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“BIAS” Indonesia School Based Immunization Program PowerPoint Presentation
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“BIAS” Indonesia School Based Immunization Program

“BIAS” Indonesia School Based Immunization Program

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“BIAS” Indonesia School Based Immunization Program

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  1. “BIAS” Indonesia School Based Immunization Program Dr Andi Muhadir, MPH Director, Surveillance Epidemiology and Immunization, Ministry of Health, Republic of Indonesia Global Immunization Meeting New York 17-19 Feb 2009

  2. INDONESIA Western Indonesian Time Central Indonesian Time Eastern Indonesian Time Total infant (0-11 month): 4,8 million Total school immunization target: 15 million

  3. School Immunization Program (“BIAS”) • School Immunization Month is immunization services conducted at all primary schools nation wide in the months of August and November • This was introduced as collaboration of four Ministries • Target: children in grades 1, 2 & 3 • Vaccines: DT, Measles & TT • Started since 1984 and evolved gradually in 1997 and in 2002.

  4. Why Indonesia Implemented “BIAS” DT/TT • Basic immunization (DPT 3x) produces immunity up to <5 years old children • National Institute of Health and Research Development (NIHRD) conducted serological studies among 4-5 yrs old in 1996 in Papua & Central Kalimantan, it revealed declining immunity levels against Diphtheria (74-77%) • Need of booster dose for Diphtheria • Low TT2+ coverage among CBAW • As part of School Health Program (UKS) which is existing since 1956 • School enrollment rate >95% (boys and girls)

  5. Why Indonesia Implement “BIAS” for Measles control • NIHRD serological study among primary school children in 1997 at Yogyakarta, Ambon & Palu showed only 72% of children were protected against measles • Surveillance data showed high proportion (52-79%) of Measles cases in East Java in 1996 among school going children (5-14 years old) • In 1998-2000 surveillance data showed 40% of measles cases nationally were in children above 5 years of age • As a measles control strategy: 2nd dose of Measles vaccine

  6. Objectives of School Based Immunization • To provide life-long immunity against tetanus to all primary school graduates • To provide a booster dose for Diphtheria • To reduce measles mortality and morbidity

  7. School Immunization Schedule Dynamic and Evolving 1984-1997 1998-2000 2001/2 onwards  Grade 1 DT 2x DT 1x DT 1x Measles Grade 2 TT 1x TT 1x Grade 3 TT 1x TT 1x Grade 4 TT 1x Grade 5 TT 1x Grade 6 TT 2x TT 1x ELIGIBLE TARGET9 MILLION 29 MILLION 15 MILLION 2002 onwards: inclusion of routine second dose measles in class 1 on rolling basis province by province

  8. “BIAS” Strategies • Effective inter-sector collaboration (involving four Ministries: Health, Education, Religion Affair, Internal Affair) • Sound policy and guidelines for both health workers and other stake holders in place • Trained health workers in all 8,000 primary health centers across the country • Central government provides vaccines and logistics (includes cold-chain)

  9. “BIAS” Strategies (cont..) • 15 million children studying in 175,000 primary schools (public, private and religious) targeted across the country • Strong commitment with regular contribution by provincial and district governments is provided • Monitoring and supervision done by inter-sectoral teams

  10. Roles and Responsibilities • Micro planning done by teachers & health workers • Schools inform parents and this is considered as public informed consent s when children come to school for vaccination • Vaccination conducted in school by local health center staff • School immunization coverage is reported by health centers on same channels as for routine EPI • Monitoring and supervision is undertaken by joint interdepartmental school health program supervisory team

  11. Result of “BIAS” • High coverage achieved for all antigens • NIHRD serological studies showed high protection level against Diphtheria (98%) and against TT (100%) among 10-14 yrs old after “BIAS” • Low vaccine wastage rates (<20%) • Declining trends of measles incidences • High acceptance of BIAS by parents

  12. Percentage of DT Coverage Grade I (age 6-7 years), 1998 - 2007 Source: Sub Dir EPI, CDC, MoH 2008

  13. Percentage of TT Coverage Grade II and III (age 7-10 years), 1998 - 2007 Source: Sub Dir EPI, CDC, MoH 2008

  14. Percentage of Measles CoverageGrade- I (6-7 years of age), 2003 - 2007 Source: Sub Dir EPI, CDC, MoH 2008

  15. Measles Immunization Coverage and Measles Cases* Indonesia, 1983-2008 ** : SIAs *Source: Surveillance Unit, MOH

  16. Key Factors Which Make “BIAS” Successful • Compulsory education, free of charge in public schools • High enrollment of girls and boys in early primary schools (97%) • Sufficient number of health centers and staff • Regular budget: vaccines and logistics provided by MOH • Inter ministerial coordination exits through BIAS • Clear roles and responsibilities through guidelines for health provider and teachers and periodic training for providers

  17. Challenges • Absenteeism is around 5 – 10% on vaccination day • Non compliance to the public consent by some schools • Mechanism to reach for out of school children still not developed • Limited sources for monitoring and evaluation • Competing priorities at local level specifically in decentralization context, need for regular advocacy with local governments

  18. Conclusion (1) • Indonesia’s school immunization program is well-established • Key elements for a successful program exist • official policy • operational guidelines for health workers and teachers • High immunization coverage for all antigens • Not a heavy burden on health center staff

  19. Conclusion (2) • Unit cost per student vaccinated is cost effective in comparison with routine vaccination • $0,70 for TT , $0,80 for Measles • Strengthen tetanus elimination strategy in a sustainable fashion and contribute significantly in measles control • Builds infrastructure for future vaccine preventable disease control programs • BIAS inline with GIVS to reach immunization beyond the traditional target groups

  20. THANK YOU