Computerized tool for planning routine immunization, India

Computerized tool for planning routine immunization, India Presenter : Dr. Karan Singh Sagar Country Representative JSI R&T / IMMUNIZATIONbasics (in collaboration with Dr. Manish Jain, IMMbasics/UP) 36th Annual International Conference on Global Health

Presentation outline

Background Rationale for developing the tool Micro‐planning tool features & advantages Pilot Roll out of the tool Present status Achievements Challenges and way forward

Background Annual target for immunization: ~27 million pregnant women

~25 million infants/year

India has one of the lowest routine immunization rates in the world. District Household & Facility Survey–3 (DLHS 2007‐08) reveals: – 47.6% children (12‐23 months) fully immunized – 16.3% children received no vaccination (~4 million)

Countries with most unimmunized children ‐ DTP3, 2005‐2007 (in millions) 0

2

4

6

8

10

12

India Nigeria China Indonesia Ethiopia Pakistan Uganda Niger Bangladesh

2007 2006 2005

DR Congo Source: WHO/UNICEF coverage estimates 1980-2007, August 2008 Date of slide: 21 August 2008

Fully immunized Coverage (DLHS 3) 7 states < 50% Additional 5 States< 60% Only 2 states > 80%

≥ 80% 70-79% 60-69% 50-59% < 50% No data Source: DLHS3

India immunization challenges 12.5 million under immunized children each year. Wide sub‐national and local variation in coverage. Inadequate micro‐planning at primary health care level (major underlying reason).

RED strategy for Immunization WHO/UNICEF recommend “Reaching Every District” (RED) strategy for improving immunization coverage. 5 major components of RED strategy: – Re‐establishing outreach services – Supportive Supervision – Linking services with the communities – Planning and management of resources – Monitoring and use of data for action

Rationale for computerized tool Need for appropriate microplanning for RI suggested by: – National UIP Review (2004) – Multi Year Strategic Plan (2005‐10) National discussions recommended computer‐based utility for: – Preparing PHC level comprehensive microplan – Incorporation of all RED strategy components – Facilitating the process for mid level managers – Incorporating NRHM elements in planning

Microplanning Process State

District

PHC

Subcenter

State Plan (Compiled District Plans & state specific activities) District Plan (Area map, compiled PHC plans, budget, supervision, IEC, training etc) PHC Plan (Area map, compiled SC plans, AVD, supervision plan, waste disposal etc SC Plan (Area map, work plan, estimation of beneficiaries, vaccine logistics etc

Immunization Microplanning Tool

Developed by JSI/IMMUNIZATIONbasics, India (USAID‐funded).

Technical inputs from MOHFW and other partners in immunization (UNICEF and WHO/NPSP).

Microsoft Excel‐based utility.

Includes 15 formats (worksheets) covering different components of the program.

Out of these, 10 formats are self‐generated on the basis of calculations, logical relations and interlinked worksheets.

Microplanning Tool ‐ Features Tool is designed to assist mid‐level managers in: – Describing target population – Analyzing barriers – Prioritizing areas for effective use of resources – Preparing health worker immunization activity plan (Fixed Day, Fixed Site) – Estimating vaccine and other logistics (diluents, syringes, cards, vitamin A) requirements – Preparing plans for supervision, social mobilization and vaccine delivery

Microplanning Tool ‐ Features

User‐friendly and technologically simple

Tool available in English and Hindi (can be adapted to regional language)

District level compilation tool also available to facilitate district level managers.

Explanatory notes present on each worksheet.

Separate user guides available in English and Hindi.

Microplanning Tool

INDEX PAGE

Microplanning Tool

NAVIGATION SHEET

Microplanning Tool ‐ snapshots

BLOCK PROFILE WORKSHEET


HUMAN RESOURCE WORKSHEET


AREA PRIORITIZATION WORKSHEET


ESTIMATION OF BENEFICIARIES (SELF GENERATED)


Antigen wise Estimation of Beneficiaries (Self generated)


Immunization Calendar/ANM Roster (Self generated)


Social Mobilization Plan (Self generated)


Vaccine Delivery Plan (Self generated)


Session wise Vaccine Distribution Plan (Self generated)


Supervision Plan

Microplanning Tool ‐ Advantages

Prioritization of villages and urban areas on basis of: – Population base – Distance from facility (cold chain point) – Terrain and accessibility

Considers inter‐state variation of demographic rates and implementation strategies. Reduces errors due to manual calculations.

Serves as a implementation as well as monitoring tool for mid‐level managers.

Piloting of the tool Tool was piloted in 2 districts of Jharkhand state (June‐July 07) for assessing: –

Completeness and correctness

–

Ease of use (acceptability)

–

Possible role in improving coverage

Observations shared with MOHFW and partners, and the tool was revised as per the suggestions.

Implementation

Tool shared with states & partners at various forums (meetings, trainings etc) and advocacy for use at state and national level. Allotment of separate funds for microplanning through NRHM Program Implementation Plan Trainings of computer assistants, District Program Managers , DIOs’ in 3 states (430) . TA provided by partner agencies for implementation. Feedback from states being used to make tool more effective

Implementation ‐ Present status Tool endorsed and used by State governments of 3 states

1. Uttar Pradesh 2. Jharkhand 3. Madhya Pradesh

Benefit of tool ‐ Increased reach Health Centers (PHC + CHC)

Health Workers (ANM & MPW‐ M)

State

Districts

Population (millions)

Uttar Pradesh

70

166.20

4046

27,632

Jharkhand

24

26.9

542

8,663

Madhya Pradesh

48

60.35

1419

15,150

Annual target of infants (2008‐09)

% left out*

Estimated number of left outs

Uttar Pradesh

5.55 million

24%

1.33 million

Jharkhand

0.88 million

12.8%

0.11 million

Madhya Pradesh

1.89 million

9.8%

0.18 million

State

TOTAL

8.32 million

* District level Household Survey (2007-08)

1.62 million

Achievements (1)

Triggered a planning process at all levels

Enabled integration of various plans (Polio, RI)

Strengthened service delivery by prioritization of areas.

Improved reach to unreached beneficiaries.

Correct and timely estimation of vaccine and logistic requirements, reducing chances of inadequate stock and stock outs.

Achievements (2) Rationalized number of immunization sessions as per population base. Helps utilize available resources for improved cost effectiveness. Tool modified and used for JE campaigns in over 100 districts in the country (~88 million target population).

Challenges

Limited technological capacity at block and district level Does not address cold chain planning and contingency planning. Timely release of funds Yearly revision of the micro‐plans

Way Forward

Adapt tool to state needs

Advocacy for scale‐up and use by all states

Periodic update for inclusion of target population, newer vaccines & other initiatives.