1. A Presentation By Statistical Observatory, Gurgaon, India Email: statisticalobservatory@yahoo.co.in

2. Quick Review from Macro to Micro Level for Immunization Performance Objective: Using official statistics to review the achievements of child ( aged 12-23 months) immunization in the country to identify: Method: Using DevInfo - A GIS based technological application to examine and drawing the evidence-based conclusions supported by statistical principles. 1.Pattern, Trend and Impact of monthly achievements at macro and micro level. 2. Relationship (if any) between U5MR and immunization performance in four low performing states of the country. 

3. Part: 1 Note: Immunization statistics are not available in data source (DLHS III, 2007-2008) for 44 dark colored districts shown in the map.

4. Summary of the Child Immunization Performance Across Districts of India Spatial Location of Specific Districts 1.1 Computations and visualization by author based on DLHS III, 2007-2008.

5. Summary of the Child Immunization Performance Across Districts of India Contd. Spatial Location of Specific Districts 1.1 Data source: DLHS III, 2007-2008, India

6. All India Percentiles & Rank of the High Performing (90.0% and above ) Districts 1.2 Data source: DLHS III 2007-2008,, India. Rank and Percentiles computed by author.

7. Comparative Immunization Performance of the Districts Across India 1.3 Box: Low Coverage Corridor Districts with below national average performance fall in a corridor from west to east in central part of the country. Data source: DLHS III, 2007-2008, India Low Coverage Districts

8. Part: 2

9. Immunization Performance Pattern in Low Performing States 2.1 Box: Performance Pattern All four states show different pattern for immunization performance.. Immunization Performance U5MR Data source: NFHS I, II, III & CES 2009, India

10. Inter District Disparity in Immunization Performance in Low Performing States 2.2 Box: Performance Pattern Very high inter-district disparity in performance of complete immunization of children. Data source: NFHS I, II, III & CES 2009, India Key: Performance level Disparity in immunization performance (%) District with lowest performance District with highest performance

11. Movement of IMR in Low Performing States of India Data source: NFHS I, II, III & CES 2009, India 2.3 Observed IMR Future trend in IMR Key: IMR in past and future Box: Immunization impact on IMR IMR decreasing linearly in all four states!.

12. Pattern & Trend for Relationship in Under Five Mortality and Immunization Rate Key: Under five mortality rate Child (aged 12-23 mo) Complete immunization rate Data source: NFHS I, II, III & CES 2009, India 2.4 Box: Performance Pattern & Relationship 1.Ununiform patterns among all four states. 2. Decreasing trend at different rates in U5MR. 3. Increasing trend at different rates in immunization performance.

13. Part: 3

14. Data source: HMIS, Uttar Pradesh, 2007, 2008, 2009 & 2010. Districts of UP: In neighborhood of State Capital (Period: January 2007 to August 2010, Monthly) Box: Performance Pattern 1.Similar pattern of performance in all districts. 2.Inconsistent performance throughout the year. 3.Highly dominated by seasonality. 4.Oscillatory trend. 5.High fluctuations in min & max performance level. Immunization Performance in State Capital and Its Neighboring Districts 3.1

15. Immunization Performance in State Capital and Neighboring Districts Box: Performance Pattern Achievements are too low as compared to the expected performance level in all districts at any point of time during 44 months from January 2007 to August 2010. 3.2 Data source: HMIS, Uttar Pradesh, 2007, 2008, 2009 & 2010.

16. The Pattern of Monthly Immunization Performance in Blocks of Lucknow Distt. Box: Performance Pattern Lowest: January/February/March Highest: November/December Trend: Oscillatory and/or Irregular Achievement: Lower than 100% 3.3 Data source: HMIS, Uttar Pradesh, 2007, 2008, 2009 & 2010.

17. Highlights 3.4 1.There is a different pattern of immunization performance with high fluctuations across districts of the country. 2. The only district with full immunization coverage (100%) for children is Pondicherry. 4. The low coverage districts are located in middle part of the country and form a corridor from west in Rajasthan to east in Arunachal Pradesh. 5. The immunization performance in one of the low performing state – Uttar Pradesh, indicates for seasonal trend. The performance highly fluctuates with season leaving children to live with high risk of preventable diseases. The Jan, Feb and March are the months of lowest while Nov & Dec register highest performance. 3.The lowest level immunization coverage is observed in Arunachal Pradesh. The Lower Subansiri disrict with 3.8 % complete immunization rate of children. 7. The complete immunization of children in low performing states indicate a negative correlation with U5MR. Functional form is yet to be determined. 6. In low performing states, IMR is observed with decreasing linear trend.