8/8/2019 WBSISC 2008-09

1/20

Immunization- what can affectperformance

Lessons for Policy

8/8/2019 WBSISC 2008-09

2/20

A ntigen wise Dist. Coverage and comparison with last year (Cumulative since A pril 07, 08)

9 1 . 1

6

7 8 . 1 9

7 6 . 5

7

7 7 . 4

3

7 0 . 0

6

1 0 6 . 7 2

6 8 . 4

5 8 1 . 3 9

8 3 . 4

4

7 2 . 4

7

0.00

20.0040.00

60.00

80.00

100.00

120.00

BCG D T3 O V3 Measles Fully mmuni ed

2007- 2008 2008- 2009

District 1

8/8/2019 WBSISC 2008-09

3/20

Dropout up to the month of arch 0 and comparison with last year (Cumulative since A pril 08)

0

8

8

0

8

000

00

000

00

000

00

C

easles D D D

easles

2007- 2008 2008-2009

District 1

8/8/2019 WBSISC 2008-09

4/20

5.31

10.79

16.7

27.98

33.35

37.76

34.7138.08

40.84

46.81

54.92

64.50

5.31

10.69

16.4422.44

28.4133.07

36.0839.98

43.89 49.81

57.46

66.47

8.33

16.67

25.00

33.33

41.66

50.00

58.33

66.66

75.00

83.33

91.66100.00

0

20

40

60

80

100

April May June July August Se ptember October November ecember January February March

PERCENT

GE

PT 3 OPV 3 ELA

DIS TR ICT COVER GE DPT3 & OPV3(APR IL-08 TO ARCH -0 )

SNID with mOPV decreasedOPV coverage & shortage of DPT vaccine decreased DPT coverage

8/8/2019 WBSISC 2008-09

5/20

8/8/2019 WBSISC 2008-09

6/20

YE A WIS E COM P A IS O OF RI C OV E RA E District

294962925730070TT( W)

284762944330430MEASLES

28 1 6129989311 03OPV-3

3 0030 1 2531 090DP T-3

324283374934474BCG08-007-080 -07VA CCIN E

Shortage of DP vaccine decreases the coverageLack of quality in reporting system

8/8/2019 WBSISC 2008-09

7/20

9596

2956432889

36999

54031

62055

1385618811

2399427631 28766

31519 33819

45312

53213

13750

20625

27500

3437541250

48125

55000

61875

68750

7562582500

4895

1495019872

2481928220

45203

4382 8966

38745

6875

0

15000

30000

45000

60000

75000

90000

A p r i l M a

y J u n

e J u l

y A u

g S e

p t O c t

N o v

D e c

J a n u a r

y

F e b r u

a r y M a r c h

N O

O F C H I L D R

E N

DPT-1 DPT-3 ELA

Drop out : 8842 children(14.25%)

DR O P OU : DP - O DP - 3(A PRIL-08 O MA RC H -0 ) Dist

8/8/2019 WBSISC 2008-09

8/20

COM P A RIS O N OF RI C OV E RA E

9 5

. 5

8 4

. 2

8 4

. 1

8 3

. 5

7 7

. 0

6 4

. 5 0

6 6

. 4 7

7 5

. 0

6 9

. 6

9 1

. 8

0

20

40

60

80

100

BCG D P 3 O PV 3 Meas les TT( P

P E R C E N

A

E

2007-2008 2008-2009

69 vacant Sub-Center from April to JulyPresently 18 Sub-centers are vacantShortage of DPT vaccine from September

to December

8/8/2019 WBSISC 2008-09

9/20

S O CK P O SI IO N OF VA CCIN E & LO IS ICS( District on 3 0.0 .0 )

Vaccine (doses)/Logistics (pcs)

OpeningBalance

Receive Distribution ClosingBalance

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 1365000.1 ml ADS 3400 6400 4800 5000

0. 5 ml ADS 776900 0 0 776900

5 ml DS 9300 12000 2300 19000

8/8/2019 WBSISC 2008-09

10/20

District S A U S OF 0. ml A DSIN 008- 00

RECEIVING DATE QUANTITY RECIEVD (pcs)

O pening balance as on 1.4.2008 6000

15.7.2008 8000

6.11.08 91007.1.09 2600

10.2.09 5200

TOTAL 30900

B C coverage during 008- 00 : 7 7 8A NM s are using Insulin syringes for B C vaccination

8/8/2019 WBSISC 2008-09

11/20

BCG

40000

0

30000

0 0

20000

30000

0

10000

30000

00

5000

10000

15000

20000

25000

30000

35000

40000

45000

A

' 0 8

a ' 0 8

J

e ' 0 8

J

' 0 8

A

' 0 8

e

' 0 8

c ' 0 8

N o v

' 0 8

e c

' 0 8

J a

' 0 9

e

' 0 9

Vacc i e Rece ive d a a i s o h R e q i e m e ie 09

o h R e q i e m e

119 0

District 3

8/8/2019 WBSISC 2008-09

12/20

DPT

30000

0

46000

0 0 0 0

18500

87000

60000

00

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

A

' 0 8

a ' 0 8

J

e ' 0 8

J

' 0 8

A

' 0 8

e

' 0 8

c ' 0 8

N o v

' 0 8

D e c

' 0 8

J a

' 0 9

e

' 0 9

o h R e q i e m e

47840

Vacc i e Rece ive d a a i s o h R e q i e m e ie 09

8/8/2019 WBSISC 2008-09

13/20

OPV

0 0

120000175000

062100

093000

692000782000

00

100000

200000

300000

400000

500000

600000

700000

800000

900000

A

p r ' 0 8

M a y ' 0 8

J u n e ' 0 8

J u l y ' 0 8

A u g ' 0 8

S e p ' 0 8

O

c t ' 0 8

N o v ' 0 8

D e c ' 0 8

J a n ' 0 9

F e b ' 0 9

Month ly Re qu ire m ent

47840

Vacc ine Rece ive d aga in s t M o n th ly Re q u ire m ent till Feb 09

8/8/2019 WBSISC 2008-09

14/20

Measles

10000

0 0 0

29500

0

29000

0 0

5000

00

5000

10000

15000

20000

25000

30000

35000

A p r '

0 8

M a y

' 0 8

J u n e

' 0 8

J u

l y ' 0 8

A u g

' 0 8

S e p

' 0 8

O

c t ' 0 8

N o v

' 0 8

D e c

' 0 8

J a n

' 0 9

F e

b ' 0 9

Mont h ly Re q u ire m ent

11960

Vacc ine Rece ive d aga inst Mont h ly Re q u ire m ent till Feb 09

8/8/2019 WBSISC 2008-09

15/20

Specific issue District

Child tracking system very poor.O utreach session plan very poor.Communication is difficult in 4 village Lochanpur

.P ( 6 km road only V an)H uge Shortage of V accine .A NM working is less ( Session start late, closesearly, session planned but not held etc).

Political ProblemStaff Change

8/8/2019 WBSISC 2008-09

16/20

SP E CIF IC ISS U E S - L O W C OV E RA EDistrict

Low awa r ss l l Poo r dr op ou t tr a ckiHome v isit by ANM s pe rsist en tly low

Re sist an ce peop leLack of coo r dina tion be tween Hea lt & ICDSHa r d to r ea c a r ea/ Dist an t village f r om Sub-Cen te r

r equen t tr an s fer of A NM s and long vacancy

8/8/2019 WBSISC 2008-09

17/20

Possible Reasons for LowPerformance

Way to Solve

Sub-centre vacant . Advocacy with Dist . Secondly use thenearby SCs ANM in other days .

No proper planning . Plan made after WBSISCsintervention .

Less session held . Regular monitoring .

Poor tracking system . 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 Dist . & Block .

Vaccine shortage . Beyond hand .

Less involvement of otherstakeholders (Like GP, ICDS, etc .)

Regular meeting with stakeholders .

Resistant people . Social mobilization in villages .

Migration to other places . Beyond hand .

District 3

8/8/2019 WBSISC 2008-09

18/20

S/C Session M onitoring on 3 . .0 District

A ll ype Vaccine kept in IC E Pack

Vaccine supply same day from B P H Cfor S/C clinic and outreach session

Reconstitute ime written on vial

8/8/2019 WBSISC 2008-09

19/20

O utreach session monitoring District on 4. .0

A D Syringes open B efore use

O utreach session held at. ?

A fter M otivation

wo IC E pack kept inImmunization tray

8/8/2019 WBSISC 2008-09

20/20

Acknow ledgemen ts

P r e s en ta tion s in May 2009 by District Ex tende rs of WBSISC

WBSISC P r oje ct Manage r Kolka ta Med ica l Co llege- Depa rtmen t of

Commun ity Med icine

CMO H of cove r ed d istrictsUNICEF s uppo rt to WBSISC