Immunization Services DR KANUPRIYA CHATURVEDI DR S K

Immunization Services DR. KANUPRIYA CHATURVEDI DR. S. K. CHATURVEDI

Objectives • Describe what comprises routine immunization services – Components – Activities within components – Role of a Plan of Action

What is “routine immunization” • No standard definition – Hard to define – Means different things to different people – Regional and agency differences • The sum of human and logistical activities/events to ensure the regular delivery & uptake of vaccines & the monitoring of their positive & adverse impact

What is “routine immunization” • Implies the “regular” delivery, i. e. , known schedule, of EPI vaccines – Fixed posts &/or outreach • Part of a larger plan • Not time limited • Goal to provide needed vaccines to all eligible persons and to successive birth cohorts

Routine services: Ensuring that all children receive the WHO recommended vaccination schedule Age EPI visit Vaccine Hepatitis B - options Option 1 Option 2 Option 3 Hep B Birth 0 BCG (OPV) 6 weeks 1 OPV 1, DTP 1, Hib 1 Hep B 1 OPV 2, DTP 2, Hib 2 Hep B 2 monovalent or in combo (monovalent) OPV 3, DTP 3, Hib 3 Hep B 3 monovalent or in combo (monovalent) 10 weeks 14 weeks 9 -12 months 2 3 4 Measles (Rubella) DTP-Hep B 1 monovalent or in combo DTP-Hep B 2 DTP-Hep B 3

WHO’s Approach: Components of routine immunization systems Vaccine Supply & Quality Logistics Service delivery Surveillance Advocacy & Communication

Components glued together by: • • • Planning Management Coordination Supervision Training Financing Components & “glue” exist at national, provincial, district & local level…. Cascading effect

Activities……………. . Vaccine Supply & National level. . Policy on Quality • Procurement • Quality • Local production • National Regulatory Authority • Strategies for international procurement • Timely vaccine ordering • Financial security for purchase • Supply planning (VVMs, vaccines, syringes) Lower Levels. . Ordering & supply planning. . Getting vaccine & supplies to the lower levels for administration

Activities……… National Level. Policy statement & implementation • Injection safety • Health care waste disposal • Cold chain • National central cold store • Vaccine/supply management • Transport management • Supplies, supervision • Lower levels • Vaccine/supply management • Cold chain • Transport • Getting the vaccine to the people Logistics

Activities……. Surveillance National level • Policy • Standards & guidelines • Case definitions • Disease, coverage, adverse events monitoring for nation • Data management systems • Improving data quality • Laboratory Services Local level • Disease, adverse events monitoring • Vaccine supply • Vaccination info management • Register • Tally sheets

Activities……. Surveillance Types of surveillance in EPI • Routine • Generally passive, provides idea on trends, impact of program • Special routine – AFP, fever/rash • Sentinel • Complements weak routine for key diseases • Early warning for outbreaks • Special Surveys • Set baseline disease burden

Activities……… National Level • Technical documents & guidelines • Capacity building • Partnerships with media • Social Mobilization Local Level • Partnerships with the community • Social Mobilization Advocacy & Communication

Activities………… National Level • Supporting local level Local level • Vaccination activities Service delivery

Activities………… Delivery modes - Fixed sites - Outreach - Mobile services - Pulse campaigns - Campaigns Service delivery Each mode has its own advantages & disadvantages, its own indications for use, $$ considerations No single mode is appropriate for all circumstances/diseases

The “glue” 5 key components of EPI 1. Planning 2. Management 3. Coordination 4. Supervision 5. Training 6. Financing Activities to get the job done National provincial district health facility

Monitoring Program Performance • Key indicators (an example) – Coverage levels • Fully vaccinated child, individual antigens – Access to services • BCG and/or DTP 1 coverage – Tracking & follow up activities • Dropout - DTP 1 to Measles • Median age of receipt of vaccines – Missed opportunities – Cold chain quality • Vaccines at correct temperature – Provider knowledge/practices

Plans of Action (POA) 5 key components of EPI 1. Planning 2. Management 3. Coordination 4. Supervision 5. Training POAs. . Detailed & costed activities to ensure adequate implementation of key components and the “glue” … 5 year & 1 year plan … National, provincial, district level plans Must be a living document used to monitor routine immunization services

Plans of Action • Different formats in different countries, regions • Should contain – For each component • • • Goals/objectives Key activities Timeline Cost Responsibility – For each type of glue • Key activities • Timeline • Cost

District Plans of Action • Important for efficient service delivery • Similar to national, but with emphasis on – – – High risk areas High risk populations Special activities, e. g. , outreach, mobile services Social promotion Supervision Local funding – sources and channels

Inter-agency Coordinating Committee (ICC) • Composition – Example: MOH, WHO, UNICEF, USAID, Rotary, NGOs, etc – Varies by country • Promotes collaboration & cooperation • Prevents – Duplication of activities – Ensures that all activities/components/”glue” are covered and will be addressed in the POA