1. Joint DirectorImmunization Tamil Nadu

2. Current Scenario -Coverage Annual Target Coverage DLHS 3 QuantumInfants(A) Pregnant Women(B) Fully Immunized(C) BCG-DPT3 Dropout rate(D) Number of Children Not Fully Immunized [100-(C)] x (A)/100 Number of BCG-DPT3 Dropout Children(D) x (A)/100 10.97 12.06 83.2 10.7 1,84,000 1,17,000 3. Categorization of districts according to FI coverage(DLHS 3) Less than30% 30% - 50% 50% - 70% More than70%

Madurai(60)

Theni(61)

Virudhunagar(65)

27 Districts 4. Categorization of districts according to Drop-outs (DLHS3) Less than 10% 10% - 20% 20% - 30% More than 30% NIL 1 VILLUPURAM 2 TUTICORIN 3 NAGAPATTINAM 4 PUDUKOTTAI 5 TIRUCHIRAPALLI 6 THIRUVALLUR 7 THE NILGIRIS 8 THIRUVARUR 9 ERODE 10 KANCHEEPURAM 11 RAMANAD 12 THANJAVUR 13 CUDDALORE 14 PERAMBALUR 1 THIRUVANNAMALAI 2 DHARMAPURI 3 CHENNAI 4 NAMAKKAL 5 MADURAI 6 VELLORE 7 KARUR 8 DINDIGUL 9 KRISHNAGIRI 10 SIVAGANGA 11 KANYAKUMARI 12 TIRUNELVELI 1 COIMBATORE 2 SALEM 3 THENI 4 VIRUDHUNAGER 5. >50% < 30% 30% to 40% 40% to 50% 6. Drop-out (BCG-DPT3 ) > 30% 20% to 30% 10% to 20 % 7. Current Scenario Micro planning No. of Districts with micro plans revised in 2010 Percent Planned sessions held No. of Sub centers without VHN posted Number of Alternate Vaccinators hired(last FY) 30 Districts 98% 140 81 8. Cold Chain Equip ment Total Needed Total Available Functional Remarks / ReasonsILR Small 951 2855 2821 New requirement +Conversion of CFC to NCFC DFSmall 1010 1973 1961 ----Do----- ILR Large 25 134 130 ----Do----- DF Large 36 243 238 ----Do----- 9. Cold Chain Equipment Total Needed Total Available Functional Remarks / ReasonsWIC 3* 15 11

1 norequired for expansion

2 Nos requiredfor Conversion of CFC to NCFC .

WIF 2* 2 2

1 norequired for expansion

1 No required forConversion of CFC to NCFC .

Cold Box (L) 1000 2822 2059 New requirement + Replacement Cold Box(S) 400 1647 1481 ----Do----- Vaccine Carrier 5000 79964 76240 ----Do----- 10. Current Scenario Health Workers (HWs) Training M.O. TrainningTraining Load Trainings Completed No. of Health Workers No. of Batched Planned No. of Batches Completed No. of HWs Trained % HWs Trained21000 525 HW Training module received on 24-2-2011 and trainingwill be completed in 6 months Training Load Trainings Completed No. of MO No. of Batched Planned No. of Batches Completed No. of MO Trained % MO Trained4155 105 Training will becompleted in 6 months 11. AEFI 2010 No. of Districts with AEFI Committees No of Serious AEFI Reported No. of AEFI Deaths Reported No. of Serious AEFI Investigated 31district 14 9(Coincidental) 14 12. Access analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-DPT3, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) All districts 26 districts Low (< 70%) Nil **** **** 4. Districts 1 COIMBATORE 2 SALEM 3 THENI 4 VIRUDHUNAGER 13. Utilization analysis Coverage (BCG, DLHS 3) Dropout Rate (BCG-Measles, DLHS 3) Low (< 20%) High (> 20%) High (> 70%) All districts All districts Nil Low (< 70%) Nil Nil 14.

MCP card with growth monitoring chart issued to all mothers

IEC activities through TV channal on all Saturdays

Modernizing PHC Infrastructure on par with PVT. Hospitals which enhance confidence among the public to avail PHC service.

All PHCs 24 hours

Immunization is also planned on Village Health Nutritionday (ie on Fridays) to cover dropout

Creation of community awareness and self help women group participation through village health sanitation committee

Demand Generation Activities 15. 16. Status : Alternate Vaccine Delivery 2009-10 2010-11 Issues Sessions Planned (Nos) 214722 196531 Held (Nos) 211022 192485 % age Held 98 % 98 % Alternate Vaccine Delivery (AVD) No of sessions planned with AVD 36792 38634 No of sessions held with AVD 16518 4864 % Sessions held with AVD 45 13 17. Status : Alternate Vaccinators & Mobilizers 2009-10 2010-11 Issues Sessions planned using Alternate Vaccinators Planned (Nos) 27840 29140 *** Held (Nos) 16148 22240 *** % age Held 58 76 *** Mobilizers (Paid mobilizers like ASHAs/ Link workers/ Others) No of sessions planned with soc mobilizers Not relevantNo of sessions held with mobilizers % Sessions held with mobilizers 18. Status :Computer Assistants 2009-10 (Nos) 2010-11 (Nos) Issues Computer Assistants Required in State 30 30 Hired20 18 Quit from work % CA s in place 67 56 19. Status of RI supervisionState & District level2009-10 2010-11 Issues No.ofVisitsby State officials ( Director, Addl. Director,JD) 60 120 No.ofVisits made bydistrict officials24024 (includes visits by Mid level Supervisors-SHN/CHN ) 24024 (includes visits by Mid level Supervisors-SHN/CHN ) 20. Existing Supervisory Mechanism in state

Field level:

Mid level supervisors CHN / SHN at PHC & Block :

To verify the immunization status of minimum 20 children in a month. The mechanism is under progress.

Medical officer is verifyingdropoutchildren during his field visit.

District level:

Deputy Director of Health Services supervises the conduct of immunization sessions.

District Maternal Child Health Officer, Assistant Director (SBHI), Personal Assistant (Technical) provides regular visits to thePHC to supervise immunization sessions.

21.

Dropouts /missed out/migrant children identified and covered.

Injection safety ensured.

Adequate availability of vaccine, AD syringes and other logistics ensured.

Co-ordination with ICDS staff strengthened.

Ensuring proper disposal of bio-medical waste management.

Outcome/ Impact of Supervisory visits 22. RIreview mechanism in State

Weekly Review meetingis conducted by Medical officer on every Tuesday at PHCtoreview the field activities with reference to completeness and qualitative aspect.

Block level review is conducted by the Block Medical Officer

Monthly review meeting is conducted by district officers with all Medical Officers in the 1st week of every month at district head quarters.

Once in 3 months, State level review meeting for district officials

23. Status of RI Review Meeting contd..

Key participants

State level-Review by Director / Programme Office

1.District Officers( Deputy Director of Health Services), Corp. Health Officer

2.Asst. Director, District Maternity and Child Health Officer, District Statistician

District level- Review by Deputy Director of Health Services

1.Block Medical Officers, PHC Medical Health Officer and Corp. Health Officer, Municipal Health Officer and Medical Officers

2.Asst. Director, District Maternity and Child Health Officer, District Statistician

3.Community Health Nurse, Sector Health Nurse, Pharmacists

24. Status of RI Review Meeting contd..

Key participants

Block level- Review by Block Medical Officer

Community Health Nurse, Sector Health Nurse, Pharmacists, Village Health Nurse

PHC level Review by PHC Medical Officer

Sector Health Nurse, Pharmacists, Village Health Nurse, Anganwadi worker

25. Status of RI Review Meeting contd..

Key issues discussed

Performance indicators, Outreach immunization, vaccine stock management, Cold Chain management , dropouts children, migrant population. VPD, Outbreak of Measles, AEFI.

Key Recommendations of meetings

Immunization to drop out children during VHNDs. Special efforts to cover migrant children.Management of AEFI.Ensure complete reporting of Measles cases.

26. Dropout coverage BCG > Measles(10%) 27. Inconsistency Measles > FI 28. Inconsistency in DPT vaccination 29. Inconsistency in DPT vaccination 30.

Steps to improve

1.Supervisory components needs to be strengthened.

2.Refresher training to field functionaries and supervisors.

3.Special focus in High risk areas /inaccessible / remote /migrants

31. Status : Disposal pits Waste Disposal Pits 2009-10 (Nos.) issues Reqd. in State 1598 Pits Built 1473 % age pits in place 92 32.

State Level

BCG-A bulk supply of 6.95 lakh doses was made

during February 2011 after a gap of 8 months

TT-A quantity of 6.00 lakh doses were during

January2011 with short expiry (June 2011)-

CDRL, Kausali

Measles-Diluents supplied by IIL, Hyderabad were found

in broken stage (5,000) which was replaced.

Key issues regarding vaccine stocks 33. Key issues regarding vaccine stocks

State Level

DPT

Irregular supply by BE,Hyderabad A bulk quantity of 10.00 lakh doses supplied during Feb11 (whichshould have been supplied during Sep - Oct 10).

Another bulk quantity of 17.37lakh dosesduring Mar.11(which should have been supplied duringNov Dec. 10)

34. HMIS

HMIS is being implemented in all districts.

Proper training has been given to all district officials to assessquality of data through outlayers

District officials have starteduploading the data.

35. Measles vaccination

Status of measles 2 nddose in RI Implemented in theState during1-3-2011in all districts.

36. JE vaccination 2010-11(status of integration in UIP) JE vaccination is implemented in 9 DistrictsS.NO DISTRICT TargetChildren No. of children covered % coverage 1 CUDDALORE 39171 22660 58 2 VILLUPURAM 58645 24823 42 3 TANJAVUR 40624 13113 32 4 TIRUVARUR 20340 5591 27 5 TIRUCHIRAPALLI 40265 24193 60 6 PERAMBALUR 20821 7721 37 7 MADURAI 51500 16029 31 8 VIRUDUNAGAR 30557 11193 37 9 THIRUVANNAMALAI 40542 10824 27 Total 342465 136147 40 37.

Activities undertaken

-Publicities through display material

• - Publicities through FM radio and Doordharshan

• - ICDS co-ordinated with immunization and other health activities inthe field

• - NGOs/ self help group / Students involved in campaign activities

RI related IEC Status 38.

All Immunization clinics are conducted under the supervision of Medical Officer

All children and mothers are screened by a Doctor before vaccination

Separate counters are opened for different vaccination in the Health facilities.

Multiple checks are done for ensuring quality of vaccines and AD syringes before administration.

Mobile Medical teams deputed to cover remote and inaccessible population.

New State initiatives forimproving Coverage & Quality 39.

Key Issues

Many health programmes are implemented in the field, soprioritizationto the immunization programme reduced.

Solutions

GOI may give such advertisements about the importance of Routine immunisation through various prominent media channels as was done in early years.

IEC through various TV channels and electronic media about the need, safety, and importance of different immunization to create demand generation among the community.

Key Issues and possible Solutions 40.

Key Issues

Cold chain maintenancein the state and the District to be strengthened .

Transport of vaccines to the Regional storeto be strengthened

Requirement of Warehouse store at regions as frequent supply of immunisation materials

Repair van suppiled for HER unit

Key Issues and possible Solutions 41.

Solutions :

Refrigerated vansare required at State Directorate to re-distribute vaccines to the Regional and District Stores. (proposed under NRHM additionality.)

14 no. of vaccine carrier vansare required at District level

4 no. of shell type vans are required for Health Equipment Repair

Unit(HER unit)

Warehouses:As voluminous quantity of AD syringes and other cold chain equipments are supplied in frequent interval to the regions/districts,it is required to have warehouses at the specified regional stores. (a minimum of 10 stores are required)

Funds may approved under PIP 11-12 additionality

42. What works!!

Supervisory componentis good

Field level monitoring CHN/SHN at mid level is good

Refresher training cum review during collection of report from SHN.

Adequate manpower.

1. Virudhunagar2. Madurai district

43. What doesnt work

List reasons why the performance is low-

• Field staff & Medical officer post vacant

What can be done to improve routine immunization in these districts

• • Vacancy position to be filled up.

• • Field monitoring to be strengthened

• • Out reach sessions to be strengthened

• • MMU Immunisation to be monitored

1. Pudukottai2. Nagapattinam

44. Definitely needs Improvements We will achieve .. 45. *Funds released for 2009-10 is utilised for 2010-11 Immunization Budget Status Consolidated status 2009-10* Total Funds released to state (Immunization PIP fund) A 1,79,43,950 Total Funds Utilized based on SOEs receivedfrom districts(upto 31 stMar11) B 95,77,203 Unspent balance available with State as on 1/4/2011 A-B 62,26,468 46. Immunization Budget Status Consolidated status 2010-11 Total Funds released to state (Immunization PIP fund) A Nil Total Funds Utilized based on SOEs receivedfrom districts(upto 31 stMar11) B Unspent balance available with State as on 1/4/2011 A-B 47. * Funds released for 2009-10 is utilized for 2010-11 Component wise expenditure during 2010-11 Consolidated year status Alt. Vaccine delivery Alt. Vaccinators Hired Social Mobilizers (ASHA/ Others) Computer Assistants Waste disposal pits Printing /Stationery Fund Allotted(PIP fund approved) 19.32 5.12 ---- 38.4 ---- 37.90 Fund Utilizedbased on SOEs recd from districts (as on 31 stMar11)* 4.53 2.43 ---- 13.47 --- 37.90 % age Fund Utilized based on SOEs recd from districts (as on 31 stMar11) 23 47 ---- 35 --- 100 48. * Funds released for 2009-10 is utilized for 2010-11 Component wise expenditure during 2010-11 Other heads under which funds utilized Supervisory Visits (funds for State level) Supervisory Visits (Funds for District Level) RI Review meetings (State & below Level) Fund Allotted(PIP fund approved) 17.00 7.00 Fund Utilizedbased on SOEs recd from districts (as on 31 stMar11) 10.98 6.89 % age Fund Utilized based on SOEs recd from districts (as on 31 stMar11) 65 98 49. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Vaccine Supply, Quality and Logistics

Short and irregular supply

Manufacturer not supplying the vaccine in time

Regular and long expiry vaccine to be supplied

Poor Bio-medical waste disposal practices

state has planned only for UGPHC with CTF

No proper implementation ofBMWM

State BMWM has been prepared & it will be implemented

50. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Service Delivery

Difficult areas like Inaccessible / Remote / Urban Slums / SC /ST areasnot properly covered.

Villages far away from Institution

Proper Mapping of difficult areas like Inaccessible / Remote / Urban Slums / SC /ST areasnot properly doneTo cover the Dropouts in these areas ,Proposed to conduct outreach Session byVHN after completing intensive refresher trainingto all VHNs. 51. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Weak reporting system poor data quality Online Data entrythro HMISat PHC /Urban centreisyet to pickup in certainPHCsDepending on field staffwho has to make data entrybesides her routine field work. Net connectivity problem in rural areas. One person (SHN/HI) is exclusively nominatedto each block toensure complete data This temporary arrangementwill continue till the data management is streamlined. 52. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Program Management including supervision Female Health worker is not spending adequatetime for immunisation atfield .Mid level supervisionis weak in certain areas. Due to the implementation of various new health programmes at times(Chikunkunia, DEC, etc ), the health workers are notfully involved in Immunization programme. The post ofSHN s are vacantin certain areas.SomeHSC are most populatedwith vast area .

Action is taken then and there to fill up the vacant posts.

Support of village link volunters & SHG is strengthened .

Re- organisation og HSC with Population.

New HSCs and new VHN whever population is high

53. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Advocacy and Communication Importance of regular Immunization and knowledgeof qualityin Govt. vaccinationis lessamong mother communityin certainareas. Due tolack ofIEC/IPC Acutual cases are not seen by the community now so seriousness of the disease is not known to the rural community.At the time of malicious rumourspreadby media after occurrence of AEFI

Already IECis going on thro Podhigai TVevery week.

GOImay giveGeneral mass media advertisement for routine immunisation .

54. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Expired JE vaccineRequire disposal guidelines for disposingshort expiry/VVM changevaccines.(JE vaccine after JEMass campaign) Due to the supply of short expiry /VVMdiscard vaccines, they are to be disposed. 55. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Vaccine Supply, Quality and Logistics Shortexpiry vaccinesupplied (TT)Some times Bulk supply received (DPT)Manufacturer not supplying the vaccine in time . Hence short expiry vaccine received fromCRL Kosouly Regular with long expiry vaccine to be supplied 56. Bottlenecks/Hurdles System ComponentsMain Problems (Based on current scenario or data, identify issues here. An example is quoted) Causes(Causes for the problems to be identified here) Solutions(with existing and extra resources) Bio-medical waste disposal practices Poor Bio-medical waste disposal practices No uniform guidelinesdeveloped Disposal is effectively donein certainBlocksthro CTF whereverCTF is available. Uniform guide lines developed after training it will be implemented 57. VisionWhere do we want to reach? System Component Indicator* Target by 2012 Service Delivery % Fully Immunized Children (FIC) 100 % Dropout Rate (BCG-DPT3) Less than5 % Program Management Adequate man power Adequate logistics Strengthening supervision 100 % Monitoring and Surveillance Non-polio AFP rate, stool collection rate AFP rate 2per one lakh under 15 popn. Stool collection rate100 % Reporting system and data quality Entry status(%) Out layer(%) Entry status100% Out layers checked for100 % Advocacy and communication IECIPC VHND/AN Clinic More than 95% 58. Support required Support Required / Expectations Agency

Mass media advertisements onneed and

effective of Immunizationthro prominentTV channelas was doneduring introduction ofUIP

2.Refrigerated Van at State store

3.Replacement of vaccine carrier van

4.Supply of Long expiryvaccine

• MoHFW, GoI

• MoHFW, GoI

• MoHFW, GoI

• MoHFW / Supplier

59. T H ANK YOU 60. 61. 62. NANDHIVARAM PHC 63. 64. Inside of the PHC & Entrance of the Operation Theatre 65. 66. Medavakkam PHC