India’s Immunization Programme

1. An Update India’s Immunization Programme Immunization Division, MOHFW, Govt. of India

2. 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 Immunization Division, MOHFW, Govt. of India

3. Full Immunization Coverage (DLHS-3) Immunization Division, MOHFW, Govt. of India

4. Measles Second Opportunity • Applying 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 immunization • 4 states viz. Delhi, Goa, Poducherry & Sikkim already introduced 2nd dose • Operational guidelines for Measles catch-up campaign developed • State planning for second opportunity of Measles started Immunization Division, MOHFW, Govt. of India

5. Measles Coverage (DLHS-3) India : 69.6% 2nd Dose of RI Immunization Division, MOHFW, Govt. of India

6. Polio cases, India Most recent virus 28 May 2010 Birbhum, WB * data as on 25 June 2010

7. 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

8. Cold Chain:Status of Preparedness of WIC/WIF sites for installation • 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

9. 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

10. < 30% 30% - 50 % 50 % - 80 % > 80 % 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 (As on 1 June 10) Immunization Division, MOHFW, Govt. of India

11. Not Started < 30% 30 % - 50% 50 % -80% > 80% 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. As on 1 June10 Immunization Division, MOHFW, Govt. of India

12. New Vaccine Introduction Hepatitis B States • 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 Pilot Districts Hepatitis B Pilot Cities Immunization Division, MOHFW, Govt. of India

13. Reported Coverage 2009-10-Issues Immunization Division, MOHFW, Govt. of India

14. Reported Coverage 2009-10-Issues Immunization Division, MOHFW, Govt. of India

15. Ministry of Health & Family Welfare Name Based Tracking of Pregnant Mothers & Children – ANCs & Immunisation

16. 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)

17. 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

18. Data to be captured Pregnant Women 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 A • 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

19. 16 digit Identity Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

20. Progress made so far… Based on recent observations during field tours

21. Issues in the field • Special software required for this process • To generate beneficiary list • To maintain uniformity • To avoid duplication of beneficiaries • To access data for supervision/monitoring • To calculate coverage • Data entry at block level being done by Block Accounts Assistant; no data entry operator • Huge volume of data coming monthly • Power supply & connectivity issues at blocks

22. 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

23. Thank you Immunization Division, MOHFW, Govt. of India