Regional Update: Increasing & sustaining …...1 1 SAGE Meeting 5-7 April 2011, Geneva, Switzerland Regional Update: Increasing & sustaining immunization coverage in SEAR Immunization

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1 SAGE Meeting 5-7 April 2011, Geneva, Switzerland

Regional Update: Increasing & sustaining immunization coverage in SEAR

Immunization and Vaccine Development (IVD) SEARO Nihal Abeysinghe, RA-VPD

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Outline of this presentation

  Status of RI in SEAR   SEAR RI Coverage   Key determinants for low coverage

  SEAR Strategies

  SEAR Plans

  RI in priority countries of SEAR

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0

10

20

30

40

50

60

70

80

90

100

Ban

glad

esh

Bhu

tan

DP

R K

orea

Indi

a

Indo

nesi

a

Mal

dive

s

Mya

nmar

Nep

al

Sri

Lank

a

Thai

land

Tim

or-L

este

SE

AR

% D

TP3

Cove

rage

1997 2001 2005 2009

Source: WHO-UNICEF Best Estimates Note: Timor-Leste was part of Indonesia prior to 2002

SEAR DTP3 Coverage

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Estimated % of Children Missing DTP3, SEAR, 2009 (N=9.8 Million)

Indonesia7.45%

Bangladesh1.99%

India87.76%

Nepal1.28%Myanmar

0.96%

Others*0.56%

Source: WHO-UNICEF Best Estimates

*Others includes 6 countries of the region: Bhutan, DPR Korea, Maldives, Sri Lanka, Thailand and Timor-Leste

Estimated % of Children Missing DTP3, SEAR 2009

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Key determinants for low coverage (1)   Access:

  hard-to-reach rural areas and socially marginalized populations in urban areas

  unaware of the need for immunization   do not perceive immunization as important for child

survival

  Resource availability & utilization:   sub-optimal utilization of available resources poorly

managed services including outreach activities.   lack of adequate trained human resources

  Service delivery:   high drop-out rates, particularly where PHC services are

inadequate

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Key determinants for low coverage (2)   Information Use:

  inadequate utilization of data for action

  Managerial capacity:   inability to capitalize on opportunities and

resources available (eg accelerated disease control initiatives)

•  polio, measles, and new vaccine introduction

  Management of AEFI:   lack of proactive plans and problems in risk

communication

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  SEAR Strategies

  SEAR Plans


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Strategies for increasing & sustaining RI coverage

  Planned   High level advocacy (meeting scheduled in July 2011)

  Social mobilization: joining global immunization week 2012

  Ongoing/ Completed   Resource mapping

  Monitoring & Evaluation of immunization coverage, vaccines and logistics

  Effective Vaccine Management Assessments, cold chain capacity expansion

  SIAs used as opportunities to strengthen RI

  Mid-level Managers training in March 2011

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Strengthening capacity of Mid-Level Managers

  Re-orienting mid-level managers using the present set of EPI managers as trainers

  Institutionalizing mid-level managers training

  Improving quality of services by supporting PHC staff

  Promoting monitoring and evaluation for expanding service for quantity & quality

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  SEAR Strategies

  SEAR Plans


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IVD SEARO Plans for 2011   Updating

 Regional Immunization Policy  Strategic Plan for Immunization & vaccine

Development

  Developing   Framework for increasing and sustaining

routine immunization coverage

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  SEAR Strategies

  SEAR Plans


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Bangladesh

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9395

93

9092

9394

9594

95 95

92

9698 98 98

99

79

94

87

9192

9088 88

8786

91

98

9597

98 9899

74

84

69

7778

74

77

81

8586

87

99

9394 94 94 94

74

7879

69

72

65

7172

77 7776

74

88

78

89 89 89

60

70

80

90

100

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Percentage

BCG DTP1 DTP3 Measles

Source: WHO/ UNICEF Estimated coverage, 1993-2009

Vaccination coverage and interventions in Bangladesh 1993 - 2009

2003 RED strategy

GAVI/ISS Hep-B Intro

2009 Penta

Introduction

2006 Measles Catch-up Campaign

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  EPI Micro-plan using RED   Annual EPI micro-plan including session plans

•  1st line supervisory plan •  Identification of Hard to Reach and High Risk Areas •  Monthly meeting for field workers to review coverage, feedback

and surveillance performance

  Additional Support for Low performing Districts   WHO (23 Districts and 2 City Corporations) and UNICEF (15

Districts) •  District level workshop for review RI coverage •  Additional support for transportation of vaccines and logistics •  Listing of drop out and left out, problems and solutions •  Supervision by 1st line supervisors

The key to success of RI in Bangladesh

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India

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Percent children 12 to 23 months received 3 doses of DTP vaccine, India DLHS III 2007-08

Data not available

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHAND

WEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYA

NAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

DELHI

D&N HAVELI

CHANDIGARH

DAMAN & DIU

PONDICHERRY

LAKSHADWEEP

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Immunization Coverage

54.1%

34.6%

11.3%

No Immunization

Partially Immunized

Fully Immunized

Source: District Level House hold Survey 2008

88.7

%

26

22.6

16.618.1

2.9

0

5

10

15

20

25

30

Target Infants BCG DPT-3 Measles NoImmunization

Infants in million

Millions of Infants (0-1 Yr) reached

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High levels of drop outs of children who have entered the system

Source: DLHS-3 Data for children aged 12-23 months

Documents

Regional Update: Increasing & sustaining …...1 1 SAGE Meeting 5-7 April 2011, Geneva, Switzerland Regional Update: Increasing & sustaining immunization coverage in SEAR Immunization