Emergency Preparedness and Response Planning risk analysis, actions taken in HR areas & preparedness status for mop

p ups : West Bengal

24th Meeting of India Expert Advisory Group on Polio
New Delhi 15-16 March 2012

Dr Rashmi Kamal,IAS Addl State Mission Director, NRHM & Jt Secy to Govt of West Bengal

Outline of the presentation Risk assessment

Sustaining high population immunity in HRAs SIAs Routine Immunization Status of AFP Surveillance Preparedness for responding to importations

Risk assessment

Risk assessment in West Bengal

Location of wild polio cases
(2002 to 2011)

HR districts

WPV cases

HR districts

Sub district risk assessment

(based on past epidemiology & performance)

Howrah

9 districts

36 blocks/ urban areas

HR Gram Panchayats/ wards identified in each district

Identification of High Risk Areas, WB

Migrant sites High risk areas in settled population

= 10 Migrant site

= 10 HR site ~ 10,122 HR areas in settled population

~ 5,200 Migrant sites

Progress on Emergency Preparedness & Response Plan

EPRG constituted Two EPRG meetings held since December to assess progress RRT members selected and trained High Risk districts allocated to RRT members

Dr Soumitra Roy

Dr Kalyan Mukherjee

Dr J K Mehta Dr Amabasu Das

Dr Dipankar Maji Dr S S Basu Dr Prasanta Biswas Dr Pramit Ghosh

EPRP prepared and implemented

 Sustaining high population immunity in HRAs SIAs Routine Immunization

Intensive Government Oversight

Regular video conferences by Principal Secretary for polio SIAs with DMs /Mayors & Chair persons of urban bodies and Health / ICDS officials Senior state officials assigned to HR districts for monitoring District, sub divisional and block task forces to review preparedness & supervise operations Daily evening review meetings at districts & block PHCs
District Magistrate Howrah monitoring activity Urban area task force meeting in progress at Maheshtala

Intensification of underserved strategy

Polio advocacy at Urs

Endorsement from religious institutions

Compilation of appeals for teams working in HRAs

Sensitization of Hajis

Announcement from mosques Advocacy in religious gatherings Inauguration by religious leaders

Rally by madarsa students

Sensitization of Hajis before and after return from Haj pilgrimage

Rally by Madarsa students

Special initiatives to reduce missed children in HR districts of West Bengal

Health camps : Murshidabad Clinic booths: Howrah

120

Impact of health camps : Khargram

5000

Sick children vaccinated at clinic booths

100

80

4800

123 clinic booths

60

4600

40

4400
20

4200
0
Dec-10 Jan 27 2011 Feb 5 2011 Feb 27 Mar 27 Apr 24 May 29 June 26 Aug 28 Sept 25 Nov 13 Jan 15 2011 2011 2011 2011 2011 2011 2011 2011 2012

4000
May 2011 June 2011 Aug 2011 Sept 2011 Nov 2011 Jan 2012

Remaining houses with reluctance to vaccination

Children vaccinated

Partner supported Social Mobilization / Advocacy

1600 Field volunteers and supervisors from 23 NGOs deployed by Unicef in 6 HR district Social Mapping is being done in HR areas for planning appropriate area specific intervention Sensitization meetings with all PRI members and urban councilors
24 Pgs South Howrah

SIA inauguration and advocacy by Cricketers

Kolkata Knight Riders West Indies team

Special immunization plans for Congregations

Ganga sagar Mela Urs in different Mazars Eid congregations Other religious festivals

Vaccination at Ganga sagar mela

Vaccination at Urs

~ 20,000 children vaccinated at various congregations in 2012

Social mobilization to overcome refusals

Number of houses with reluctance to vaccination: 2011 vs 2012 North Bengal districts
1800

1200

600

0 UttarDinajpur Maldah Murshidabad Bardhaman

Feb-11 Feb-12

Birbhum

South Bengal districts

12000

8000

4000

0 Howrah Kolkata
Feb-11 Feb-12

24 Pgs South

Vaccination of children in transit

> 500,000 children vaccinated in transit during each campaign in the state

Children vaccinated at transit points: 2011 vs 2012

30000

20000

10000

0
Murshidabad How rah Kolkata 24 Pgs North 24 Pgs South

Feb-11

Feb-12

Other special initiatives to improve coverage

Targeted X-P conversion : Doctors from Medical colleges visit reluctant families (X houses) with medicines immediately after the round. Distribution of Motivational items from booths
Medical college doctors visiting an X house

ICDS feeding on booth day

Trend in remaining X houses Kolkata & Murshidabad
10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0
Apr-10 Jul-10 Aug-10 Jan-11 Feb-11 Mar-11 Apr-May- 29-May11 11 Jun-11 Aug-11 Sep-11 Nov-11 Jan-12 MURSHIDABAD KOLKATA

Outcome : Reduction in remaining X houses

ICDS feeding on booth day

12

Northern districts, West Bengal

10 8
Percent

Percent unvaccinated children End-of-round survey

6 4 2 0
Mar-10 Jun-10 Jul-10 Aug-10 Sep-10 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Aug-11 Sep-11 Nov-11 Jan-12 Feb-12

N=

1,371 4,490

2,996 4,020 3,515 6,556 7,574

7,686 7,065 10,320 6,461 6,651 7,996 6,890 8,924

12

Southern districts, West Bengal

10 8
Percent

6 4 2 0

N=

mid Feb-11 end Feb-11 Mar-11 Apr-11 7,525 6,665 8,193 11,933

May-11 11,027

Jun-11 Aug-11 11,787 12,602

Sep-11 11,343

Nov-11 Jan-12 11,816 10,919

Feb-12 17,450

Strengthening Routine immunization

Merger with SIA microplans in process
Identification of new RI/VHND sites through SIA microplan Incorporating RI session plan in SIA microplan Identification of newborns during SIA and their inclusion in RI

Training of MOs and Cold chain handlers Quarterly review of RI performance at state level

RI sessions planned vs held West Bengal

May 2011 January 2012
0% 4% 4%
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
May'11(193) Jun (114) Jul (329) Aug (222) Sep (58) Oct (115) Nov (99) Dec (296) Jan'12(156)

5%

5%

4%

3%

3%

3%

95%

95%

96%

97%

97%

97%

100%

96%

96%

Reason for session not held (N=57)

Session held

Session not held

0% 26%

State N = 1,582
ANM and Vaccine/Logistics absent
49%
26% 49% 7%

ANM present without Vaccine/Logistics Vaccine/Logistics available but ANM absent

18%

7% 18%

Other reason Reason not known

Source: Session RI Monitoring data (May 2011-January 2012)

Immunization status of monitored children, West Bengal, May 2011 - January 2012
100% 90% 80% 70% 60% 50% 40% 30% 20%

8%

5%

3% 24%

3% 23%

1% 13%

2% 19%

1% 21%

3% 22%

4% 22%

Reasons for children not being fully immunized

27%

28%

10%
86% 65% 67% 73% 74%

4% 37%

79%

78%

75%

74%

37%
Not aware of need

10%
10% 0%
May'11(611) Jun (450) Jul (1,259) Aug (898) Sep (248) Oct (438) Nov (393) Dec (1,228) Jan'12 (698)

Fear of AEFI Unaware of session site Beneficiary not available Programmatic Reason Other Reasons

2%

N= 1,629

Fully Immunized

Partially Immunized

Unimmunized

State N (children 12 to 23 months of age)= 6,223

 Status of AFP Surveillance

Status of AFP Surveillance - 2011

Non-polio AFP rate Stool collection rate

7.18

87%

AFP Surveillance is sensitive enough to pick any transmission in the state

India Less than 60% 60% to 69% 70% to 79% 80% and above No AFP case
* data as on 3 March 2012

 Preparedness for responding to importations

Preparedness for responding to importation

Prepared to hold first mop up within 7 days of detection of transmission, as demonstrated in the past.
Vaccine & other logistics reach blocks National level partners meeting Media plan operationalized Vaccine arrived in district State & District Task Force Meetings 14 additional SMOs arrive in districts IEC plan developed Marker pens & other logistics procured Field Investigation (NCDC/NPSP/UNICEF) National Technical Group Meeting Decision on mop up Chief Minister & Chief Secretary WB informed by GoI WPV notified Day 0 7 Feb 2011 Day 1 Day 2 Day 3 Day 4 Day5 Day 6 13 Feb 2011 Mop up conducted

Preparedness for responding to importation

Logistics plan
Running rate contract exists for marker pens supplies expected to districts within 7 days of placing order Printing of formats have been decentralized to districts may be done in 5 days Vaccine distribution to block PHCs (including hard to reach areas) within 4 days of receipt at state

Communication plan
Running rate contract exists for printing of banners/posters and delivery to districts

UNICEF is ready with the prototype IEC materials, will be updated in minimum time

Preparedness for responding to importation

Cold chain
Adequate vaccine carriers available in High risk blocks and urban areas Repair of cold chain equipments has been decentralized to district level to minimize delay

Microplanning
Microplans of all high priority planning units are reviewed and rationalized before each round

Manpower & training

Training of all high priority teams will be conducted within 6 days of notification

Preparedness for responding to importation

EPRG & RRT
EPRG is meeting from time to time to assess ongoing activities for increasing / sustaining population immunity and maintaining sensitive AFP surveillance can be activated within 24 hours

District, Sub division and Block / Urban area task force

will meet as soon as campaign is decided.

Highest level of political commitment to keep West Bengal polio free

Thank You