Improving UIP in India

Dear Karan, I went through your document. I agree with almost all of what you are saying. But what is the use that this document will be put to? What is the way forward with State, district and health facility level strengthening of immunization systems in the high burden (by numbers of unimmunized) States? Who will own the document? Will GOI or the State governments take this forward?

Thank you Sir, this is just a drfat outlining major points, I know that a lot more is needed to make it a good strategy document and share it with government. I would appreciate, if experts like you can guide us to develop it further.

Dear Karan sir, I wish to share the following though it looks like a story but it was true. On relinquishment from the army I joined H&FW services on 01 March 1985 as MO PHC in Udupi of Karnataka. On the first working day of April in the monthly meeting I reviewed the programme. It was attended by 4 MO's of PHUs and about 50 HCWs, female and male including supervisors. In the post lunch session I saw the ANM's collecting vaccines and other logistics and carrying vaccines in the vanity bag. I started the 'COLD REVOLUTION' since then. I stopped them carrying vaccines in the bag which made them very unhappy.The very next day I sat with the LHV, located 4 PHUs and all AW centers. Every friday was fixed as Vaccination day. On that day we planned to cover 4 to 5 AW centers. The team consisted of HQ part and peripheral part. From the PHC MO(myself)/LHV/BCG technician and the driver with vehicle we used to take vaccine in the vaccine carrier and other logistics like OCP/Condom/ IUD /Paracetamol/Mebendazole...... + emergency kit with scalpvein set and medicines. We used to reach the first spot sharp at 9 AM. The peripheral part consisted of ANM/HW(M)/AAW/Helper... often the president of Mahila mandal. They used to bring the beneficiaries (6 to 12 per site), record, make them sit in such a way that the youngest infant was the first to receive the vaccine. Vaccination was taken care of by the ANM/LHV/AWW, my presence was utilized by the care takers regarding health problems, spot examination, a little bit of curative services. We had an integrated approach even up to geriatric age. Within 6 months we cleared the backlog including >2 yr age group. Then we revised the record and included only 1 yr. The situation soon reached the stage wherein we were waiting for a lady to get married, delay, conceive, receive TT, deliver, vaccinate the baby.... The MCH indicators are at par with the developed country. We used to visit 4 to 5 AW centers on every friday religiously for about 5 years till all the PHUs were upgraded to PHCs but the vehicle was spared for this purpose. We worked like a mobile team. Touchwood, I had no chance to use the emergency kit even once. So once upon a time.... long long ago..... Can this happen again under NUHM in large corporation areas with about a crore population to cover the urban slums... which I can once again dream to realize and lead?

Dr. Holla's experience amply supports the belief that many of us including myself hold that if the basic things like complete registration of pregnant women and births, regular, supervised immunization sessions with all vaccines and the participation of the community, follow up of defaulters and adequate documentation are taken care of, the rest follows. My observation from many settings in many countries is that often we think and talk about things like mobile clinics, use of hand-held devices for real time web based data collection and transmission, computerised data collection and analysis and similar high-tech and upstream initiatives without taking care of the basics. A lot can be said in favour of these interventions but they, by themselves, cannot solve the basic issues.

Thank you sir.

Please do share more details about TIKA express with the forum. I am sure many of the members have not heard about it. Thank you.

Thanks Praveen

Dear Karan Sir, I read the guidelines in detail and a few points I like to share to enhance and sustain the participation on the basis of observations obtained by monitoring RI sessions in the last one month. Observations/Suggestions: 1. Non availability of Supplementary nutrition on VHND session site - mothers and other male community leaders are asking as to when can they get supplementary food? Suggestion: Continuous supply and availability of all logistics at VHND session sites will enhance and sustain community participation and minimize LODO's (Left-outs and Drop-outs) 2. Comparing with well performing states: Well performing states have high literacy rate/low proportion of BPL population/higher standard of living conditions/small family size/higher parental responsibility.... hence they expect better arrangement at session site - pucca building, sitting arrangement, a little privacy for breast feeding the baby sos, a chair to sit while holding the baby for vaccination, while getting the BP recorded.... In states with low socioeconomic indicators grass root level workers have to put maximum efforts to achieve participation by the beneficiaries. Suggestion: Steps to improve women literacy and income-generation scheme for women (if all girls study up to SSLC the age of marriage will cross 18, number of children per couple will get limited to 2 naturally they take care of their precious children) - there is a need for high level inter-sectoral co-ordination which will have long term effect. For the time being minimal facilities like hand washing/sitting arrangement for the beneficiaries (chair/table/benches/dhari) can be made available. 3. Data management - There is mismatch between MCH register, duelist cum session tally sheet, session reporting format, PHC reporting format, district reporting format(UIP Formats) and HMIS format hence data collation is becoming a problem resulting in reversal of indicators(Eg high -ve dropout rate). Suggestion: There is an urgent need to review all the formats from grass root level to state level both UIP and HMIS so that both can be collated to obtain performance indicators for appropriate interventions. Since these formats are integrated it has to be tested from the grass-root workers who generate the data to national level consultants for integration.

Dear Friends, Thank you very much for initiating this discussion that includes a proposal and a practical Tikka plan. I storngly feel that if we have systems functioning and their effective monitoring to plug the gaps, 100% immunization will not be a dream. Also we should keep in mind the non availability of vaccine to slum dwellers for them also some Tikka plan is required. Thanks and regards,

Ambitious it is, but as mentioned by other colleagues, getting the basics done correctly will help us to reach more children with quality vaccines. India holds the distinction of having the highest numbers of unimmunized and partially immunized children and if we are able to correct basics in the states with highest number of left/drop outs, it will go long way in pulling up the national coverage’s. I would like to pilot some of the ideas for sure but have to look at modalities for doing it. I have attached the latest immunization schedule for India, you requested.

http://www.technet21.org/components/com_agora/img/members/1821/India-UIP-schedule.pdf]India-UIP-schedule.pdf[/url]

Hello, I regret the URL you give above is not correct: Not Found The requested URL /components/com_agora/img/members/1821/India-UIP-schedule.pdf]India-UIP-schedule.pdf[/url] was not found on this server. Additionally, a 404 Not Found error was encountered while trying to use an ErrorDocument to handle the request. Apache/2.0.63 (Unix) mod_ssl/2.0.63 OpenSSL/0.9.8e-fips-rhel5 mod_auth_passthrough/2.1 mod_bwlimited/1.4 FrontPage/5.0.2.2635 Server at http://www.technet21.org Port 80 Sorry!

Here is the correct link: http://www.technet21.org/index.php/documents/view-document-details/1325-national-immunization-schedule-india.html