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Routine Immunization, one of the most-cost effective public health interventions is the foundation by which lifesaving vaccines are provided to children to minimize vaccine-preventable diseases (VPD). Efforts have been taken to ensure that targeted vaccination coverage under the UIP is reached, which ensures the provision of free vaccines by the state government against 12 preventable diseases. However, Covid-19 brought unprecedented challenges and impacted routine immunization rates, especially impacting vulnerable populations in various districts of Bihar.

As per HMIS RI ranking coverage of April 22, the vaccination coverage was lowest in five districts including Bhojpur. To restore services and safely deliver routine immunization programmes in all the 14 blocks of the Bhojpur, PCI in collaboration with the health department took transformative measures to achieve better immunization outcomes.

Hurdles such as lack of social mobilization, engagement of FLWs, communication and knowledge gap, poor coordination with the supervisors as well as increased number of dropouts and left outs cropped up. A diagnosis was planned from November 22 to November 26, to identify the loopholes which led to poor RI coverage in the district.

An extensive analysis was conducted to understand the systemic gaps. Prior to the assessment, the team briefed the District Immunization Officer (DIO) and the DPM about its purpose and outcome. The tools were also discussed with the State Immunization Officer who then issued a letter to the DIO for continuation. The assessment team described the purpose of their visit to understand the quality and use of data for action and identify the current system. This included observation of certain practices and functioning like cold chain management, review of records, data etc.

The DIO issued a letter to the MOICs that the PCI team will conduct a field visit. On the first day, the field team visited the session sites for survey register validation and reviewed the digital micro-plan for the current year in all blocks. It was planned that in the morning the team would monitor the vaccine distribution process at the PHCs. They interacted with the ANMs at the session sites and assessed the home visits coverage status through.

The team returned from field to PHC to share their feedback after developing proper insights on vaccination numbers, performance of quality assessment of RI session sites, reviewing the performance of ASHA and ANMs and understanding their challenges. They gave block-wise feedback to the DIO through PowerPoint presentations and shared their recommendations.

Key gaps were observed in the digital micro plan availability, vaccine delivery system, logistic management, ASHA survey register availability, due-list preparation, monitoring & regular feedback mechanism and proper review of ANM and ASHA in review meetings. With the help of the diagnostic process, the issues were identified that adversely affected the district’s routine immunization programme. Subsequently, required measures were taken to strengthen the reach of lifesaving vaccines to children aged 0-23 months. With this effort by PCI in collaboration with State Government, the ranking of routine immunization in Bhojpur has remarkably improved. According to the HMIS ranking of April 23, the full immunization coverage boosted to 89% as compared to 79% in August last year.

Author: Swati Savarn (Consultant)

Editor: Ronnie Clive Francis (Manager Comms KM)

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