Progress in UIP MYP

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Improving immunization coverage India
Challenges Dr. Anbumani Ramadoss Union Minister
for Health Family Welfare 7th December 2005
We want to be alive
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Demography

• India has a population of more than one Billion
• Consisting of 35 States UT
• India is like a continent consisting of plains,
  deserts, rain forests, islands, hills with varied
  climatic conditions, cultures and language

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Evolution of UIP in INDIA

• 1978 Expanded Programme of immunization (EPI).
• Limited reach - mostly urban
• 1985 Universal Immunization Programme (UIP).
• For reduction of mortality and morbidity due to 6
  VPDs.
• Indigenous vaccine production capacity enhanced
• Cold chain established
• Phased implementation - all districts covered by
  89-90
• Monitoring and evaluation system implemented
• 1986 Technology Mission On Immunization
• Monitoring under PMOs 20 point programme
• Coverage in infants (0 12 months) monitored
• 1992 Child Survival Safe Motherhood (CSSM)
• Included both UIP and Safe motherhood program
• Reproductive Child Health (RCH 1)
• 2005 National Rural Health Mission

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National Immunization programme

• District is treated as administrative unit 593
• Primary Health Centers are the last vaccine
  storage points - 23,109
• Services are provided through 142,655 sub centers
  to the population residing in about 638,588
  villages
• Target for immunization is to cover infant
  population of over 25 million and around 27
  million pregnant women

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Progress so far .
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Reported Immunization Coverage 1985-2004
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VACCINE PREVENTABLE DISEASE SURVILLANCE
In 2004 1087 NNT cases and 51546 Measles reported
Source CBHI
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VACCINE PREVENTABLE DISEASE SURVILLANCE
In 2004 8465 Diphtheria cases and 32786 Pertussis
reported
Source CBHI
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Impact of various interventions Infant Mortality
Rate 1984-2003
UIP
CSSM
RCH
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Issues .
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Full Immunization Coverage by States (in )
Coverage evaluation shows a varied coverage among
the States. While the Southern States have been
consistently achieving high coverage levels, the
situation in Northern States is a matter of
concern.
Source Unicef CES
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Drop-out BCG-Measles
Source Unicef CES
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Concerns

• Large birth cohort - 25 million births every year
• Declining coverage in some major states
• 72 of districts surveyed in RCH show a fall in
  full immunization coverage rates between 1998-99
  and 2002-03
• An average of 14.4 children receiving BGC do
  not receive measles vaccine
• Poor immunization data quality
• Discrepancies between reported and surveyed data
• Varied program management and supervision at all
  levels
• Poor IEC and demand generation leading to poor
  utilization of services
• Unsafe injection practices and waste disposal
• Significant percentage of injections used in the
  immunization sector are unsafe
• Low priority on medical waste disposal
• Over burdening ANM (Auxiliary Nurse Midwifery)
  for collection of vaccine from PHCs and carrying
  it to the sites, sterilization of glass syringes
  and mobilize children / mother at village level.

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National Rural Health Mission(NRHM)
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GOALS

• UNIVERSAL HEALTH CARE
• (QUALITY, ACCESS, AFFORDABILITY)
• REDUCTION OF IMR, MMR, TFR.

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STRATEGY

• GDP 0.9 TO 2-3
• HOLISTIC APPROACH
• HEALTH INFRASTRUCTURE (IPHS)
• HUMAN RESOURCE
• DRUG SUPPLY
• ASHA / COMMUNITY / PRI
• VILLAGE / DISTRICT / STATE PLANS

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OUTCOMES (2005 - 12)

• UNIVERSAL QUALITY CARE
• IMR to 30 / 1000
• MMR to 100 / 1,00,000
• TFR 2.1

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Progress

• Lunching of RCH II, under NRHM
• Support for alternate vaccine delivery to the
  session site
• performance incentives to ASHA (Accredited Social
  Health Activist) / Women Self Help Groups/AWW for
  mobilization of children to session site
• Mobility support for Strengthening supportive
  supervision monitoring
• Intensive monitoring
• Micro-planning at all level
• Development and implementation of a Routine
  Immunization Monitoring System software

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Progress. contd

• Introduction of AD Syringes
• AD Syringes used in the immunization programme
  since August,05 in the country.
• Guidelines for disposal finalized by Central
  Pollution Control Board (CPCB) and communicated
• 10 dose BCG vial introduced to ensure
  availability of BCG in every sessions.
• Pilot project of Hep-B implemented in 33
  districts and 15 cities with GAVI support.
  Coverage- 76 in districts 31 in cities
• Training

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Future Plans

• Expansion of Hepatitis B vaccine in the National
  Immunization programme in a phased manner
• JE vaccination in the high risk areas.

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Polio Eradication .
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Monthly incidence of polio in India January 1998
September 2005
Number of cases
NID
NID
NID
NID
NID
NID
SNID
SNID
SNID
SNID
SNID
NID
Mop-up
SNID
NID
NID
SNID
1998
1999
2000
2004
2001
2002
2003
2005
NID National Immunization Day
SNID Sub-National Immunization Day
Large scale mop-up
data as on 2nd December, 2005
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Location of poliovirus, India 2003 - 2005
2003
2004
225 cases in 87 districts
134 cases in 43 districts
2005
54 cases in 31 districts
data as on 2nd December, 2005
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Location of poliovirus, 2005
(54 cases)
Most recent virus 20th October
2005, Bulandshahar
Polio in AFP
Uttar Pradesh Bihar Jharkhand Delhi Uttaranchal Pu
njab
25 24 2 1 1 1
data as on 2nd December, 2005
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Vaccine .
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Vaccine Manufacturer Public Sector
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Vaccine Manufacturer Private Sector
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Vaccine Installed Capacity
In lakh doses
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Partners Contribution

• Government of India acknowledge the support of
  UNICEF in strengthening the cold chain, IEC etc
  WHO for their technical support and GAVI for
  introduction of Hepatitis B vaccination and
  injection safety.

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Thank you