Computerized tool for planning routine immunization, India Presenter : Dr. Karan Singh Sagar Country Representative JSI R&T / IMMUNIZATIONbasics (in collaboration with Dr. Manish Jain, IMMbasics/UP) 36 th Annual International Conference on Global Health
Presentation outline Background Rationale for developing the tool Micro planning tool features & advantages Pilot Roll out of the tool Present status Achievements Challenges and way forward
Background Annual target for immunization: ~27 million pregnant women ~25 million infants/year India has one of the lowest routine immunization rates in the world. District Household & Facility Survey 3 (DLHS 2007 08) reveals: 47.6% children (12 23 months) fully immunized 16.3% children received no vaccination (~4 million)
Countries with most unimmunized children DTP3, 2005 2007 2007 (in millions) 0 2 4 6 8 10 12 India Nigeria China Indonesia Ethiopia Pakistan Uganda Niger Bangladesh DR Congo 2007 2006 2005 Source: WHO/UNICEF coverage estimates 1980-2007, August 2008 Date of slide: 21 August 2008
Fully immunized Coverage (DLHS 3) 7 states < 50% Additional 5 States< 60% Only 2 states > 80% 80% 70-79% 60-69% 50-59% < 50% No data Source: DLHS3
India immunization challenges 12.5 million under immunized children each year. Wide sub national and local variation in coverage. Inadequate micro planning at primary health care level (major underlying reason).
RED strategy for Immunization WHO/UNICEF recommend Reaching Every District (RED) strategy for improving immunization coverage. 5 major components of RED strategy: Re establishing outreach services Supportive Supervision Linking services with the communities Planning and management of resources Monitoring and use of data for action
Rationale for computerized tool Need for appropriate microplanning for RI suggested by: National UIP Review (2004) Multi Year Strategic Plan (2005 10) National discussions recommended computer based utility for: Preparing PHC level comprehensive microplan Incorporation of all RED strategy components Facilitating the process for mid level managers Incorporating NRHM elements in planning
Microplanning Process State District PHC Subcenter State Plan (Compiled District Plans & state specific activities) District Plan (Area map, compiled PHC plans, budget, supervision, IEC, training etc) PHC Plan (Area map, compiled SC plans, AVD, supervision plan, waste disposal etc SC Plan (Area map, work plan, estimation of beneficiaries, vaccine logistics etc
Immunization Microplanning Tool Developed by JSI/IMMUNIZATIONbasics, India (USAID funded). Technical inputs from MOHFW and other partners in immunization (UNICEF and WHO/NPSP). Microsoft Excel based utility. Includes 15 formats (worksheets) covering different components of the program. Out of these, 10 formats are self generated on the basis of calculations, logical relations and interlinked worksheets.
Microplanning Tool Features Tool is designed to assist mid level managers in: Describing target population Analyzing barriers Prioritizing areas for effective use of resources Preparing health worker immunization activity plan (Fixed Day, Fixed Site) Estimating vaccine and other logistics (diluents, syringes, cards, vitamin A) requirements Preparing plans for supervision, social mobilization and vaccine delivery
Microplanning Tool Features User friendly and technologically simple Tool available in English and Hindi (can be adapted to regional language) District level compilation tool also available to facilitate district level managers. Explanatory notes present on each worksheet. Separate user guides available in English and Hindi.
Microplanning Tool INDEX PAGE
Microplanning Tool NAVIGATION SHEET
Microplanning Tool snapshots BLOCK PROFILE WORKSHEET
Microplanning Tool snapshots HUMAN RESOURCE WORKSHEET
Microplanning Tool snapshots AREA PRIORITIZATION WORKSHEET
Microplanning Tool snapshots ESTIMATION OF BENEFICIARIES (SELF GENERATED)
Microplanning Tool snapshots Antigen wise Estimation of Beneficiaries (Self generated)
Microplanning Tool snapshots Immunization Calendar/ANM Roster (Self generated)
Microplanning Tool snapshots Social Mobilization Plan (Self generated)
Microplanning Tool snapshots Vaccine Delivery Plan (Self generated)
Microplanning Tool snapshots Session wise Vaccine Distribution Plan (Self generated)
Microplanning Tool snapshots Supervision Plan
Microplanning Tool Advantages Prioritization of villages and urban areas on basis of: Population base Distance from facility (cold chain point) Terrain and accessibility Considers inter state variation of demographic rates and implementation strategies. Reduces errors due to manual calculations. Serves as a implementation as well as monitoring tool for mid level managers.
Piloting of the tool Tool was piloted in 2 districts of Jharkhand state (June July 07) for assessing: Completeness and correctness Ease of use (acceptability) Possible role in improving coverage Observations shared with MOHFW and partners, and the tool was revised as per the suggestions.
Implementation Tool shared with states & partners at various forums (meetings, trainings etc) and advocacy for use at state and national level. Allotment of separate funds for microplanning through NRHM Program Implementation Plan Trainings of computer assistants, District Program Managers, DIOs in 3 states (430). TA provided by partner agencies for implementation. Feedback from states being used to make tool more effective
Implementation Present status Tool endorsed and used by State governments of 3 states 1. Uttar Pradesh 2. Jharkhand 3. Madhya Pradesh
Benefit of tool Increased reach State Districts Population (millions) Health Centers (PHC + CHC) Uttar Pradesh 70 166.20 4046 27,632 Jharkhand 24 26.9 542 8,663 Madhya Pradesh 48 60.35 1419 15,150 Health Workers (ANM & MPW M) State Annual target of infants (2008 09) % left out* Estimated number of left outs Uttar Pradesh 5.55 million 24% 1.33 million Jharkhand 0.88 million 12.8% 0.11 million Madhya Pradesh 1.89 million 9.8% 0.18 million TOTAL 8.32 million 1.62 million * District level Household Survey (2007-08)
Achievements (1) Triggered a planning process at all levels Enabled integration of various plans (Polio, RI) Strengthened service delivery by prioritization of areas. Improved reach to unreached beneficiaries. Correct and timely estimation of vaccine and logistic requirements, reducing chances of inadequate stock and stock outs.
Achievements (2) Rationalized number of immunization sessions as per population base. Helps utilize available resources for improved cost effectiveness. Tool modified and used for JE campaigns in over 100 districts in the country (~88 million target population).
Challenges Limited technological capacity at block and district level Does not address cold chain planning and contingency planning. Timely release of funds Yearly revision of the micro plans
Way Forward Adapt tool to state needs Advocacy for scale up and use by all states Periodic update for inclusion of target population, newer vaccines & other initiatives.