1) Bihar conducted a Measles Catch-up Campaign in 5 districts targeting over 2.7 million children aged 9 months to 10 years. 2) The campaign saw strong state-level coordination and oversight. Over 24,000 vaccination sites were set up across 64 blocks. 3) Monitoring of nearly 10,000 sessions found high coverage, though some children were left out due to lack of information. A few AEFI cases were reported and duly managed. 4) Lessons learned include best practices around training, monitoring, and AEFI management, as well as areas for improvement such as coordination, microplanning, and information dissemination. Bihar plans to conduct Phase 2 across its remaining 33

1. Measles Catch-up Campaign: Lessons learnt and planning for Phase-II State: BIHAR Dr Gopal Krishna, SEPIO

2. State Perspective regarding MCUP Initially only 2 districts were allotted for first phase Following request by Principal Secretary & Secretary cum Executive Director, SHSB, the state was allowed to go for 5 districts. In 2nd Phase, the State is willing to go for all the remaining 33 districts.

3. Measles SIA Campaign 2010 at a glance 5 Districts, 64 blocks Target population (9m-10yrs): 2,715,743 (25% of Total Population) Total immunization posts: 24,088 Total schools: 8,919 Total ANMs: 1,899 Total health workers (ANMs+ASHAs): 16,700

4. BIHAR : Overview

5. Pre activity preparations Status Coordination and high-level oversight A state level co-ordination committee under the chairmanship of Principal Secretary Health was done. Health, Education and WCD (ICDS) participated in this meeting. State level committees and Operation Groups SOG was functional under the chairmanship of Secretary Health cum Executive Director, SHSB The members were SIO, Director ICDS, Director Education, WHO-NPSP, UNICEF & other partner agencies. Stress was put on microplanning, training, AEFI management, waste management, media management, IEC etc.

6. Pre activity Preparation Status State level TOT was done, where 6 trainers (DIO & 5 MOs) from each 5 districts were trained. Decentralised review meeting at divisional level by SEPIO to assess the preparedness State Level Control Room under the chairmanship of SEPIO was formed. To review the preparedness of each district on day to day basis Timely feedback and follow-up system was established

7. Constraints which were tackled during the campaign Assembly Elections Strike of the Health Staffs Festivals Shortage of injectors mainy in urban areas Cold Weather conditions

8. District Task Force Meeting Status First 2 DTFs were done during preparatory phase. Next 2 DTFs during the implementation phase & 5th DTF was post campaign to assess the completeness of activity & to plan the repeat activity in areas with poor activity.

9. State Pre activity preparations: District and Block level trainings

10. District-wise coverage

11. Monitoring findings A total of 9724 sessions were monitored Findings are mentioned below-

12. RCA Findings: Coverage

13. Reason for not Vaccinating the child during the campaign Left outs can be decreased with better IEC & IPC

14. Management of AEFIs * Clustering at Nawada in a school following measles vaccination

15. Communication and social mobilization Activities carried out Distribution of invitation cards to parents by AWW & ASHA Distribution of Flip Charts & FAQs to AWW & ASHA Separate sessions on mobilisation trainings of AWWs & ASHAs State level Media workshop along with divisional & District level media briefings by CS Rally of school children School activity worked in favour of communication and social mobilisation Inauguration of campaign by Minister, Divisional Commissioner, DMs & Civil Surgeons.

16. Communication and social mobilization Areas for improvement Delayed printing of Invitation cards & other formats Proper use of due list for both school & outreach session sites Sensitisation of Principal of private schools Sensitisation of private practitioners regarding 2nd dose for measles Use of Village Health & Sanitation Committee

23. Future Plans for subsequent Phase No. of Districts – All remaining 33 districts Target beneficiaries – 2,32,18,410 Plan for addressing shortcomings All the DIOs of remaining 33 districts had been sensitised during their State review meetings. State level review meeting done in April 11 Final document to be circulated to all the PHCs Timeline – Anticipating national level meeting for 2nd Phase in June 11 Starting of preparation at State & district level in July- Aug 11 Implementation of campaign Sep 11 onwards

24. Support from GOI for Next Phase Letter to concerned departments for co-ordination at State & District level Supply of new vaccine carriers & icepacks AD Syringes must be compatible with the hub cutters. Diluents in plastic containers. Financial support for Monitoring of activity Elaborate financial guidelines, especially for Supervisors per diem & mobility Per diem for cold chain handlers & personnel managing waste at PHCs

25. DIO of Arwal District in District Microplanning Workshop

26. State Level Media Workshop before the SIA – Principal Secretary & Secretary

27. Use of Hoardings

28. Use of Audio-Visual during training sessions

29. Rally of School Children at Gaya district – CS Gaya

30. AEFI Kit

31. Use of Alternate Vaccine Delivey System

32. A session site with AD syringes, Hub cutters, keeping vial in hole of icepack

33. Children waiting for their turn at school session site

34. A DIO on deployment, from non-implementing district, doing monitoring

35. Children Under Observation following Vaccination

36. Monitoring by CS Arwal & WHO-NPSP

37. RCA – availability of Vaccination & Invitation Cards

38. Monitoring in a Brick Kiln by State Officials

39. Thank You