regional update: increasing & sustaining …...1 1 sage meeting 5-7 april 2011, geneva,...
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1 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Regional Update: Increasing & sustaining immunization coverage in SEAR
Immunization and Vaccine Development (IVD) SEARO Nihal Abeysinghe, RA-VPD
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2 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Outline of this presentation
Status of RI in SEAR SEAR RI Coverage Key determinants for low coverage
SEAR Strategies
SEAR Plans
RI in priority countries of SEAR
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3 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
0
10
20
30
40
50
60
70
80
90
100
Ban
glad
esh
Bhu
tan
DP
R K
orea
Indi
a
Indo
nesi
a
Mal
dive
s
Mya
nmar
Nep
al
Sri
Lank
a
Thai
land
Tim
or-L
este
SE
AR
% D
TP3
Cove
rage
1997 2001 2005 2009
Source: WHO-UNICEF Best Estimates Note: Timor-Leste was part of Indonesia prior to 2002
SEAR DTP3 Coverage
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4 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Estimated % of Children Missing DTP3, SEAR, 2009 (N=9.8 Million)
Indonesia7.45%
Bangladesh1.99%
India87.76%
Nepal1.28%Myanmar
0.96%
Others*0.56%
Source: WHO-UNICEF Best Estimates
*Others includes 6 countries of the region: Bhutan, DPR Korea, Maldives, Sri Lanka, Thailand and Timor-Leste
Estimated % of Children Missing DTP3, SEAR 2009
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5 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Key determinants for low coverage (1) Access:
hard-to-reach rural areas and socially marginalized populations in urban areas
unaware of the need for immunization do not perceive immunization as important for child
survival
Resource availability & utilization: sub-optimal utilization of available resources poorly
managed services including outreach activities. lack of adequate trained human resources
Service delivery: high drop-out rates, particularly where PHC services are
inadequate
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6 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Key determinants for low coverage (2) Information Use:
inadequate utilization of data for action
Managerial capacity: inability to capitalize on opportunities and
resources available (eg accelerated disease control initiatives)
• polio, measles, and new vaccine introduction
Management of AEFI: lack of proactive plans and problems in risk
communication
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7 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Outline of this presentation
Status of RI in SEAR SEAR RI Coverage Key determinants for low coverage
SEAR Strategies
SEAR Plans
RI in priority countries of SEAR
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8 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Strategies for increasing & sustaining RI coverage
Planned High level advocacy (meeting scheduled in July 2011)
Social mobilization: joining global immunization week 2012
Ongoing/ Completed Resource mapping
Monitoring & Evaluation of immunization coverage, vaccines and logistics
Effective Vaccine Management Assessments, cold chain capacity expansion
SIAs used as opportunities to strengthen RI
Mid-level Managers training in March 2011
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9 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Strengthening capacity of Mid-Level Managers
Re-orienting mid-level managers using the present set of EPI managers as trainers
Institutionalizing mid-level managers training
Improving quality of services by supporting PHC staff
Promoting monitoring and evaluation for expanding service for quantity & quality
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10 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Outline of this presentation
Status of RI in SEAR SEAR RI Coverage Key determinants for low coverage
SEAR Strategies
SEAR Plans
RI in priority countries of SEAR
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11 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
IVD SEARO Plans for 2011 Updating
Regional Immunization Policy Strategic Plan for Immunization & vaccine
Development
Developing Framework for increasing and sustaining
routine immunization coverage
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12 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Outline of this presentation
Status of RI in SEAR SEAR RI Coverage Key determinants for low coverage
SEAR Strategies
SEAR Plans
RI in priority countries of SEAR
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13 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Bangladesh
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14 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
9395
93
9092
9394
9594
95 95
92
9698 98 98
99
79
94
87
9192
9088 88
8786
91
98
9597
98 9899
74
84
69
7778
74
77
81
8586
87
99
9394 94 94 94
74
7879
69
72
65
7172
77 7776
74
88
78
89 89 89
60
70
80
90
100
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Percentage
BCG DTP1 DTP3 Measles
Source: WHO/ UNICEF Estimated coverage, 1993-2009
Vaccination coverage and interventions in Bangladesh 1993 - 2009
2003 RED strategy
GAVI/ISS Hep-B Intro
2009 Penta
Introduction
2006 Measles Catch-up Campaign
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15 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
EPI Micro-plan using RED Annual EPI micro-plan including session plans
• 1st line supervisory plan • Identification of Hard to Reach and High Risk Areas • Monthly meeting for field workers to review coverage, feedback
and surveillance performance
Additional Support for Low performing Districts WHO (23 Districts and 2 City Corporations) and UNICEF (15
Districts) • District level workshop for review RI coverage • Additional support for transportation of vaccines and logistics • Listing of drop out and left out, problems and solutions • Supervision by 1st line supervisors
The key to success of RI in Bangladesh
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16 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
India
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17 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Percent children 12 to 23 months received 3 doses of DTP vaccine, India DLHS III 2007-08
Data not available
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYA
NAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
DELHI
D&N HAVELI
CHANDIGARH
DAMAN & DIU
PONDICHERRY
LAKSHADWEEP
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18 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
Immunization Coverage
54.1%
34.6%
11.3%
No Immunization
Partially Immunized
Fully Immunized
Source: District Level House hold Survey 2008
88.7
%
26
22.6
16.618.1
2.9
0
5
10
15
20
25
30
Target Infants BCG DPT-3 Measles NoImmunization
Infants in million
Millions of Infants (0-1 Yr) reached
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19 SAGE Meeting 5-7 April 2011, Geneva, Switzerland
High levels of drop outs of children who have entered the system
Source: DLHS-3 Data for children aged 12-23 months