Rationale:

India’s Universal Immunisation Programme (U.I.P.) is one of the largest in the world in terms of quantities of vaccine used, the number of beneficiaries, the number of immunization session organised, the geographical spread and diversity of areas covered.

Immunisation is one of the most cost effective interventions for disease prevention. Traditionally the major thrust of Immunisation services has been the reduction of infant and child mortality. However, newer vaccines like the Hepatitis B vaccine which is administered in infancy, gives life long protection against cancer liver and other complications of Hepatitis B infection in adults. Immunisaton is an important vehicle for health promotion and therefore is a true national investment.

The national policy of immunization of all children during the first year of life with DPT, OPV, BCG to complete the series of primary vaccination before reaching the age of one year was adopted in 1978 with the lunching of EPI to increase the immunization coverage in infancy to 80%. Universal immunization programme UIP was lunched in 1985 in a phased manner. The measles vaccine was added in 1985 and in 1990 Vit A supplementation was added to the program.

As per NFHS-3 data full immunization coverage in Orissa was 52% and no immunization is 9%. Evaluated coverage by UNICEF in last 3 years indicates that there is decline in coverage of all antigens. Proportion of districts achieving 80% DPT3 coverage has also decreased. However high stable BCG coverage indicates that things can improve. There is a wide gap between reported and evaluated coverage (2001-BCG reported coverage 112% and evaluated coverage is 84%). In reported coverage there is confusion in denominators and in it also non immunized children are left unaccounted. As per NHFS-3, full immunization has increased to 51.8% children 12 to 23 months and sustained efforts can increase it further.

Measles still accounts for large number of deaths in children. There is fear of resurgence of VPD cases. Considering these and the short falls of activities in RCH-I, many new intervention have been introduced to achieve 100% full immunisation status by 2010 and to maintain it.

Success

• Strong links between Immunisation System and ICDS, AWW and PRIs. Initiatives have been taken by State for involvement of PRIs.
• Most LHVs and ANMs posts are filled.
• FID and fixed site strategies are being implemented.
• Annual Action plans and coverage improvement plans are in place.
• Cold Chain system is established at most levels according to GOI standards.
• AD Syringes are in use since 2001 in BDCS districts
• Timely support of UNICEF, WHO and NGOs are encouraging.
• Relatively high and stable BCG coverage support that things can improve by reducing bottlenecks.

Barriers

• Micro planning to reach remote areas on routine basis is inadequate.
• In urban areas no micro plans as in rural set up, shortage of staffs, no follow up in drop out cases, poor services in urban slums, non reporting of immunisation performances by Clinics / NHs and inadequate Cold Chain Maintenance in Clinics/ NHs.
• Vaccine delivery system is erratic due to shortage of mobility support and less number of Health Worker (M).
• Injection practices as well as waste disposal practices are often hazardous.
• Poor use of data analysis for action at all levels.
• Poor monitoring and supervision at all levels.
• VPD surveillance is also weak.
• No-electrification, non-payment of electric charges, low voltage and voltage fluctuations at outreach areas.
• Shortage of cold chain mechanics, helpers, WIC operators for monitoring/ repairing Cold Chain equipments.
• Vacancy of medical officers and Para-medical staffs in remote areas.
• Social mobilization is weak
• Lack of IEC materials.
• Inadequate training and knowledge in cold chain maintenance of health staffs.
• Lack of AD syringes and waste disposal pits.

Objectives

Districts will provide equitable, efficient and safe immunisation services to all infants and pregnant women. Aim is to achieve 100% full immunisation status by 2009-2010 and to maintain it for long.
2005-06---------50%
2006-07---------60%
2007-08---------75%
2008-09---------95%
2009-10---------100%

• Contribute global eradication of Polio by 2007.
• Elimination of Neonatal Tetanus, Diphtheria and Pertussis by 2009.
• Measles mortality and morbidity reduction to 80% by 2010, compared to 2000 estimates.
• Achieve and maintain vitamin A supplementation coverage >80% under the age of 3 yrs.
• Establish sufficient sustainable and accountable fund flow at all levels.
• Ensure there is sustained demand and reduced social barriers to access immunisation services
• Accelerated introduction of licensed new and under utilized vaccines against diseases with significant reduction in mortality and morbidity.
• Monitor and use accurate, complete and timely data on vaccine preventable Diseases, AEFIs , antigen coverage and drop out rates by districts.

Strategies :

• Strengthening Micro planning processes in all districts and urban areas.
• Strengthening coordination with national operational guidelines, supervision practices and prioritizing poorly performing districts and under served populations.
• Reducing drop outs rate and missed opportunities.
• Fixed day fixed site,& integration with private sector.
• Strengthen coordination and review meeting at all levels.
• Strengthen institutional training at all levels.
• Strengthen coordination & regular access and monitor cold chain status.
• Appropriate procurement and inventory keeping of equipment maintenance.
• Implement open vial vaccine and bundling policies.
• Introduction of AD Syringes, needle cutters for all immunisation sessions.
• Strengthen-AFP Surveillance & R.I. activities, IPPI activities.
• To achieve 100% mothers TT immunisation status.
• Ensure safe delivery Practices, surveillance and data analysis.
• Achieve 100% DPT3 coverage.
• Improve measles vaccine coverage
• Case study during out break and introducing MMR / MR immunization.
• Providing Vit. A dose during measles vaccination.
• Developing Political commitment, partnerships.
• Reaching the under served by influencing behavior at household level through BCC.
• Undertaking Advocacy cost effectiveness studies
• Undertaking Research & Studies.
• Strengthening surveillance.
• Phased introduction of RIMS.
• Increasing accuracy and use of data at local levels, private sector and community involvement
• Provide training in AEFI, SOPs and standardize reporting & establish response mechanisms.