Routine Immunization

1. Intensification of Routine Immunization
(IRI) in India
Coverage Improvement Plans for 2012-13
SEPIO
Swasthya Bhavan
GoWB

2. • August 2011 - High Level Ministerial Meeting
(HLMM) on “Intensification of Routine
Immunization”.
• September 2011 - All SEAR countries endorsed
2012 as the “Year of Intensification of Routine
Immunization”.
• GoI has declared 2012-13 as “Year of
Intensification of Routine Immunization”.
• Strategy for IRI discussed within Imm. Division of
Ministry, with Partners and also during focused
review meetings held with priority states.

3. Proportion of Fully immunized (FI) children
CES 2006 CES 2009
FI: 62% FI: 61%
• OPV3: 68% • OPV3: 70.4%
• DPT3: 68% • DPT3: 71.5%
• Measles: 71% • Measles: 74.1%
JAMMU & KASHMIR
HIMACHAL PRADESH
PUNJAB
UTTARANCHAL
HARYANA
ARUNACHAL PR.
SIKKIM
RAJASTHAN UTTAR PRADESH ASSAM
NAGALAND
BIHAR MEGHALAYA
MANIPUR
TRIPURA
JHARKHAND
GUJARAT MADHYA PRADESH MIZORAM
WEST BENGAL
India State CHHATTISGARH
ORISSA
DLHS-2 D&N HAVELI
Below 40 MAHARASHTRA
40 to 50
50 to 60 ANDHRA PRADESH
60 to 70 GOA
Above 70 KARNATAKA
A&N ISLANDS
PONDICHERRY
TAMIL NADU
LAKSHADWEEPKERALA

4. FI coverage: CES 2009 vs CES 2006
30
20
Assam: +20 %
Rajasthan: +6 %
10
Maharastra: +6 %
Punjab: +8 %
Bihar: +11 % UP: +4
0 %
AN AP AC AS BI CH CG DN DD DL GO GU HA HP JK JH KA KE LD MP MH MN ME MZ NA OR PD PB RJ SI TN TR UP UA WB
Jharkhand: +7 %
-10
-20
-30
WB: - 5 %
Haryana: -3 %
Delhi: - 14 % MP: - 11 %
12 low performing states improved, However, 17 states declined

5. System weakness in tracking and following children:
Percentage difference between BCG and MCV1 coverage
JAMMU & K ASHMIR
HIMACHAL PRADESH
PUNJAB
UTTARANC HAL
HARYANA
DELHI ARUNACHAL PR.
SIKKIM
RAJASTHAN UTTA R PRADESH ASSAM
NAGALAND
BIHAR MEGHALAYA
MANIPUR
WE ST BENGAL TRIPURA
GUJA RAT MADHYA PRADES H JHARKHAND MIZORAM
CHHATTISGARH
ORISSA
D&N HAVELI
MAHARASHTRA
0 – 10%
ANDHRA PRADESH
10 – 20%
GOA
KAR NATAKA
20 - 28%
A&N ISLANDS
PONDICHERRY
TAMIL NADU
LAKSHA DW EEPKER ALA
Source: DLHS 3 2007-08

6. Prioritization:
• DTP3 : important indicator
• > 90% DPT3 at national level
• > 80% at least, at district level
• CES-2009(India):
– FIC%:61%
– DPT3%: 71%
– 14 states under national average.
– Others(includes WB): Low performing pockets
for focused attention.

7. • Prioritization of districts also based on
– % of fully immunized children (as per DLHS-3 survey).
• in WB: 6 districts identified for special focus 2yrs back.
– Districts with < 50% FI children prioritized for focused
interventions to improve coverage.
• In WB lowest FIC% of 54% (DLHS-3) was UDP.
• Prioritization of blocks in all districts based on risk analysis

8. Purpose of IRI
• To improve immunization coverage in
all the districts of the country.
• State and district wise realistic targets
to improve immunization coverage.

9. D. Strategies for IRI

10. Proposed activities
1. National and State level advocacy
2. Strengthening communication and social mobilization
3. Regular program reviews at all levels
4. Development of Coverage Improvement Plans
5. Institutional Capacity Building
6. Vaccine and logistics management
7. Cold chain strengthening and maintenance
8. Teeka Express
9. Immunization Weeks
10. Strengthening RI monitoring and supervision
11. Strengthening partnership with all stakeholders
12. Institutionalizing AEFI and VPD surveillance
13. Operational Research studies planned during 2012-13

11. National and State level advocacy
Proposed actions:
• 2012-13 as the “Year of Intensification of RI”.
• Interdepartmental coordination.
• State and District level Task force
• State level launch of the Year of IRI.

12. Strengthening communication and social mobilization
• Focus on components and strategies for addressing
– left outs,
– drop outs and
– increasing community participation in immunization.
• Social mobilization activities :activate wider networks
and groups to include:
– ICDS,
– Education,
– Panchayati Raj Institutions,
– Professional bodies,
– Women Self Help Group,
– NGOs etc.

13. Regular program reviews at all levels
Review meetings –
– to track progress, identify problems and analyze
issues and address them.
– quarterly at national/state level
– and monthly at district and block levels

14. Development of Coverage Improvement Plans
• States and districts
- to conduct risk analysis to identify and prioritize
high risk blocks,
- gap analysis to identify bottlenecks in HRA,
- review and update the micro-plans of these areas
and
- strengthen monitoring of session sites and
community.

15. • Institutional Capacity Building :
Vacancy etc
• Vaccine and logistics/CC management
EVM guideline & post EVM follow up
• Planning and strengthening AVD
Linkage with rational micro-plan
• Strengthening partnership with all stakeholders
ICDS, PRI, Urban local bodies, NGO/SHG, Education
dept. Unicef, WHO-NPSP, Professional bodies etc.

16. Strengthening RI monitoring and supervision
• All levels
• Use standard monitoring formats.
• Immediate feedback & record in Inspection book.
• Compilation, convergence and Analysis of Data
- from RI monitoring,
- HMIS,
- surveillance and
- coverage surveys

17. Institutionalizing AEFI and VPD surveillance
• Present AEFI/VPD reporting status poor.
• District AEFI committee to be operational.
• Capacity building of AEFI committee members will be
undertaken.
• DMCHO should be the nodal person.
• Timely report of minor & serious AEFI including FIR, PIR
& DIR .
• DMCHO would be held responsible personally for
AEFI/VPD surveillance

18. Operational Research studies planned
during 2012-13
1. Evaluation of MO training in immunization;
2. Cold chain assessments;
3. Studies on vaccine freezing and
4. Injection safety studies

19. G. Indicators to be monitored at each level

20. District Opening Release Expenditures Refund Closing % of
Balance as on to State Balance as on Exp
01.04.2011 HQ 31.03.12
Bankura 8510342 1365966 5472324 0 4403984 55.41
Birbhum 4231934 4298991 4428646 0 4102279 51.91
Burdwan 7425758 9325489 4633056 0 12118191 27.66
Cooch Behar 3341892 3899054 3513469 0 3727477 48.52
Dakshin Dinajpur 3086269 2021732 2983082 0 2124919 58.40
Darjeeling 3769466 94001 718103 0 3145364 18.59
Hoohgly 6799026 10975099 4046517 0 13727608 22.77
Howrah 5173267 5574703 2575496 0 8172474 23.96
Jalpaiguri 5013342 4571702 3239656 0 6345388 33.80
Kolkata 0 1054521 358184 27900 668437 33.97
Malda 4995504 3837213 1143647 0 7689070 12.95
Murshidabad 8456624 6428354 7531952 0 7353026 50.60
Nadia 5870861 3693203 3232666 0 6331398 33.80
North 24 Pgs 13078896 4826482 4935126 0 12970252 27.56
Paschim Medinipur 10082909 4105521 10105900 0 4082530 71.23
Purba Medinipur 8144388 4063575 2685606 0 9522357 22.00
Purulia 2719249 6787407 4602941 0 4903715 48.42
Souuth 24 Pgs 13005613 8853237 5766205 0 16092645 26.38
Uttar Dinajpur 2876085 3906084 3889201 0 2892968 57.34
Darjeeling (DGHC) 551266 0 0 0 551266 0.00
Grand Total 117132691 89682334 75861777 27900 130925348 36.68

21. DPT3 target (increase of 15% from DLHS-3)
State target >80%

22. Can we do this?

23. A declining trend in the state

24. Thank you