Lessons for Policy

Immunization- what can affect performance

Dropout District 1up to the month of March 09 and comparison with last year
(Cumulative since April 08)

25.00
Performance District 2

95.5
20.00
100
Factors identified district 2
69 vacant Sub-Center from April to July
Presently 18 Sub-centers are vacant

15.0080
Shortage of DPT vaccine from September to December

District
Performance District 3

100%
ELA %
90%
District 3
Possible Reasons for Low Performance
Sub-centre vacant.
Way to Solve
DPT-3 %
Advocacy with District. Secondly use the nearby
SC’s ANM in other days.

80%
No proper planning.
Less session held.
Poor tracking system.
Plan made after WBSISC’s intervention.
Regular monitoring.
Use of Social Mobilizers by using Tickler Bag.
Hard to reach area. Special plan for Hard to reach area.
Poor monitoring from Upper level. Advocacy with District & Block.

Msles %
Vaccine shortage. Beyond hand.
Less involvement of other stakeholders (Like GP, Regular meeting with stakeholders.
ICDS, etc.)
Resistant people. Social mobilization in villages.
Migration to other places. Beyond health department.

70%

60%
Three year Performance District 4

VACCINE 06-07 07-08 08-09

BCG 34474 33749 32428

DPT-3 31090 30125 26300
OPV-3 31103 29989 28161
MEASLES 30430 29443 28476
TT (PW) 30070 29257 29496

Second ANM under NRHM has improved the situation with regard to vacant centres

Vaccine Shortage was due to closure of PSUs and lack of regular supplies- NRHM could address this

NREGA could address migration- or there could be Immunization Months through NRHM

Stock Position District 2

Vaccine (doses)/ Opening Balance Received Distribution Closing Balance
Logistics (pcs)

BCG 19000 60000 17000 62000

DPT 27000 100000 26000 101000
OPV 66620 100000 34120 132500
Hep-B 50320 36000 36000 50320
Measles 0 35000 16500 18500
DT 14000 60000 18500 55500
TT 42000 120000 26000 136500
0.1 ml ADS 3400 6400 4800 5000
0.5 ml ADS 776900 0 0 776900
5 ml DS 9300 12000 2300 19000

The mismatch between BCG doses and 0.1 ml syringes is chronic- obviously they are not bundled
during purchase. Or else there is surplus BCG from past years and inadequate supply currently.
Measles had also run out.
Minimum BCG Required Monthly 11960 (District 3)

45000 BCG
40000 40000
35000

30000 30000 30000 30000

25000

20000 20000
15000

10000 10000
5000

0 0 0 0 0 0
8 8 8 8 8 8 8 8 8 9 9
0
'r 0
' 0
' 0
' 0
' 0
' 0
't 0
' 0
' 0
' 0
'
p y e y
l g p c v c n b
a n u u e o e a e
A M u J A S O N D J F
J

Vaccine Received against Monthly Requirement till Feb’09

100000
DPT
90000
87000
80000
70000
60000 60000
46000
50000
Monthly
40000 Requirement
30000 30000 47840
20000
18500
10000
0 0 0 0 0 0 0
Jan'09

Feb'09
Dec'08
Nov'08
Oct'08
Apr'08

Sep'08
May'08

July'08

Aug'08
June'08

District
3
Some Other issues in Immunization

Summary of an AEFI:
Death after BCG and OPV vaccination(0 dose)
Age of the child – 4 DAYS
Date of vaccination – 23.4.09
Date of death – 25.4.09
Place of death – Medical College
Cause of death – Birth asphyxia with neonatal septicemia ( as per Preliminary Investigation)
The baby was not breast fed

Increasing early coverage of BCG has led to some neonatal deaths being reported as AEFI. Complete
reporting of AEFI and of infant deaths is useful for future planning.

Local Issues (District 2)

• Low awareness level

• Poor drop out tracking
• Home visit by ANMs persistently low
• Resistance of people
• Lack of coordination between Health & ICDS
• Hard to reach area/ Distant village from Sub-Center
• Frequent transfer of ANMs

Acknowledgements-
Presentations in May 2009 by District Extenders of WBSISC
WBSISC Project (supported by UNICEF)
Kolkata Medical College- Department of Community Medicine
CMOH and staff of covered districts