Update on Progress in 66 HR Blocks & other Initiatives

Uttar Pradesh

Director General

Deptt, of Family Welfare, Uttar Pradesh

23rd IEAG

13 – 14 July, 2011

Polio Epidemiology

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WPV Polio Cases – Uttar Pradesh (2006 – 2011*)

2006

548 cases 53 districts

2007

341 cases 44 districts

2008

305 cases 44

districts

2009

602 cases 26

districts

2010

10 case 7 districts

2011*

0 case

Most recent P1 case reported from Moradabad on 13 Nov 2009

Most recent P3 case reported from Ferozabad on 21 April 2010

Lowest no of polio cases ever

in 2010

Polio cases - Uttar Pradesh

Polio cases of type 1

Polio cases of type 3

No P1 case for 20 Months

No P3 case for 14 Months

Risks to Polio Eradication in UP

• Risk of re-introduction of poliovirus from areas with recent cases outside the State

• Survival and spread of virus through migrant populations

• Risk of ongoing low level circulation

• Complacency in efforts

1. Ensuring high quality SIA activities in 66 high risk blocks

2. Tracking Migratory population for immunization coverage during each SIA round and in between the rounds

3. Maintaining SIA quality all over the state

4. Sustaining high quality AFP surveillance

5. Preparedness for rapid response in case of any wild poliovirus detection

6. To sustain the gains, need to strengthen Routine Immunization

Programme Priorities in UP

Progress in 66 High Risk Blocks

% Teams identifying and immunizing newborns

<60%

60% - <80%

80% - <90%

>90%

*Monitoring Data

0

20

40

60

80

100

Jan Feb Mar Apr May

95%

May ‘11

2011

Continued focus on most vulnerable population

X houses generated – 66 HR blocks, Uttar Pradesh

Out of all houses visited, an average of 15-18% are X houses

X houses converted – 66 HR blocks, Uttar Pradesh

Following intensive tracking of X to P conversions,

50-60% of X houses are converted to P

X houses left at the end of activity – 66 HR blocks, Uttar Pradesh

Convertible X houses: Reluctant to accept OPV or child unvaccinated due to other reasons

Non-convertible X houses: Permanently locked house (>6 weeks) or child out of village during round

Out of the remaining X houses, nearly 90% are not convertible to P

Improved quality of SIA coverage in Uttar Pradesh

2009 2010 2011

< 2 % Unvaccinated children at end of round in West UP

Intensified support of Partners: 66 HR blocks

• NPSP(WHO)

– 55 SMOs and 99 Field Volunteers assigned– Support in microplanning, training of vaccinators, monitoring of SIAs – RI monitoring

• UNICEF & CORE– 10 convergence consultants deployed

– 344 additional CMCs deployed

– Mobilization for RI sessions / RI monitoring.

– Facilitated conversion of 45000 manual scavenger operated dry latrine to sanitary latrines with district administration support in Badaun. Expanding support to Moradabad, Ghaziabad and in Meerut.

• Rotary

– Polio Block Coordinators deployed in 6 HR blocks

– IEC activities

All partners promoted use of Zinc and ORS

Challenges……..

• Staff vacancies exist: fresh appointments with priority placements in HR blocks

– 36% MO Vacancies exist (state avg. 27%)

– 23% ANM Vacancies exist (state avg. 13%)

• Experienced ANMs being placed in 66 HR blocks

• Increasing Routine immunization coverage in HR blocks

• Additional RI sessions planned

• Need to strengthen ORS and zinc distribution

• Zinc procured and distributed

Tracking Migratory Population in UP

The biggest challenge is to immunize these children repeatedly in every round

Tracking of High Risk Groups – UP Feb 2011

7733*

18627*

11633* 5076*

* No. of sites in each category

No of children vaccinated

Group Meeting for sensitization of Nomads

% Missed children found among migrants – 2011, Uttar Pradesh%

Data Source : End of Round Survey Monitoring

Less than 1% children missed in 66 HR blocks

New initiatives for increasing reach amongst migrant &

mobile populations

KHERI

BAHRAICH

BALRAMPUR

SIDDARTH NAGAR

MAHARAJ GANJ

SRAWASTI

PALIA

MIHINPURW A

NAW ABGANJ

SIRSIYA

SHEOPURA

TULSIPUR

PACHPERW A

GAINSARI

BARHNIBIRDPUR

RATANPUR

NICHLAUL

BAHADURILAXMIPUR

UTTAR PRADESH

INDIA

NEPAL

MWDR

FWDR

WDR

KhajuriyaGaurifranta

Chandan Chowki

Katarniya Ghat Kothiya

Ghat

Murtiha

Achkawa

Balai Gaon

Shivpur Mohraniya

Rupaideeha

Suiya Naka

Rampur Bandha

Bankatwa

NandmahraJarwa

Balapur

Majhgawan (Trilokpur)

Chamanganj

Seema Booth

Khunuwa Bazaar

Aligarhwa

Kakrahwa

Bansgaon Deeh

Kast Khera

Jogia Bari

Hardi Dali

Sonouli

Bargadwa

Toothibari

Regahia

Jhulnipur

Immunizing children in transit along the Indo Nepal border

1 Dot = 1 Entry / Exit Point (As per Actual Location)

30 Booths established with support of UNICEF

Continuing Vaccination along the Indo-Nepal border

10957

6413059063 61423

55670

20603

7556871853

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Aug.10 Sep.10 Oct.10 Nov.10 Dec.10 Apr.11 May.11 Jun.11

No. of Children Immunized

Children vaccinated at transit booths along the Indo-Nepal border

*Coverage data till 30 June 2011

Children Vaccinated in 2010 – 251,243

Children Vaccinated in 2011* – 168,024

Total No. of Transit Points - 30

Additional vaccination of migrants between Polio Campaigns

Building Immunity in migrant population

Using every opportunity – Vaccinating children at Melas & Congregations - 2011

Activity District PeriodTotal

Children Immunized

Dargah Mela

Bahraich 19 May – 19 Jun 122,908

Magh Mela

Allahabad 15 Jan – 08 Feb 47,864

Mela Karikot

Bahraich 10 Jun – 14 Jun 22,463

Lakkad Shah Baba

Bahraich 02 Jun & 03 Jun 3,998

Ajmer Urs

Agra 09 Jun – 14 Jun 1,045

Total Children Immunized 198,278

16.59 82%

Non-polio AFP rate Stool collection rate

Surveillance performance indicators, UP - 2011*

* data as on 9 July 2011

IndiaLess than 60%60% to 69%70% to 79%80% and aboveNo AFP case

Highly sensitive AFP Surveillance in UP

Preparedness for rapid response in case of any wild poliovirus detection

• State Emergency Preparedness and Response Group formed

• Rapid Response Team (RRT) Members identified and notified

• Senior state officials identified for deployment to districts for supervising mop up at the shortest possible time

• Risk Analysis done in every district to identify the areas at risk of importation: – 19 districts in west UP with 66 HR Blocks– 3855 HRAs identified in West UP districts– 7277 HRAs identified in C/E UP districts

• Commissioners and District Magistrates mobilized for intensification of SIA activity by Principal Secretary:– Video conferencing– DO letters

State Emergency Preparedness & Response Plan

Strengthening Routine Immunization

Strengthening Routine Immunization

• Monitoring data shows positive trend:

– Steps initiated in Jaccha Bachha Suraksha Abhiyan (JBSA) being followed up for immunization days

– Newborn data of SIA campaigns being used for generation of due lists

– Village wise list of beneficiaries used by ANMs for tracking RI coverage

– RI coverage in HR blocks of West UP being monitored for intensification of efforts

• DMs reviewing RI progress in DTF meetings

• District level senior officers involved in monitoring

• Intensified monitoring by NPSP, UNICEF, CORE and Govt officers

– Harmonization of polio SIA and RI microplans

– Ensuring timely vaccine availability before stock-outs

– Building a system for sending alerts through SMS to ANMs as a reminder for due dates

23

30.3

40.9

0

10

20

30

40

50

60

70

80

90

100

NFHS-III [2005-06] DLHS-III [2007-08] CES [2009]

Data sources: CES- Coverage Evaluation SurveyNFHS- National Family Health SurveyDLHS- District Level Household & Facility Survey

Survey evaluated coverage of Fully Immunized – Uttar Pradesh

39% 39% 41% 45% 46% 47% 46% 50% 50% 50% 49% 50% 52% 53% 55% 57%

43% 43% 42% 40% 40% 39% 40% 37% 38% 38% 39% 37% 36% 36% 35% 33%

18% 17% 17% 15% 14% 14% 14% 13% 12% 13% 12% 13% 12% 11% 10% 10%

0%10%20%30%40%50%60%70%80%90%

100%

Jan'

10 (n

=408

7)Fe

b'10

(n=7

142)

Mar

'10 (n

=151

29)

Apr'1

0 (n

=161

89)

May

'10 (n

=110

48)

Jun'

10 (n

=141

76)

Jul'1

0 (n

=223

52)

Aug'

10 (n

=235

20)

Sep'

10 (n

=122

39)

Oct

'10 (n

=189

20)

Nov

'10 (n

=104

04)

Dec'10

(n=2

4545

)Ja

n'11

(n=1

6131

)Fe

b'11

(n=1

7438

)M

ar'11

(n=1

2422

)Ap

r'11 (

n=16

513)

Fully Immunized Partially Immunized No Immunization

Immunization status of monitored children (12-23months) UP (Jan 2010 to Apr 2011)

JBSA from August’10 to March’11

JBSA – Jachha Bachha Suraksha Abhiyan -UP Source: RI monitoring data Jan to May - 2011(NPSP,GOVT,UNICEF & CORE)

Monitoring data shows increase in coverage of fully Imm.

Immunization status of monitored children Jan to May, 2011 Uttar Pradesh

35%

55%

10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UP (n=81,655)

Fully Immunized

PartiallyImmunized

No Immunization

n=children 12 to 23 months of age

20%

6%

5%

3%

19%

17%

30%

n=28,384

5%6%

4%

5%

46%

23%

11%

Reason for children not being fully immunized

n=8,511

Source: RI monitoring data Jan to May - 2011(NPSP,GOVT,UNICEF & CORE)

Review of RI monitoring data at least once during last 2 DTFs in HR block districts (May’11 & Jun’11)

17/19 (89%)

Districts where RI monitoring data reviewed

Districts where RI monitoring data not reviewed

Districts with no HR blocks

Data not available

HR Blocks monitored 8 sessions per month (56 blocks)

HR Blocks not monitored 8 sessions per month (10 blocks)Source: RI monitoring data

(Jan – May 2011)

6603 sessions monitored

Intensified RI Monitoring 66 High Risk Blocks (NPSP,GOVT,UNICEF & CORE)

State’s Commitment • State is highly committed for polio eradication

– Strong political and administrative support

• Regular review meetings by Principal Secretary– State task force meeting to review preparedness before each SIA– Regular review in DIOs meeting– Review through video conferencing

• Tracking quality of SIA rounds

• Increasing district administration’s involvement – DO letters to DMs– Holding of DTFs at least 10 days before round

• Increasing awareness through enhanced Media involvement and IEC

High political commitmentHon’ble Health Minister launching SIA on

26 Jun,2011

Support required

• Supply of cold chain equipments

– Repair of ILR and Deep freezers

– Replacement of non serviceable vaccine

carriers

– Supply of ice packs

– Supply of hub cutters

• Regular supply of routine immunization

vaccines

– To avoid stock outs – buffer stock required

IEAG Proposed SIA calendar, 2011

Aug Sep Oct Nov

NIDs

Dec

bOPV

Mar Apr May Jun JulJan Feb

SNIDZone 1 UP/Bihar,

Delhi

SNIDEndemic & risk states

tOPV

SNIDEndemic & risk states

SNIDZone 1 UP/Bihar

& Delhi

tOPV / bOPV

SNIDEndemic & risk states

SNIDZone 1 UP/Bihar,

Delhi

Require an additional round to narrow the gap in this high

transmission period

Lastly……..

• The UP Govt. stands committed to eradicate polio from the State

• Will continue to ensure high quality rounds to maintain high population immunity levels