RI in India Concurrent Evaluation NRHM

8/8/2019 RI in India Concurrent Evaluation NRHM

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Routine Immunization

Dr SD KhapardeDeputy Commissioner (I.D &Imm)

Ministry of Health & Family WelfareGovernment of India


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Province/states: 35

s r c s:

Projected Infants (2007): ~ 27 million


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Child Health Pro rammes

1978- Ex anded Pro ramme of immunization EPI

1984- Universal Immunization Programme (UIP) Forprevention of deaths due to 6 VPDs

1985- Oral Rehydration Therapy Programme for prevention ofdeaths due to diarrhoea

1990- UIP and ORT universalized in all districts

1992- CSSM1997- RCH-1

2005- NRHM and RCH II

The focus is a DistrictDistrict Action planning

ec veness o po cy

coordination at District


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NATIONAL GOALS & MDG

2007 2010 2015Current

Infant MR 45


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IT ATI NAL ANALY I

. .

immunized children

54.5

.

1.5%

42 43.5

20 lac more

fullyimmunized

in one year

5

NFHS 2 NFHS 3 CES 2005 CES 2006


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Immunization coverages increased in traditionally low performing states(NFHS 2-3)

14.6

17.7 18.519.1

20.5 21.222.2

25.7 26.90-9%

10-19%

20-29%

30-39%

NFHS 2 FI data

2.6 2.74.5

6.97.9 8.1

9 9.210

-

50-59%

60-69%

HARYANA

UTTAR

PRADESH

MANIPUR

NAGALAND

RUNACHAL

PRADESH

ORISSA

TRIPURA

AJASTHAN

JAMMU&

KASHMIR

ASSAM

MADHYA

PRADESH

EGHALAYA

ARANCHAL

TBENGAL

BIHAR

SIKKIM

HARKHAND

TTISGARH

Immunization coverages decrease from 4-19.6% in high performing states-(NFHS 2

A M

U

TT

W

E JCH

0MAHARASHTRA MIZORAM

ANDHRA

PRADESH PUNJAB

HIMACHAL

PRADESH TAMIL NADU GUJARAT DELHI KARNATAKA KERALA GOA

--12

-9.2-8 -7.8

-6.6

-5 -4.4-4

-10

NFHS 2 FI data

6-19.6

- . .

-20

50-59%

60-69%70-79%

80-89%


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Immunization s ecific Initiatives

Improving service delivery yr nges roug ou e coun ry

Alternate vaccinators in areas with no ANM and in urban areas

.

Increased services through catch Up rounds

Monthly Village Health & sanitation Days ASHAs for tracking the children and mobilizing the community

Additional ANMs active in Immunization

Session Monitoring in poor performing states


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states -

Hepatitis-B implementation expanded to 10.

Policy decisions undertaken

o ntro uce vacc ne n t e

Second opportunity for measles and measlescampa gns


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STRATEGIES TO INCREASE IMMUNISATION IN

Service delivery improvement

Catchup Campaigns Immunization + other interventions (Vit A, Deworming UP, Bihar, Chhattisgarh,etc) Jharkhand, NE States

External quality assurance mechanism for health workers training Bihar

Outsourcing immunizations to NGOs in underserved areas Arunachal Pradesh

Incentives to health worker/ families Jharkhand, Orissa

Improving vaccine, cold chain and logistics management

Mobile Cold-Chain Workshop in Rajasthan Rajasthan

Vaccine and logistics management assessment Orissa

Programme monitoring and supervision

District level CES Bihar, Gujrat

Partner supported monitoring UP, Bihar, Rajasthan,Jharkhand, Orissa

9

Supportive supervision Jharkhand, MP

Divisional level reviews UP


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STRATEGIES TO INCREASE IMMUNISATION IN

Strengthening service delivery

PPP with medical college & youth organizations Karnataka, Mizoram

Establishing support groups Maharashtra

En a ement with PRI to mobilize beneficiaries Kerala

Incentives for health workers Kerala, Karnataka

Operationalization of additional static and mobile clinics Mizoram, Delhi

r va e e ca prac oners nvo vemen s, u sourc ng

immunization to NGOs in underserved areas

a aras ra, oa, era a,

Delhi

Strengthening vaccine, cold chain and logistics management

Emergency vaccine procurement fund, Vaccine stockmanagement systems

Tamil Nadu, Maharashtra

Strengthening programme monitoring and supervisionState task force/operational core group for monitoring Kerala, Karnataka

District level supervision Punjab

10

ose mon tor ng, c uster an nterna eva uat on, an

supportive supervision of low performing areas

era a, arnata a, w t

Medical Colleges), TamilNadu, Maharashtra


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PROGRESS

JE Hep B

Hep B in 10 states JE in endemic districts

11 Districts in 2006 27 districts in 2007 24 districts in 2008

Highest Priority DistrictHigh Risk DistrictsMedium Risk Districts

Validation of elimination of Maternal andneonatal tetanus in

15 States -Andhra Pradesh, Kerala,

Tamil Nadu, Karnataka, Maharashtra,

West Bengal, Haryana, Goa, Sikkim,

Punjab, Chandigarh, Pondicherry,Lakshadweep, HP, and Gujarat

Routine Immunization monitorin s stems RIMS introduced in all districts and bein used b

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nearly 180 districts

Catch-up rounds and Immunization weeks in low performing states

Training of more than 90,000 ANMs and other health workers


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IMM NI ATI N: KEY I E

Shortage of vaccines and cold chain equipment

Inconsistent delivery of vaccines to outreach session sites.

Operational issues :

Immunization sessions not being held regularly

HR shortages at all levels

Inadequate mobility of health workers and supervisors

at district & state levels

Urban areas - inade uate health infrastructure,multiple agencies, poor coordination.

12


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IMMUNISATION: WAY FORWARD

1. Introduction of new vaccines based on disease specific mortality and morbidity

HepB-DPT-HiB Pentavalent

2nd Dose of measles and Rubella in select states

JE in remaining 42 districts

2. System Strengthening :

Operationalization of RIMS in all districts.

Activity based funding to strengthen service delivery Alternate vaccine delivery to ensure reach into villages

Strengthening Supportive supervision

Half yearly meeting at State with districts to ensure monitoring. upport or to ass st act ve superv s on

Demand generation through social mobilization

3. Streamline procurement and supply chain

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4. Capacity Building: Training of the remainder of >100,000 health workers & managers

5. Survey of more states for MNT elimination validation


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CoverageinChildImmunization

15


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1state


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7states


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IMMUNIZATION MONITORING


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State

Block

Session Site


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Documents

RI in India Concurrent Evaluation NRHM