Pulse polio program and microplanning

The microplan is developed prior to the polio round by the Government and WHO-NPSP with support from partners at block, district and state levels. It gives a detailed plan of the house-to-house activity with team numbers, names of team members, supervisors, including influencers and routine immunization indicators.

1. PULSE POLIO PROGRAM AND MICRO PLANNING Dr.Aishwarya.R.G 1 st year MPH RGIPH & CDC 9/28/2020 1

2. Index Pulse polio immunization Introduction Objectives Steps taken Progress Risks or challenges in strategy Program priorities Micro planning Introduction Micro-planning and implementing NID’s/SNID’s Other key components of planning and implementation 9/28/2020 2

3. PULSE POLIO PROGRAM 9/28/2020 3

4. INTRODUCTION With the global initiative of eradication of  polio  in 1988 following World Health Assembly resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995.  Children in the age group of 0-5 years administered polio drops during National and Sub-national immunization rounds (in high risk areas) every year. About 172 million children are immunized during each National Immunization Day (NID). The last polio case in the country was reported from Howrah district of West Bengal with date of onset 13th January 2011. WHO on 24th February 2012 removed India from the list of countries with active endemic wild polio virus transmission. 9/28/2020 4

5. OBJECTIVES The Pulse Polio Initiative was started with an objective of achieving hundred per cent coverage under Oral Polio Vaccine. It aimed to immunize children through improved social mobilization, plan mop-up operations in areas where poliovirus has almost disappeared and maintain high level of morale among the public. 9/28/2020 https://www.nhp.gov.in/pulse-polio-programme_pg 5

6. Steps taken by the Government to maintain polio free status in India Maintaining community immunity through high quality National and Sub National polio rounds each year. An extremely high level of vigilance through surveillance across the country for any importation or circulation of poliovirus and VDPV is being maintained. Environmental surveillance (sewage sampling) have been established to detect poliovirus transmission and as a surrogate indicator of the progress as well for any programmatic interventions strategically in Mumbai, Delhi, Patna, Kolkata, Punjab and Gujarat. All States and Union Territories in the country have developed a Rapid Response Team (RRT) to respond to any polio outbreak in the country. An Emergency Preparedness and Response Plan (EPRP) has also been developed  by  all  States  indicating  steps  to  be  undertaken  in  case  of detection of a polio case. 9/28/2020 https://main.mohfw.gov.in/sites/default/files/Pulse%20Polio%20Programme.pdf 6

7. …CONTINUED To reduce risk of importation from neighbouring countries, international border vaccination is being provided through continuous vaccination teams (CVT) to all eligible children round the clock. These are provided through special booths set up at the international borders that India shares with Pakistan, Bangladesh, Bhutan Nepal and Myanmar. Government of India has issued guidelines for mandatory requirement of polio vaccination to all international travellers before their departure from India to polio affected countries namely:  Afghanistan, Nigeria, Pakistan, Ethiopia, Kenya, Somalia, Syria and Cameroon. The mandatory requirement is effective for travellers from 1 st  March 2014. A rolling emergency stock of OPV is being maintained to respond to detection/importation of wild poliovirus (WPV) or emergence of circulating vaccine derived poliovirus (c-VDPV). National Technical Advisory Group on Immunization (NTAGI) has recommended Injectable Polio Vaccine (IPV) introduction as an additional dose along with 3rd dose of DPT in the entire country in the last quarter of 2015 as a part of polio endgame strategy. 9/28/2020 7

8. Progress South-East Asia Region of WHO including India has been certified polio free by “The Regional Certification Commission (RCC)” on 27th March 2014. India has achieved the goal of polio eradication as no polio case has been reported  for  more  than  3  years  after  last  case  reported  on  13th  January, 2011. WHO on 24 th  February 2012 removed India from the list of countries with active endemic wild polio virus transmission There are 24 lakh vaccinators and 1.5 lakh supervisors involved in the successful implementation of the Pulse Polio Programme 9/28/2020 https://main.mohfw.gov.in/sites/default/files/Pulse%20Polio%20Programme.pdf 8

9. …CONTINUED The total number of cases and number of affected districts during past 10 years is as shown : 9/28/2020 Source:   National Health Mission 9

10. Risks/Challenges to Polio Eradication Strategy International Importation of wild polio virus. Neighbouring countries like Afghanistan, Pakistan and China has had a major outbreak of Wild Polio Virus in the recent past who pose a major threat to Polio Eradication. Complacency both for public & system. Gaps in AFP (acute flaccid paralysis) Surveillance or delays in detection of wild polio virus. Delayed and or inadequate response to importation. Areas with low population immunity. Gaps in Routine Immunization & SIA (supplementary immunization activity) especially in High Risk Areas. Various resident societies are not allowing vaccinators to enter their premises and immunize children in these societies. 9/28/2020 10

11. Current program priorities Intensify AFP Surveillance including environmental surveillance Maintain Intensified program in High Risk Areas Fully and consistently cover Migrant and Mobile populations. Strengthening Routine Immunization. Prepare for Emergency: rapid and effective response to any wild polio virus 9/28/2020 http://health.delhigovt.nic.in/wps/wcm/connect/3956e00048b5b90793ac93c185840765/PPD.pdf?MOD=AJPERES&lmod=-382194844 11

12. MICRO PLANNING AND PULSE POLIO PROGRAM 9/28/2020 12

13. INTRODUCTION Microplanning is one of the tools that health workers use to ensure that immunization services reach every community. Microplanning is used to identify priority communities, to address barriers, and to develop workplans with solutions. In the broadest sense, micro-planning covers all planning activities at sub-national level; that is, regional, local and institutional, so as to enable the successful attainment of the set goals.   It is a planning process that focuses on local characteristics and needs and builds local capacities.  9/28/2020 https://agora.unicef.org/course/info.php?id=6730 https://learningportal.iiep.unesco.org/en/glossary/educational-micro-planning 13

14. MICRO PLANNING AND IMPLEMENTING NIDs/SNIDs Successful implementation of SIAs requires meticulous microplanning . Important components of micro plan are as under : Booth activity. House-to-house activity. Transit site activity. Activity in high risk and underserved areas Activity at Brick kilns, construction sites, congregation sites, urban areas. 9/28/2020 14

15. Booth activity Booths will be setup on day 1 of the NID/SNID campaign to take advantage of IEC/ Social Mobilization efforts. On this day OPV vaccine shall be provided to all children aged 0 – 5 years (including new-borns) who are brought to the booth. All departments of the government (e.g. education, social welfare, ICDS, panchayat raj institutions, civil defence, revenue etc.) as well as NGOs and the community participate. Therefore it is essential that adequate social mobilization (refer to the section on social mobilization) measures are undertaken prior to the NIDs/SNIDs so that parents are fully informed about the: Dates of immunization at the booth. The locations of the booths. The benefits of receiving OPV 9/28/2020 15

16. …CONTINUED 9/28/2020 16

17. MARKING OF CHILDREN All children vaccinated at booths transit sites or h-t-h visit in NIDs/SNIDs should be marked with indelible ink marker pen on the left little finger. 9/28/2020 17

18. HOUSE TO HOUSE IMMUNIZATION ACTIVITY The aim of the NIDs/SNIDs is to vaccinate all under 5 children. To ensure this teams would visit each household in the NID/SNID area. Area allocation and workload of teams Composition of teams Activities of teams - Search and Immunization of children during house to house visits - Immunizing children outside houses - Marking of houses by vaccination teams - Revisit to X houses 9/28/2020 18

19. Marking of houses by vaccination team All visited houses should be marked with white/coloured chalks or geru as : P/date: All children less than 5 years of age staying in the house have received OPV dose in this round. This includes children visiting the house when the supplementary immunization activity is on. No child less than 5 years in the house. All children in the house are over 5 years of age. X/date: All or some children less than 5 years of age have not received OPV dose for reasons like: Children not at home for the following reasons Away to fields, school or market places Visiting friends or relatives Accompanying parents to place of work Refusal Locked house - even if the family is not expected to return for a period of one to two years. 9/28/2020 19

20. Planning and immunizing children in transit Large number of children would be in transit during NIDs/SNIDs. It is essential to cover all these children through Transit teams. Transit teams should be present at major railway stations, bus terminuses, ferry crossings, highways and airports. Transit teams should also be deployed at prominent road crossings in cities and major tourist attraction points. Vaccinators must be proactive in seeking and immunizing children at Transit points, Melas and other Congregation sites 9/28/2020 20

21. Indicators for High-risk areas and underserved population A wild poliovirus confirmed case in the recent past (year 2005 onwards). Problems in surveillance like non-reporting/ late reporting of AFP cases, non-collection/ late collection of stool specimens. Large immunity gap (large proportion of children who have received less than 4 doses of OPV) as determined by proportion of less than 5 years old Non Polio AFP cases having less than 4 doses. Low routine immunization coverage. Urban slums or peri urban areas not recognized by district authorities. Remote, sparse and difficult to reach population groups like nomadic tribes, boat people, isolated families living along riverbanks for farming, river islands etc. Mobile population and tribes People with working hours that do not coincide with the visit of teams (for example children going to the fields along with their parents during harvesting and sowing seasons are simply missed because teams do not reach either before they leave or after they come back from the fields). Children living at construction sites, brick kilns 9/28/2020 21

22. …CONTINUED Travellers, who may be on the road or in the train when the campaign takes place. People living in houses outside recognized settlements (the “no man’s land”). People that have lost their faith in the health programme, because of low quality of services provided, lack of explanation, and/or rude behaviour of vaccinators or supervisors in the past. People of specific socio economic status, which require ‘special’ efforts to reach. Persons with high socio economic status may disagree with supplemental immunization, because their child has already received routine doses. People of low socio economic status may distrust anything offered for free and request other services. Misinformed groups, who may refuse immunization because of wrong beliefs about side effects of OPV (impotence etc.) based on rumours. They do not oppose immunization because of religious reasons, but because of lack of proper information through the proper channels. 9/28/2020 22

23. …CONTINUED Special efforts for high risk areas and underserved populations Immunizing children of misinformed groups. Brick kilns, construction sites may be covered by either house-to-house immunization teams or mobile teams specifically constituted for this purpose. Mobile teams. Coverage of children in major melas and religious congregations should be included in the micro-plan. 9/28/2020 23

24. MICRO-PLANNING FOR URBAN AREAS Planning for urban areas is crucial for successful implementation of NIDs/SNIDs. Some of the commonly observed deficiencies in urban areas are : Lack of adequate health infrastructure and manpower Large slums (unauthorized) Peri urban areas with new settlements and some areas/colonies not recognized by municipal health authorities Multiple construction sites 9/28/2020 24

25. Micro planning for urban areas For planning and implementation purposes, urban areas should be divided into smaller planning units based on municipal wards or assemblies and if this is not possible then by roads or prominent landmarks. Each such unit should be put under the charge of a medical officer or nodal officer. Involvement of local municipal bodies and their staff is essential in urban areas. Coordination with education department, social welfare, civil defence, other local NGOs, resident welfare associations and community leaders is vital for meeting shortage of vaccinators, transport and also for social mobilization. Maps must be used while planning for urban areas. 9/28/2020 25

26. 9/28/2020 26 video

27. OTHER KEY COMPONENTS OF PLANNING AND IMPLEMENTATION Besides planning and implementation of activity at booths, house-to-house, transit site etc. other key components which require planning and implementation are as under Supervision Mapping of areas Orientation training of vaccinators and supervisors Vaccine, cold chain maintenance, other logistics and transportation IEC/Social Mobilization Recording and reporting Review of micro plans and data analysis for planning interventions Use of data for planning actions 9/28/2020 27

28. Supervision High quality supervision is vital to the success of the programme. Supervision should not merely be inspection for fault-finding. Supervisors should be supportive and should be able to : Identify problems and help to solve them. Support, encourage and motivate vaccinators in carrying out high quality vaccination activities completely. 9/28/2020 28

29. Mapping Maps are useful for planning and ensuring completeness of activities. Planning unit Maps Maps should be developed at each block/ PHC/ Urban area and should indicate: Supervisors’ areas with demarcation Vaccine distribution points High risk and difficult to reach areas Areas from where wild virus or compatible cases have been detected Population likely to be missed Ice factories Major landmarks and roads 9/28/2020 29

30. Supervisor Maps 9/28/2020 30

31. 9/28/2020 31

32. TEAM MAPS TRANSIT SITE MAPS 9/28/2020 32

33. Orientation Training of Supervisors and Vaccinators Orientation of Vaccinators The briefing will be organised in batches of 40 – 50 vaccinators per session and will last for about half a day. Orientation of Supervisors The District training team /Block Medical Officers/Urban Health Officials/ Surveillance Medical Officers of NPSP should undertake a half-day orientation of the supervisors. 9/28/2020 33

34. Vaccines, Cold Chain, other Logistics and Transport Vaccines Vaccine handling guidelines Vaccine Vial Monitor (VVM) Other logistic materials Transport 9/28/2020 34

35. Recording and Reporting A tally sheet (Form 8 A ) should be used for recording number of children immunized and houses visited. No other system of recording should be used. Areas that have conducted mop-ups and have experience of using different tally sheets on booth (Form 8C) and house to house days (Form 8D) should continue to use the same tally sheets. At the end of each day, each supervisor should go through the tally sheets of all his/her teams, compile the information and submit a consolidated report using the reporting form for supervisors (Form 9A). 9/28/2020 35

36. IEC and Social Mobilization Key Strategies Messages Branding of the campaign Central level activities Television Radio Print Preparation and Distribution of IEC materials District-Level Activities Block Level Activities Mobilize local cable-operators and cinema theatres in urban/peri-urban areas to screen polio messages in the local cable-TV network and cinema theatres 9/28/2020 36

37. Review of Micro plans Review and updation of micro plans is critical for implementation of good quality NIDs/SNIDs rounds. The review is essential before each round to identify deficiencies/ shortfalls based on the observations of previous rounds, incorporate appropriate changes and interventions for improved implementation of subsequent rounds. Micro-plans should be developed and reviewed with the vaccinators, supervisors, immunization officer, block medical officer, community mobilizers, field volunteers (if available) and surveillance medical officer (SMO) sitting together and should be in local language. 9/28/2020 37

38. Use of Data for Planning Actions It is essential to use the existing data for identifying actions required to plan and implement NID/SNID immunization in the area. Surveillance data SIA Data Major sources of SIA data Micro-plans Vaccinators Tally sheets Supervisors and monitors feedback Percent houses with potentially missed children (commonly called percent missed houses) : This indicator is derived by adding the % X houses left at the end of the activity (data from tally sheets) and % false P houses detected by monitor (data from monitors formats). 9/28/2020 38

39. The micro planning review forms Helpful in the analysis of micro-plans to identify the areas within blocks for interventions 9/28/2020 39

40. 9/28/2020 Reference: OPERATIONAL GUIDE FOR PULSE POLIO IMMUNIZATION IN India by MOHFW 40

41. Slogans Here are some polio slogan, which can be used to spread awareness about polio vaccination and eradication. "Do Boond Zindagi ki " "Spare the children, give the vaccine" "Prevent Birth Defect." "Stop Polio, Vaccinate." "Get A Drop, Stop The Strop." 9/28/2020 41

42. 9/28/2020 42 Rotary club – What polio eradication means to me?

43. THANK YOU 9/28/2020 43