

h

Karna

taka

Mahar

asht

ra

D & N

H

Mizor

amDel

hi

Wes

t Ben

gal

Uttara

khan

d

Jam

mu

& Kas

hmir

Orissa

Chhat

tisga

rh

Gujar

at

Jhar

khan

d

Harya

na

Rajas

than

Aruna

chal

Pra

desh

Assam

Manip

ur

Madhy

a Pr

ades

hBih

ar

Megha

laya

Trip

ura

Uttar P

rade

sh

Nagal

and*

0

10

20

30

40

50

60

70

80

90

100

99

.1

97

.6

94

.5

92

.8

92

.5

91

.9

91

.1

90

.9

89

.1

88

.6

87

.9

87

.3

85

.2

84

.5

84

.4

83

.9

83

.1

82

.8

82

.1

81

.4

81

.1

79

.9

72

.6

70

.5

69

.0

67

.5

65

.5

64

.4

58

.9

57

.7

54

.2

52

.5

51

.8

47

.0

Catch-up Cam-paigns

India : 69.6%


2nd Dose of RI

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010*

P11735

397 139 212 1487

203 127 62 648 83 75 80 5

P3190 730 127 59 116 22 7 4 28 794 484 662 17

125

375

625

875

1125

1375

1625

1875

* data as on 25 June 2010

Polio cases, India

State P1 P3 Total

Jammu & Kashmir 1 0 1

Maharashtra 1 0 1

West Bengal 3 0 3

Uttar Pradesh 0 10 10

Bihar 0 6 6

Haryana 0 1 1

Total 5 17 22

WPVs

Most recent virus28 May 2010Birbhum, WB

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:Status of Preparedness of WIC/WIF sites for installation

State WIC WIF Status as per record

Chhattisgarh 2 1 Site Not Identified;1 WIC lying for 3 yrs

H.P 1 1 Site NOT Identified

Manipur 1 - Site NOT Identified

West Bengal 4 1 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 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 on priority basis

(As on 1 June 10)

< 30%

50 % - 80 %

> 80 %

30% - 50 %

Completed

Immunization training of Health workers

Rest of the states have completed the training or achieved 90%

of Total training load

HW Trainings started in 2007-08; ~175,000 out of 220,000 (79%)

HWs trained

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARANCHAL

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADW EEP


State/UT s Annual Target Trained in 2009-10

Andhra Pr 6728 19413

Arunachal Pr 319 0

Assam 1567 0

Bihar 5558 0

Chattisgarh 2266 5638

Haryana 1211 0

J & K 574 483

Kerala 3297 2687

Madhya Pr 7077 5937

Maharashtra 13057 8131

Orissa 4587 2408

Punjab 933 150

Rajasthan 4758 0

Sikkim 200 0

Uttar Pradesh 6700 0

West Bengal 7855 13795

Total 69397 41763


As on 1 June10

< 30%

50 % -80%

30 % - 50%

> 80%

Not Started

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 to be strengthened.

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHANDWEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARANCHAL

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADW EEP


New Vaccine Introduction

Hepatitis B Already in 10 states and

selected cities and districts of the country

Expansion of Hepatitis B vaccine in the remaining states of country in phased manner is under consideration

Service delivery issues -Birth dose of Hep B not being given within 24 hours

Reluctance to use due to concerns about AEFI and vaccine wastage (Punjab & Tamil Nadu)

Pentavalent Introduction of Hib-containing

pentavalent in select states is under process

Hepatitis B States

Hepatitis B Pilot Districts

Hepatitis B Pilot Cities

Reported Coverage 2009-10-Issues


0%

20%

40%

60%

80%

100%

120%

140%

BCG OPV3Measles FIC*(12-23 months)

Source: HMIS

Reported Coverage 2009-10-Issues


Karn

atak

a

Kera

la

Laks

hadw

eep

Mad

hya

Prad

esh

Mah

aras

htra

Man

ipur

Meg

halaya

Mizo

ram

Nagalan

d

Orissa

Pudu

cher

ry

Punjab

Rajas

than

Sikk

im

Tam

il Nad

u

Tripur

a

Uttar P

rade

sh

Uttara

khan

d

Wes

t Ben

gal

0%

50%

100%

150%

200%

250%

BCG OPV3Measles FIC*(12-23 months)

Name Based Tracking of Pregnant Mothers & Children – ANCs & Immunisation

Ministry of Health & Family Welfare15

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)

16

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

17

Data to be captured

PREGNANT WOMEN

Location Details State, District, Block, Address

Identification details Name, DOB, Phone No, JSY, caste

Health Provider details HSC, ANM, ASHA, Linked facility

for delivery ANC details

LMP, ANC dates, TT, IFA, Anemia, complications

Pregnancy Outcome Place, delivery date, JSY benefits

PNC Details - dates Infant details

INFANTS

Location Details State, District, Block,

Address Identification details

Name, DOB, Phone No, JSY, caste

Health Provider details HSC, ANM, ASHA

Immunization details Dates for BCG, OPV, DPT,

Hepatitis, Measles, Vit A18

16 digit Identity Code

Digits (Nos)

Item Description /Remarks

01-02 (2) State Code As per Census codes

03-04 (2) District Code As per Census codes

05-07 (3) Block PHC/CHC Code As per Census codes given to Block HQ

08-09 (2) Health Sub-Centre Code To be serially given by Block HQ.

10-10 (1) Pregnant Woman – Code 1; Child – Code 2

11-12 (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

13-16 (4) To be given serially to each mother / child from 1st December, 2009 starting from 5000

From 1st April each year, the codes will be given afresh starting from 0001. 19

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

2 3 22 1 1 3 1 6 1 01 0 0 0 1

Progress made so far…

States Status

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

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

Based on recent observations during field tours

Issues in the field

Special software required for this processTo generate beneficiary listTo maintain uniformity To avoid duplication of beneficiariesTo access data for supervision/monitoringTo calculate coverage

Data entry at block level being done by Block Accounts Assistant; no data entry operatorHuge volume of data coming monthly

Power supply & connectivity issues at blocks

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


Thank you

Documents

Immunization-NRHM