Immunization Services

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Immunization Services

• DR. KANUPRIYA CHATURVEDI
• DR .S.K. CHATURVEDI

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Objectives

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

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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

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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

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Routine services Ensuring that all children
receive the WHO recommended vaccination schedule
Age EPI visit Vaccine Hepatitis B - options Hepatitis B - options Hepatitis B - options
Age EPI visit Vaccine Option1 Option2 Option3
Birth 0 BCG (OPV) Hep B Hep B
6 weeks 1 OPV1, DTP1, Hib1 Hep B1 monovalent or in combo DTP-Hep B1
10 weeks 2 OPV2, DTP2, Hib2 Hep B2 monovalent or in combo Hep B2 (monovalent) DTP-Hep B2
14 weeks 3 OPV3, DTP3, Hib3 Hep B3 monovalent or in combo Hep B3 (monovalent) DTP-Hep B3
9-12 months 4 Measles (Rubella)
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WHOs Approach Components of routine
immunization systems
Vaccine Supply Quality
Logistics
Service delivery
Advocacy Communication
Surveillance
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Components glued together by

• Planning
• Management
• Coordination
• Supervision
• Training
• Financing

Components glue exist at national,
provincial, district local level. Cascading
effect
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Activities..
Vaccine Supply Quality

• National level
• ..Policy on
• 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

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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
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Activities.

• 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

Surveillance
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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
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Activities

• National Level
• Technical documents guidelines
• Capacity building
• Partnerships with media
• Social Mobilization

• Local Level
• Partnerships with the community
• Social Mobilization

Advocacy Communication
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Activities

• National Level
• Supporting local level
• Local level
• Vaccination activities

Service delivery
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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
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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
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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

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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
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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

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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

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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