STRATEGIES AND PROGRESS IMMUNIZATION

SITUATIONAL ANALYSIS Evaluated coverage of 43.5% by NFHS 3 and 62.4% by UNICEF CES 2006 fully immunized children 20 lac more children fully immunized in one year

Immunization coverages increased in traditionally low performing states (NFHS 2-3) Immunization coverages decrease from 4-19.6% in high performing states-(NFHS 2 to 3)

GENERIC INTERVENTIONS Introduction of new vaccines based on disease specific mortality and morbidity indicators – JE, Hep B System Strengthening : Activity based funding to strengthen service delivery Alternate vaccine delivery to ensure reach into villages Alternate Vaccinators to ensure sessions are held ASHA/Link workers used for Social Mobilization to ensure demand creation in community. Strengthening supportive supervision by support for POL Half yearly meeting at State with districts to ensure monitoring. Capacity Building: Trainings at all levels for all aspects of immunization service delivery Monitoring and supervision of the programme at service delivery level Demand generation: Social Mobilization Injection Safety: AD syringes and waste disposal guidelines for immunization sessions

STRATEGIES TO INCREASE IMMUNISATION IN LOW PERFORMING STATES Service delivery improvement Catchup Campaigns – Immunization + other interventions (Vit A, Deworming etc) UP, Bihar, Chhattisgarh, Jharkhand, NE States External quality assurance mechanism for health workers training Bihar Quality Assurance Network for training of Health Workers Rajasthan 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 Annual Maintenance Contract for cold chain Bihar Vaccine and logistics management assessment Orissa Programme monitoring and supervision District level CES Bihar, Gujrat Partner supported monitoring UP, Bihar, Rajasthan, Jharkhand, Orissa Supportive supervision Jharkhand, MP Divisional level reviews UP

STRATEGIES TO INCREASE IMMUNISATION IN HIGH PERFORMING STATES Strengthening service delivery PPP with medical college & youth organizations Karnataka, Mizoram Establishing support groups Maharashtra Engagement with PRI to mobilize beneficiaries Kerala Incentives for health workers Kerala, Karnataka Operationalization of additional static and mobile clinics Mizoram, Delhi Private Medical practitioners involvements, Outsourcing immunization to NGOs in underserved areas Maharashtra, Goa, Kerala, Delhi Strengthening vaccine, cold chain and logistics management Emergency vaccine procurement fund, Vaccine stock management systems Tamil Nadu, Maharashtra Strengthening programme monitoring and supervision State task force/operational core group for monitoring Kerala, Karnataka District level supervision Punjab Close monitoring, cluster and internal evaluation, and supportive supervision of low performing areas Kerala, Karnataka, AP (with Medical Colleges), Tamil Nadu, Maharashtra

PROGRESS JE Hep B New vaccines introduced in UIP Hep B in 10 states Highest Priority District High Risk Districts Medium Risk Districts JE Hep B New vaccines introduced in UIP Hep B in 10 states JE in endemic districts 11 Districts in 2006 27 districts in 2007 24 districts in 2008 Validation of elimination of Maternal and neonatal 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 monitoring systems (RIMS) introduced in all districts and being used by nearly 180 districts Catch-up rounds and Immunization weeks in low performing states Training of more than 90,000 ANMs and other health workers

IMMUNISATION: KEY ISSUES 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 - inadequate health infrastructure, multiple agencies, poor coordination.

IMMUNISATION: WAY FORWARD Introduction of new vaccines based on disease specific mortality and morbidity indicators/ NTAGI inputs HepB-DPT-HiB Pentavalent 2nd Dose of measles and Rubella in select states JE in remaining 42 districts System Strengthening : Operationalization of RIMS in all districts. Activity based funding to strengthen service delivery Alternate vaccine delivery to ensure reach into villages Alternate Vaccinators to ensure sessions are held Strengthening Supportive supervision Half yearly meeting at State with districts to ensure monitoring. Support for POL to assist active supervision Demand generation through social mobilization 3. Streamline procurement and supply chain 4. Capacity Building: Training of the remainder of >100,000 health workers & managers 5. Survey of more states for MNT elimination validation 6. Mid term evaluation of the program against the milestones stated in the multi year plan