India’s Universal Immunization Programme An Overview GAVI Alliance Board Meeting 13 June 2012, Washington DC Anuradha Gupta Ministry Of Health & Family Welfare Govt. of India
Presentation outline Program Progress Issue & challenges Initiatives under UIP Summary
Immunization Program in India: A Snap Shot ~26 million new born targeted each year ~9 million immunization sessions held annually ~25,000 cold chain points Vaccine against 7 vaccine preventable diseases Polio SIAs , 800 million children vaccinated every year • HepB vaccine universalized in the country. • Measles Catch-up campaign initiated in 61% Full Immunization Coverage 2010 , targeting 135 million children (evaluated 2009) JE vaccination campaign conducted in 112 endemic districts covering 78 million children Hib containing Pentavalent vaccine introduced in two states. Introduction in 6 more states planned .
Polio Eradication : Major Success Factors • Strong political and financial commitment • Painstaking planning, execution & monitoring • Ongoing tactical and scientific innovations based on analysis and research; • Strong, enduring, effective partnerships • Perseverance and resilience to overcome the range of challenges In 2012, WHO drops India from the and opposition list of Polio endemic countries Strengthening UIP is imperative for sustaining gains in Polio Eradication 4 4
Measles Mortality Reduction Initiative • Catch-up campaigns initiated in 14 states & 365 districts in phased manner in 2010 • Target population (9mths-10 yrs): 135 million • All catch-up districts incorporating Measles 2 nd dose under RI after 6 months of campaign SIA: A: MCV1 <80%: %: 14 states • MCV2 introduced in RI in remaining 21 RI: MCV1 > > 80%: 21 states states targeting ~10 million children annually. ~48 million children covered in catch up campaigns Estimated measles deaths reduced from 106,000 in 2005 to 65,000 in 2010
Pentavalent Vaccine Introduction • Initiated in 2 states in Dec 2011 JAMMU & KASHMIR • Already vaccinated more HIMACHAL PRADESH PUNJAB CHANDIGARH UTTARAKHAND HARYANA than 1 million children DELHI ARUNACHAL PR. SIKKIM RAJASTHAN UTTAR PRADESH ASSAM NAGALAND till April 2012 BIHAR MEGHALAYA MANIPUR JHARKHAND TRIPURA GUJARAT MIZORAM MADHYA PRADESH WEST BENGAL • Proposal to introduce in CHHATTISGARH ODISHA DAMAN & DIU D&N HAVELI MAHARASHTRA six more states ANDHRA PRADESH GOA • HiB surveillance initiated KARNATAKA A&N ISLANDS PONDICHERRY as bacterial meningitis LAKSHADWEEP TAMIL NADU KERALA surveillance in 11 Pentavalent vaccine introduced sentinel sites Pentavalent vaccine to be introduced
Reaching the Unreached: A critical Appraisal Fully immunized children (12 – 23 months) Access issue Utilization Issue DLHS-2 JAMMU & KASHMIR Below 40 40 to 50 HIMACHAL PRADESH 50 to 60 PUNJAB 60 to 70 UTTARANCHAL HARYANA Above 70 ARUNACHAL PR. SIKKIM RAJASTHAN UTTAR PRADESH ASSAM NAGALAND BIHAR MEGHALAYA MANIPUR TRIPURA JHARKHAND GUJARAT MIZORAM MADHYA PRADESH WEST BENGAL CHHATTISGARH ORISSA D&N HAVELI MAHARASHTRA ANDHRA PRADESH GOA KARNATAKA A&N ISLANDS PONDICHERRY TAMIL NADU KERALA LAKSHADWEEP 239 Districts identified for priority attention
Reaching the Unreached: A critical Appraisal Demand side issues Supply side issues Others 8 Source CES 2009
National Immunization Programme-Issues Programme Human Policy Vaccine Logistics VPD Monitoring Issues Safety Resource Surveillance Limited Limited AEFI Patchy VPD capacity Weak evidence for Inadequate Apprehension in of PSUs Surveillance tracking introduction Programme Community Data of New mechanism Management Vaccine Structure at National , Limited Few Vaccine Limited State & Manufacturer Demand outcome District level Generation Monitoring Need for Research Top down Weak Polcy Vacant post vaccine Laboratory Planning of Medical supply Surveillance unit Officers, ANM, ASHA Variable AVD mechanism Hard to Reach Areas/Migrant Population High load of Training Cold Chain Space
Strategic Actions to improve Immunization Coverage Year 2012 declared as year of ‘Intensification of Routine Immunization’ • Action 1: Health Systems Improvement • Action 2-Identifying the Unreached & conducting Immunization Week • Action 3- Tracking Every Mother Every Child • Action 4- Social Mobilization Efforts • Action 5- Improving Public Confidence • Action 6-Improving Logistics and Supply Chain • Action 7-Evidence Generation • Action 8- Policy Strengthening
Strategic Action 1 Health Systems Improvement NRHM mandates to rejuvenate health delivery system through Universal Health Care which is Accessible, Affordable and with Quality • Decentralized planning & need based funding. • Improving service delivery through: 2 nd ANMs , Alternate vaccinators • Cold Chain System strengthening • Intensified session Monitoring • Reaching the unreached - Teeka Express , Mobile medical units • Convergence of Polio and RI microplan • Immunization Technical support Unit (ITSU) to strengthen UIP 11
Strategic Action 2 Organizing Immunization Weeks 239 Districts with lowest full immunization(%) in DLHS 3 191 200 187 • Special 150 143 drive in form of 184 186 190 45 161 171 149 188 52 151 121 176 160 141 119 53 136 192 182 196 116 167 144 3 130 154 194 157 166 146 118 193 179 9 135 159 181 163 177 19 172 124 128 122 148 155 126 123 139 164 12 198 156 18 38 39 8 127 64 138 80 173 30 1 ‘Immunization Week’ developed 115 174 40 27 189 197 13 10 131 129 168 5 74 140 183 20 4 68 158 169 145 36 29 34 90 165 99 162 15 26 25 102 120 170 175 17 16 33 103 91 180 147 142 199 101 100 11 137 153 152 23 28 31 35 37 62 117 185 24 93 14 58 178 65 85 32 22 2 21 61 7 6 73 82 87 60 46 125 195 55 57 92 54 134 79 95 86 59 84 67 56 132 105 50 94 89 for poor performing areas/blocks 44 133 76 83 77 81 71 49 47 51 41 78 70 69 42 104 75 88 66 72 63 98 96 to improve immunization 48 43 107 106 110 97 109 112 113 108 10 - 20 111 20 - 30 coverage 30 - 40 40 - 49.1 114 • Exclusive immunization strategy for Migratory Population & Urban slums based on Polio Micro-plans • Strengthening Inter-sectoral co- ordination
Strategic Action 3 ‘Tracking Every Mother, Every Child’ • Web Based Mother and Child Tracking System (MCTS) as one of the key strategies to prevent left out and drop outs • Name based tracking of all pregnant mothers with contact details including mobile number. • SMS alerts in local language regarding due date of vaccination for the child • Advance preparation of village-wise due list for the scheduled immunization session using tracking bags 30 million mothers and children registered
Strategic Action 4 Social Mobilization Efforts • More than 860,000 ASHA workers in position for social Mobilization • ASHA incentive linked with mobilization and performance • Proposal to brand Routine Immunization program
Strategic Action 5 Improving Public Confidence • AEFI operational guidelines revised • National and district AEFI committees constituted • Capacity building of health care providers in Causality assessment 395 316 • Improved reporting of serious 299 AEFIs Serious AEFI Reporting 198 • Media sensitization and involvement in AEFI 55 36 29 32 13 6 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Strategic Action 6 Improving logistics and supply chain Alternate Vaccine Delivery (AVD) forms the life line of the National Immunization Programme for vaccine delivery from the last cold chain storage point to session site • Proposal to initiate Teeka Express • Specially designed vehicle to deliver vaccine at session site in Sub hard to reach areas. center • Also provides branding to the Immunization program Sub center session site Alternate Vaccine Delivery
Strategic Action 7 Evidence Generation • Polio Surveillance Network now being extended for surveillance of other Vaccine Preventable Diseases • Sentinel Hospital based Bacterial meningitis surveillance initiated with ICMR in 11 states • Scale-up of laboratory enhanced measles outbreak surveillance • Strengthening of National Integrated Disease Surveillance Program for Vaccine Preventable Disease
Strategic Action 8 Policy Strengthening • National Vaccine Policy developed • Revised Multi year plan (MYP) for UIP in India (2010-17) prepared • Vaccine Policy Unit being constituted for evidence collection and compilation for under-utilized and newer vaccine.
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