Measles Catch-up Campaign Lessons learnt and planning for Phase-II

Jharkhand

Dr. Ajit Kr. Prasad

MAP OF STATE SHOWING PHASE-1 DISTRICTS

[

Dumka

Jamtara

DeogharGiridih

Koderma

Godda

Sahibganj

Pakur

Dhanbad

Singhbhum East

Garhwa

Palamu

Chatra

Latehar

Lohardaga

Gumla

Simdega

Saraikella

Singhbhum West

Bokaro

Khunti

Ranchi

Hazaribagh

Ramga

Deoghar

Gumla

Jamtara

Khunti

Lohardaga

Jharkhand : Overview

District Dates of campaign

Total population

*MCV1 coverage (%)

*Fully Immunized

coverage (%)

DEOGHAR

31st Jan 2011

1415082 55.9 35.7

JAMTARA 730906 53.5 38.6

GUMLA 983723 84.9 68.6

LOHARDAGA 452572 96.5 81.2# KHUNTI (Ranchi) 550424 89.0 69.0

State 32,858,434 70.5 54.1

*: DLHS-III 2007-08# Khunti separated from Ranchi after DLHS-III survey, therefore putting the data of Ranchi district.

Coordination and high level oversight

– All the departments participated in state task force meeting and decided to send a letter to their respective departments for campaign.

– ICDS secretary ensured best possible involvement of AWWs.

– More support is needed from education department for successful campaign

– It will be helpful to state if other departments get the letter from national level.

Coordination and high level oversight

Sl. No. Meetings No. of

meetings Key Decisions

1 State Task Force Meetings 2

•Letter from Education dept. to all district education offices.•Deployment of govt. monitors•Media workshop to be conducted at State level•Refresher training of vaccinators is to be conducted

2State operational group meeting

2

•District will conduct the activity either sector wise or sub centre wise depending on local geographic & human resource situation.•District can extend the activity if there is shortage of manpower.•State instructed district to take precaution in Vaccine wastage and fund calculation•State instructed districts to print IEC in advance

DTF Status

District No of DTFs held for MCUP

Total no of participants

No of DTFs attended by DM

or ADM (%)

No of DTFs attended by

CMO or DIO (%)

DEOGHAR 2 48 50% 100%

JAMTARA 2 44 100% 100%

GUMLA 2 86 100% 100%

LOHARDAGA 2 38 100% 100%

KHUNTI 2 62 100% 100%

Total 10 278 100% 100%

State Pre activity preparations: District and Block level trainings

District

MCUP planning workshops AEFI workshops Health Worker training sessions

No. held

No. trained No. held No.

trained No. held

No. of ANM and supervisors trained

No. of ASHA,

AWW & volunteers trained

DEOGHAR 1 48 1 20 37 255+78 3857

JAMTARA 1 41 1 27 20 216+66 1462

GUMLA 1 53 1 53 12 412+116 2220

LOHARDAGA 1 33 1 20 6 165+48 602

KHUNTI 1 25 1 30 19 140+70 368

Total 5 200 5 150 57 1188+378 8509

Results

District Dates of Campaign

Target population

(9m to 10yrs)

Children Covered

Children Immunized (%)

DEOGHAR

31st Jan 2011

283016 251072 88.7

JAMTARA 146181 119096 81.5

GUMLA 196745 184555 93.8

LOHARDAGA 90514 77499 85.6

KHUNTI 110085 89356 81.2

Total 826541 721578 87.3

Data as on 10th Apr 2011

Performance & quality indicators(monitoring data)

• Good points– Time of reconstitution is found noted on the label of the vial

(92%)– Number of vials used and beneficiaries vaccinated as per tally

sheet match reasonably (94%)– Vaccinators know what to do in case of a serious AEFI (primary

care, referral and reporting) (92%)

• Bad points– Supervisor visited this session site at least once today (69%)– Functional hub cutter found available at session site (74%)– Vaccination site have visible IEC (Banners / Posters) (73%)

RCA Findings: Coverage

DistrictsNo. of

children checked

No. of Children

found missed

% Childrenfound missed

No. of Area visited

No. of Area>=20%

missed children

% of area with >= 10%

missed Children

DEOGHAR 6602 803 12.2 332 16.3 77.1

GUMLA 3189 410 12.9 169 14.8 72.2

JAMTARA 6180 1541 24.9 309 59.2 82.2

KHUNTI 6608 613 9.3 381 15.2 36.2

LOHARDAGA 808 190 23.5 47 51.1 68.1

Grand Total 23387 3557 15.2 1238 27.8 64.8

RCA findings: reasons for missing MCUP dose

1. Travelling (706, 19.1%)2. Did not know about the campaign (574, 16.1%)3. Parents did not give importance (566, 15.9%)4. Fear of injection (517, 14.5%)

Management of AEFIs

DISTRICTNo. Of

children Vaccinated

Minor AEFI Major* AEFI

CountIncidence /million

dosesCount

Incidence /million

doses

DEOGHAR 251072 4 16 0 0

JAMTARA 119096 0 0 0 0

GUMLA 184555 0 0 3 17LOHARDAGA 77499 0 0 1 13KHUNTI 89356 3 34 0 0

TOTAL 721578 7 10 4 6

* Major AEFI: Death, hospitalization, cluster (Includes anaphylaxis)

Communication and social mobilization

• Activities carried out – Media workshop at the state level.– Media workshop at one of the districts.– Press coverage of the pre campaign DTFs

• Areas for improvement– For 2nd phase, it is important to print the IEC in advance at State level

to maintain the quality & timeliness.– Additional emphasis should be given for distribution of invitation slips – Financial guidelines for IEC should be clearer. (For eg. funds allotted

for printing of Banners & hoardings)– Media workshop in all the districts.

Lesson Learned

• Fixation of dates well in advance is utmost importance for effective programme implementation.

• Centralized IEC material will help to maintain quality and timeliness.

• Cold chain assessment should be done in advance so that electrical cold chain equipment & non electrical cold chain equipment will be supplied as per actual need for phase II.

• More clear financial guideline required to districts either from central or State level.

• Blocks & districts should follow the training guidelines given by Govt. of India.

Lesson Learned

• Inclusion of more private practitioners for AEFI treatment will be beneficial for the programme and in long run also.

• For better involvement of schools, there should be letters to concerned departments from higher levels (national-state-district) well in advance.

• Grass root level workers should be made accountable for information to schools & AWW into these areas.

• Blocks need to learn to implement programme in planned manner & specific instruction should be given to them from higher authorities in this regard.

Future Plans for subsequent Phase

• No. of Districts & Target:– 19 district / 5,877,284 children

• Plan for addressing shortcomings:– State review meeting as early as possible for discussions

on lesson learned.– Sensitization of education & ICDS department well in

advance.– Quality trainings at all levels.

• Timeline:– Proposed month for 2nd phase : Nov/Dec 2011

Thank You