Immunization Services

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 Birth 6 weeks EPI visit 0 1 Vaccine BCG (OPV) OPV1, DTP1, Hib1 OPV2, DTP2, Hib2 Hepatitis B - options Option1 Option2 Hep B Hep B1 monovalent or in combo Option3 Hep B DTP-Hep B1 10 weeks 2 Hep B2 monovalent or in combo Hep B2 (monovalent) DTP-Hep B2 14 weeks 9-12 months 3 4 OPV3, DTP3, Hib3 Measles (Rubella) Hep B3 monovalent or in combo Hep B3 (monovalent) DTP-Hep B3 WHO’s Approach: Components of routine immunization systems Vaccine Supply & Quality Logistics Service delivery Advocacy & Communication Surveillance 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……. National level •Policy •Standards & guidelines •Case definitions •Disease, coverage, adverse events monitoring for nation •Data management systems •Improving data quality •Laboratory Services Surveillance Local level •Disease, adverse events monitoring •Vaccine supply •Vaccination info management •Register •Tally sheets Activities……. 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 Surveillance 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 DTP1 coverage – Tracking & follow up activities • Dropout - DTP1 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