TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Narayana Holla
  2. Programme management
  3. Friday, 30 August 2019

Dear viewers

The following illustration emphasizes the importance of keeping vaccination data up to date on a regular basis and to explore the measures to promote EIR. 

PHC Kollamogru is one of the 3 planning units attached to KVG Medical College Sullia located in the interior hilly area with sparse population, rich with forest, rubber plantation, coconut trees, plantains etc. It has a population of 9692, five sub-centers, an estimated 130 pregnant women, 117 below one year children [birth rate 12/1000 per year], 521 under five years residing in 2084 houses  [child house ratio of 0.25  & people @4.6 per house].

This PHC is enumerating / line listing vaccination data in the “Extended Immunogram” since April 2013 coinciding with introduction of Pentavalent in the National Immunization Schedule [NIS].

Proactively, on updating vaccination data as a routine, we prepared the duelist for the month of August 2019. With the introduction of RCH Portal, ANMs became busy in entering data to RCH portal, poor connectivity drastically retarded the process and resulted in the following:

  1. Provisional duelist had 62 children – 53% of annual target, about 10% more than Expected Due Children (EDC).

[Calculating EDC: A child has to visit 5 times as per present NIS in India for completing FIC below one year and booster before 2nd year excluding newborn vaccination. i.e. 117×5=585 visits. 585÷12= ~49; 41.88% of annual target  of 117. Since vaccination is done once a month in the outreach and once a week at the PHC, EDC will be a little more than 42% of annual target].

  1. On updating the data, the list got shortened to 47 by 24.2% [40.17% of annual target – more specific].
  2. Data of 9 children (19.1%) yet to be fed to RCH portal hence not in Electronic Immunization Register [EIR]. EIR has ~20% less data than in manual register.
  3. On 29th August 2019 dose wise mobilization of children is given in the table below:

Dose

1st dose

2nd dose

3rd dose

MR1

Booster

MR2

Total

FIC

 

Due in Aug

7

9

3

10

24

53

10

Vaccinated in Aug

4

8

3

8

10

33

8

  1. Following is the table with dose wise due children prepared on updating the data in the Extended Immunogram master register at the PHC for the month of September 2019. We wish to study the proportion of mobilization

Dose

1st dose

2nd dose

3rd dose

MR1

Booster

MR2

Total

FIC

 

Due in Sep

10

10

7

6

23

56

 

Vaccinated in Sep

             
  1. In this list 15 children of 56 (26.78%) are yet to be entered in to RCH portal. At any given time, in the existing situation and process, EIR is having about 25% less data than actual and hence the indicators are not reliable for performance review to guide the programme.

So what: An expert team has to genuinely study and explore as to how to make the RCH Portal very useful for the grass root level workers and managers at all levels. All PHCs can easily replicate Kollamogru model.

best wishes

Holla n Team

 

Attachments (1)
Comment
There are no comments made yet.
Narayana Holla Accepted Answer

Thnank you for sahring the success of EIR.

India also needs to improve and is committed; however we wish to share te following with concern for making it possible by the doers.

We shared the facts from one of the planning units in India. India has ~28000 planning units. India is known for unity in diversity – if an intervention is successful, it will be almost successful throughout the country as all sub centers have 3 ‘A’ces – ANM/AWW/ASHA – all 3 are females, however there is ~30% vacancy and areas without this luxury. Mother and Child Tracking System [MCTS] was theoretically meant to work very successfully to increase the sensitivity, specificity, ease the workload and hasten the achievement. MCTS was selected by the Rockfeller foundation award for the top innovative programme of the year 2011. But 65.53% of ANC data and 39% vaccination data of children were “MCTiSed” in 2012-13, depicting 34.47% ANC’s and 61% children as spuriously left-out. As per ITSU dashboard indicators, in 2017-18 MCTS portal depictedFIC as low as 8.3% for India and 0.04% for Karnataka – very hard to believe and explain such a low utilization.

Recently (>2years) Government of India in collaboration with stakeholders redesigned the MCP card [HBR], we too revised our Immunization card [Combo-Card] which we issue to the mothers on discharge. It has cells to enter due date as a result, many parents (paradoxically other than doctors/staff nurses and medical people) brought their children dot on the due date. Earlier, all outreach sessions in Dakshinakannada district were on a fixed date - say 17th of every month irrespective of holidays. Parents had no confusion and used to bring exactly on that date. To appreciate the parental commitment, last year we celebrated “Eu-Vac award ceremony” on 14th Nov 2018; about 50 parents were awarded appreciation certificate by the KVG team, parents and the babies brought by the 3 ‘A’ces of neighboring sub-centers.

India is the most populous country with a huge birth cohort of 27 millions, ~9.3 million either partially immunized or unimmunized has a very good scope for revamping MCTS as RCH portal but it has to be made very purposeful & useful from grass-root level workers to programme mangers at all level otherwise history of MCTS will repeat. Having independently reached moon and mars, this should be possible in India.

best wishes and regards

Holla n KVG Team

 

 

Comment
There are no comments made yet.
  1. more than a month ago
  2. Programme management
  3. # 1

Thank you for sharing.

Decision support capabilities are some of the functionalities of Electronic Immunization Registries (EIRs) that are proven to improve vaccine uptake (along with facilitaing recall/reminders for veaccines due or overdue and with monitoring by health facility/vaccinator, and others) - see review by Groom et al, 2015 - attached and the IDEA realist review 2019: https://findyourfinding.org/idea-report by PATH and PAHO.

I take the opportunity to share the latest PAHO Newsletter that includes the following article: "Using Electronic Immunization Registries to Improve Vaccination Coverage and Timeliness: Experience of the City of Villa María in Córdoba, Argentina" - www.paho.org/immunization/newsletter - look at mots recent issue.

 

Please keep sharing,

Carolina

Attachments (1)
Comment
There are no comments made yet.
  1. more than a month ago
  2. Programme management
  3. # 2


There are no replies made for this post yet.
Be one of the first to reply to this post!