REFERENCE NOTE

No.47/RN/Ref./November/2016

For the use of Members of Parliament NOT FOR PUBLICATION1

MISSION INDRADHANUSH

Prepared by Smt. Sunanda Das Mohanty, Additional Director (23035036) and Shri Rajkumar Patton,

Junior Library Assistant of Lok Sabha Secretariat under the supervision of Smt. Kalpana Sharma, Joint

Secretary.

The reference material is for personal use of the Members in the discharge of their Parliamentary duties, and is not for publication. This Service is not to be quoted as the source of information as it is based on the sources indicated at the end/in the text. This Service does not accept any responsibility for the accuracy or veracity of the information or views contained in the note/collection.

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contained in the note/collection.MISSION INDRADHANUSH

INTRODUCTION

The objective of Mission Indradhanush is to ensure high coverage of children and

pregnant women with all available vaccines throughout the country, with emphasis

on the identified 201 high focus districts. It was launched in December 2014 as a

special drive to vaccinate all unvaccinated and partially vaccinated children under

Universal Immunization Programme (UIP).1 The mission focuses on interventions

to improve full immunization coverage in India from 65% in 2014 to at least 90%

children in the next five years to be done through special catch-up drives.

OBJECTIVES

With the launch of Mission Indradhanush, the Government aims at

Generating high demand for immunization services by addressing

communication challenges;

Enhancing political, administrative and financial commitment through

advocacy with key stakeholders; and

Ensuring that the partially immunized and unimmunized children are fully

immunized as per national immunization schedule.

1 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 Immunisation session organised, the geographical spread and diversity of areas covered. Universal Immunisation Programme (UIP) was launched in 1985 in a phased manner. The measles vaccine was added in 1985 and in 1990 Vit A supplementation was added to the program.

2

AREAS UNDER FOCUS

Under Mission Indradhanush, in Phase I2, the Government had identified 201 high

focus districts across the country that have nearly 50% of all unvaccinated or

partially vaccinated children. Four States of Bihar, Madhya Pradesh, Rajasthan and

Uttar Pradesh account for 82 of the 201 high focus districts and nearly 25% of the

unvaccinated or partially vaccinated children of India. In Phase II3 of Mission

Indradhanush 352 districts have been selected including 279 mid priority districts,

33 from the North East States and 40 districts which commenced from 7 October

2015 for a week. In Phase-III of Mission Indradhanush 216 select districts in 27

States/Uts conducted for seven days in each between April and July 20164.

Key areas reached through Mission Indradhanush:

Areas with vacant sub-centers: No Auxiliary Nurse Midwife (ANM) posted

for more than three months.

Villages/areas with three or more consecutive missed Routine Immunization

(RI) sessions:

ANMs on long leave or other similar reasons.

High Risk Areas (HRAs)5 identified by the polio eradication programme.

Other migrant settlements (fisherman villages, riverine areas with shifting

populations)

2 A list of 201 high focus districts under Phase I has been provided in Annexure I. 3 Coverage Report (Phase-1 & 2) shows in Annexure II

4 The States/UTs-wise details of the number of districts covered are given in Annexure III

5 These include populations living in areas such as Urban slums with migration, Nomadic sites, Brick kilns

Construction sites.

3

Underserved and hard to reach populations (forested and tribal populations,

hilly areas etc.).

Areas with low RI coverage, identified through measles outbreaks, cases of

diphtheria and neonatal tetanus in last two years.

Small villages, hamlets, dhanis, purbas, basas (field huts), etc., clubbed with

another village for RI sessions and not having independent RI sessions.

HIGHLIGHTS

Mission Indradhanush is a nationwide drive, with focus on 201 identified high focus

districts on Phase I 352 districts have been selected including 279 mid priority districts, 33 from the

North East States and 40 districts in the Phase II of Mission Indradhanush done on

7 October 2015. 216 select districts in 27 States/UTs conducted for seven days in each between April

and July 2016 carried out in Phase-III.

STRATEGY

The broad strategy6, based on evidence and best practices, includes four basic

elements-

Meticulous planning of campaigns/sessions at all levels: Ensure revision of

micro plans in all blocks and urban areas in each district to ensure availability

of sufficient vaccinators and all vaccines during routine immunization

sessions. Develop special plans to reach the unreached children in more than

6 The Ministry of Health and Family Welfare is working in collaboration with other Ministries, ongoing programmes

and international partners to promote a coordinated and synergistic approach to improve routine immunization

coverage in the country.

4

400,000 high risk settlements such as urban slums, construction sites, brick

kilns, nomadic sites and hard-to-reach areas.

Effective communication and social mobilization efforts: Generate

awareness and demand for immunization services through need-based

communication strategies and social mobilization activities to enhance

participation of the community in the routine immunization programme

through mass media, mid media, interpersonal communication (IPC), school

and youth networks and corporates.

Intensive training of the health officials and frontline workers: Build the

capacity of health officials and workers in routine immunization activities for

quality immunization services.

Establish accountability framework through task forces: Enhance

involvement and accountability/ownership of the district administrative and

health machinery by strengthening the district task forces for immunization in

all districts of India and ensuring the use of concurrent session monitoring

data to plug the gaps in implementation on a real time basis.

ACHIEVEMENT OF GOALS

PHASE I

The first round of the first phase started from 7 April 2015-World health Dayin

201 high focus districts in 28 States and carried for more than a week. This was

followed by three rounds of more than a week in the months of April, May, June

and July 2015, starting from 7th of each month. The 201 high focus districts

account for nearly 50% of all unvaccinated or partially vaccinated children in the

5

country. Of these, 82 districts account for nearly 25% of all unvaccinated or

partially vaccinated children of the country. Within the districts, the Mission

focused on 4, 00,000 high risk settlements identified as pockets with low coverage

due to geographic, demographic, ethnic and other operational challenges.

PHASE II

In the second phase of Mission Indradhanush, 352 districts have been selected

including 279 mid priority districts, 33 from the North East States and 40 districts

from phase one where large number of missed out children were detected. The

second phase commenced from 7 October 2015 for a week and followed by

weeklong intensified immunization drives for three consecutive months, starting

from 7 November and 7 December 2015 and 7 January 2016.

PHASE III

Phase 3 of Mission Indradhanush was carried out in 216 select districts in 27

States/UTs. Four intensified immunization Rounds were conducted for seven days

in each between April and July 2016, in these districts. These 216 districts have

been identified on the basis of estimates where full immunization coverage is less

than 60 per cent and have high dropout rates.

ACHIEVEMENTS UNDER MISSION INDRADHANUSH

Till June 2016, the Mission has covered 195.5 lakh children and 51.1 lakh pregnant

women from various States/UTs.

The Mission has covered 497 districts across 35 States/UTs.

6

CURRENT STATUS

Mission Indradhanush aims to increase full immunization coverage in India to

atleast 90% children by 2020. Till June 2016, the Mission has covered 195.5 lakh

children and 51.1 lakh pregnant women. It has covered 497 districts across 35

States/UTs. The States/UTs-wise details of the number of districts covered are

given in Annexure III. As part of the Adverse Event Following Immunization

(AEFI) surveillance and monitoring system, the Ministry of Health and Family

Welfare constantly monitors the programme.

SOURCES CONSULTED

1. Mission Indradhanush : Aiming to Expand Full Immunization Coverage to

more than 90%, PIB dated 23.10.2015

2. Union Health Minister launches Phase 2 of Mission Indradhanush in 352

Districts targeting Full Immunization, PIB dated 05.10.2015

3. Shri J P Nadda announces start of 3rd Phase of Mission Indradhanush from

7th April in 217 select districts in 27 States/UTs, PIB dated 04.04.2016

4. Mission Indradhanush, Lok Sabha (Starred Question No. 92) dated

22.07.2016

5. Achieving a New Milestone towards Expanding Full Immunization

Coverage in the Country to reduce Child Mortality, PIB dated 26.03.2016

6. Achievement of Goals under Mission Indradhanush, Rajya Sabha (Unstarred

Question No. 543) dated: 28.04.2015

Annexure I

List of 201 High Focus Districts

S No State S No District S No District

1 East Godavari 2 Guntur

1 Andhra Pradesh 3 Krishna 4 Kurnool

5 Visakhapatnam

1 Changlong 2 East Kameng

2 Arunachal Pradesh 3 East Siang 4 Lohit

5 Upper Siang

1 Bongaigaon 2 Darrang

3 Assam 3 Dhubri 4 Goalpara

5 Hailakandi 6

Karimganj

7 Kokrajhar 8 Nagaon

1 Araria 2 Begusarai

3 Champaran East 4 Champaran West

5 Darbhanga 6 Gaya

4 Bihar 7 Jamui 8 Katihar

9 Kishanganj 10 Muzaffarpur

11 Patna 12 Saharsa

13 Samastipur 14 Sitamarhi

1 Balodabazaar Bhatapara 2 Bijaapur

5 Chhattisgarh 3 Bilaspur 4 Dantewada

5 Jashpur 6

Korba

7 Raipur 8 Sarguja

6 Delhi 1 North-East 2 North-West

1 Ahmedabad 2 Ahmedabad Corpn.

3 Banaskantha 4 Dahod

7 Gujarat 5 Dangs 6 Kutch

7 Panchmahals 8 Sabarkantha

9 Valsad

1 Faridabad 2 Gurgaon

8 Haryana 3 Mewat 4 Palwal

5 Panipat

1 Doda 2 Kishtwar

9 Jammu & Kashmir 3 Punch 4 Rajauri

5 Ramban

1 Deoghar 2 Dhanbad

10 Jharkhand 3 Giridih 4 Godda

5 Pakur 6 Sahibganj

1 Bangalore (U) 2 Bellary

11 Karnataka 3 Gulbarga 4 Koppal

5 Raichur 6 Yadgir

12 Kerala 1 Kasaragod 2 Malappuram

13 Madhya Pradesh 1 Alirajpur 2 Anuppur

3 Chhatarpur 4

Damoh

5 Jhabua 6 Mandla

7 Panna 8 Raisen

9 Rewa 10 Sagar

11 Satana 12 Shadol

13 Tikamgarh 14 Umariya

15 Vidisha

1 Beed 2 Dhule

14 Maharashtra 3 Hingoli 4 Jalgaon

5

Nanded 6 Nasik

7 Thane

15 Manipur 1 Churachandpur 2 Senapati

3

Tamenglong 4 Ukhrul

16 Meghalaya 1 East Khasi Hill 2 West Garo Hills

3

West Khasi Hill

17 Mizoram 1 Lawngtlai 2 Lunglei

3

Mamit 4 Saiha

1 Dimapur 2 Kiphire

18 Nagaland 3 Kohima 4 Mon

5 Tuensang 6 Wokha

1 Boudh 2 Gajapati

3 Ganjam 4 Kandhamal

19 Odisha 5 Khurda 6 Koraput

7 Malakangiri 8 Nabarangpur

9 Nuapada 10 Rayagada

20 Pondicherry 1 Yanam

21 Punjab 1 Gurdaspur 2 Ludhiana

3

Muktsar

1 Alwar 2 Barmer

3 Bundi 4 Dhaulpur

22 Rajasthan 5 Jaipur 6 Jodhpur

7 Karauli 8 Sawai Madhopur

9 Tonk

1 Coimbatore 2 Kancheepuram

23 Tamil Nadu 3 Madurai 4 Thiruvallur

5

Tiruchirapalli 6 Tirunelveli

7 Vellore 8 Virudhunager

24 Telangana 1 Adilabad 2 Mahbubnagar

25 Tripura 1 Dhalai 2 Tripura North

3

Tripura West

1 Agra 2 Aligarh

3 Allahabad 4 Amethi

5 Amroha 6 Auraiya

26 Uttar Pradesh 7 Azamgarh 8 Badaun

9

Badohi 10 Bahraich

11 Balrampur 12 Banda

13 Barabanki 14 Bareilly

15 Bulandshahar 16 Chitrakoot

17 Etah 18 Etawah

19 Farrukhabad 20 Ferozabad 21 Ghaziabad 22 Gonda

23 Hapur 24 Hardoi 25 Hathras 26 Kannauj 27 Kasganj 28 Kaushambi 29 Kheri 30 Mainpuri

31 Mathura 32 Meerut 33 Mirzapur 34 Moradabad 35 Muzaffarnagar 36 Pilibhit 37 Sambhal 38 Shahjahanpur 39 Shamli 40 Siddharthnagar

41 Sitapur 42 Sonbhadra 43 Srawasti 44 Sultanpur

27 Uttarakhand 1 Hardwar

1 24-Parganas North 2 24-Parganas South

28 West Bengal 3 Bardhaman 4 Birbhum

5 Murshidabad 6 Uttar Dinajpur

*Source: Lok Sabha Starred Question No.82 dated 4 December 2015.

ANNEXURE II

Mission Indradhanush Coverage Report (Phase-1 & 2)

*Source: Rajya Sabha Unstarred Question No.990 26th

July, 2016

Sl.No. Indicator Phase I Phase II Total

1 No. of sessions held 9.7 11.6 21.3

2 No. of antigen administered 191.9 174.9 366.8

3 No. of pregnant women immunized 21.1 17 38.1

4 No. of pregnant women completely

immunized 11.2 9 20.2

5 No. of children immunized 76.8 71.6 148.4

6 No. of children fully immunized 20.2 18.5 38.7

7 No. of children vaccinated for the first time N/A 9.3 9.3

8 No. of Vit A doses administered 20.5 21.2 41.7

9 No. of ORS packets distributed 17.1 13.9 31

10 No. of zinc tablets distributed 57.3 45.2 102.5

Annexure III

State/UT-wise Details of number of districts and children covered in Mission Indradhanush

S. No. States/UTs

Number of Total no. of children Total no. of children

districts immunized fully immunized

1 A&N Islands 2 67 0

2 Andhra Pradesh 13 141,748 39,004

3 Arunachal 16 32,602 5,559

4 Assam 26 290,838 75,497

5 Bihar 20 946,258 230,128

6 Chandigarh 1 4,530 868

7 Chhattisgarh 19 411,986 126,812

8 D&N Haveli 1 458 113

9 Daman & Diu 1 629 118

10 Delhi 8 930,084 264,299

11 Goa 1 826 220

12 Gujarat 23 454,804 146,975

13 Haryana 16 916,954 206,628

14 Himachal 6 11,340 4,089

15 Jammu & 11 84,016 23,107

16 Jharkhand 13 639,503 180,467

17 Karnataka 17 587,667 143,303

18 Kerala 9 90,808 19,339

19 Madhya Pradesh 38 1,603,196 445,179

20 Maharashtra 28 284,972 73,890

21 Manipur 8 33,383 8,041

22 Meghalaya 7 71,064 12,293

23 Mizoram 7 9,405 1,378

24 Nagaland 11 26,640 4,663

25 Odisha 23 341,489 66,733

26 Puducherry 3 598 210

27 Punjab 14 149,885 41,663

28 Rajasthan 24 1,350,726 390,895

29 Sikkim 2 65 14

30 Tamil Nadu 26 588,009 196,725

31 Telegana 9 160,962 56,195

32 Tripura 8 10,880 2,225

33 Uttar Pradesh 66 8,643,420 2,165,396

34 Uttarakhand 5 195,750 43,775

35 West Bengal 15 422,214 92,776

Total 497 19,553,253 5,106,441

* Source: Lok Sabha Starred Question No. 92 22nd

July, 2016