1. STRATEGIES FOR IMPROVING ROUTINE IMMUNIZATION
Current Status and Goal
The objective of the immunization programme is in line with the objectives framed under NRHM with additional inputs from GOI, it is envisaged to attain a level of immunization coverage in line with the National goals.
Summary of Activities
a). To improve coverage by increasing the access through Govt. facilities.
In lower belt / soft area numbering 224 SC of the total SCs, ors would be organized (896 ors / month) The districts would prepare detail work plan at the sc level for conducting ors and would be ensured that the activities are implemented as per the plan.
A PHC level team / district level immunization team will be constituted comprising of MOs, ANM, LHV, HA, AWW, ASHA for providing outreach sessions in 224 SC area every month wherever there is no manpower. Additional mobility support is absolutely necessary due to lack of staff at the sc level or non-functional status of majority of the SCs in the state. AWW / ASHA will be engaged for mobilization of children during immunization sessions at a rate stipulated by GOI.
b). To increase immunization coverage in inaccessible areas
In 154 inaccessible sc areas, ors (4 times / month / SC) would be conducted which will need special consideration in terms of funding for vaccine lifting and mobility support (TA, DA) This is absolutely necessary due to lack of staff at the SC level or non-functional status of majority of the SCs in the state.
c). To provide routine immunization to all children in urban areas by increasing access through government and society run facilities.
Apart from the proposed outreached sessions under urban health program (Itanagar-Naharlagun and Pasighat), an additional immunization camps will be organized in all the district headquarters at the rate of 2 Immunization camps per district headquarter (2 Slum areas) per month in 15 district headquarters (360 Immunization camps per year). The mobility support would be provided along with logistics at GOI norms. Manpower would be provided from the District Hospital after establishing a proper mobile unit. Apart from involving 2 society run Hospitals to conduct immunization sessions on a fixed day, an additional NGOs would be involved to organize vaccination camps along with the above proposals in the urban areas.
d). Mobilization of children by AWW / ASHA to the Immunization site.
In all the session sites village-wise, mobilization of children would be done through AWW / ASHA / Link worker etc and the support involved would be provided at Rs 50 /- for AWW / ASHA per session for all sessions.
e). Strengthening the Cold Chain Systems.
Proper maintenance of cold chain equipments and storage will be ensured at all level and the old equipments will be phased out. Provision for 20 solar operated refrigerators in non-electrified PHCs during the year. Fund for cold chain maintenance would be provided to 1 WIC (State cold chain room), 16 districts, 25 CHCs and 81 PHCs where cold chain systems are in place to ensure timely procurement of spares as per GoI norms. The supply of AD syringes, Hub cutter and plastic bags along with vaccines would be made available to all the facilities providing immunization services.
position of Cold chain equipments in the state
f). Orientation training of ANM, Technician and doctors on immunization
g). strengthening program management and supervision.
It will be strengthened to improve services, identify bottlenecks, timely corrective intervention for optimal utilization of resources. The state level Officer would be provided mobility supports for supervisory visit to districts 2 times each district per year in the form of TA / DA, POL.
Mobility support would be provided for supervisory visit to the field area in the district (1 visit to all the area within the district per month) by the DRCHO as per GOI allocation norms.
Computerization of MIS system with introduction of RIM at the state and district headquarters will be ensured. For which, 4 Computers with accessories and a computer operator each to state and all the districts will be provided on contract at the rate of Rs. 6500/- per month.
h). Program evaluation.
A quarterly review of the immunization program will be organized for one day among State and District level immunization officials at the state headquarters for assessing service delivery, supplies, equipments, logistics, manpower resource and district performances (16 districts X3 person @ Rs 1250 per person including stationery expenses).
Similarly, the DRCHO will hold at least one review meeting per 2 months with the program personnel. All the activities under this PIP would be evaluated at all level. The program outcome indicators and performance level would be reviewed at the end of every year so as to ascertain the level of achievements.
i). Waste management
Waste disposal mechanism would be put in place in all the PHCs, CHCs and wherever cold chain systems are in place (n=40) during the year at the rate of Rs 20000/- per centre. Remaining health centres would be taken in a phased manner.
j). Provision for Diesel Generator
In view of no power supply in many far flung areas, in the identified health centre, provision for Diesel generator would be provided to 15 Health Centres (Rs 1 lakh/ set) and POL provision would be made from the RCH fund at the rate of Rs 2000/- per centre.
k). Additional Manpower
In view of the acute shortage of Refrigerator Mechanic (RM), 4 nos. of RM will be appointed on contract for 4 districts presently without RM. This is necessary in order to minimize the sick time of the cold chain equipments. It is very often seen that RM has to travel several hundred kilometers to repair sick cold chain equipments either from state headquarters or neighboring districts. An additional Refrigerator Mechanic has been appointed on contract basis to oversee the cold chain repair and maintenance from state headquarters at a consolidated pay of Rs 8000/- per month. This is absolutely necessary considering the experience gained over the years on cold chain maintenance and would continue.
l). Mobility (POL) support for vaccine lifting
An additional need are mobility support for lifting of vaccines from nearest airport Guwahati (10 lifting per year) to the state cold chain system (POL support may be provided at the rate of Rs 5000/- per collection), lifting of vaccines from state cold chain room to 16 districts whenever required would be made available (6 times per year) and for lifting of vaccines from district cold chain room to all the CHCs and PHCs. An amount of Rs. 5000/- per month per district would be provided as POL / DA support.
m). Provision for Immunization Card/ Register
It is proposed to procure the necessary Immunization Card (100,000 nos) at the state level yearly at the rate of Rs. 3/- per card (as per GOI norms) and provision of Rs 200000/- for provision of Immunization registers.
n). IPPI (Intensified Pulse Polio Immunization)
The IPPI program would be implemented in the state as and when GoI directions are received. The fund requirement for such IPPI program is Rs.1 Crore.
o). Helicopter Sorties.
There are 11 exclusively airfed and hard to reach areas which requires helicopter sorties. The areas will be covered 4 times per year. Therefore total sorties required is 44 and the rate for each sortie (3 hours / sortie – average) is Rs 120000/ -. Therefore for 44 sorties the total requirement will be Rs 5280000/- per year. The above requirement is absolutely required.
a. With the introduction of Immunization weeks during the last two years the immunization coverage level has gone up many fold. The State plan to organize more immunization week during the year on alternate months.
The fixed Immunization Days in the state is on Tuesday & Saturday and outreach session are carried out as per the microplan of the particular areas. The state strives to generalize availability of microplan in all the health facilities.
b. State Level steering committee is in place for special immunization drive like IPPI etc.
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