Our Achievements

  • Adverse Event Following Immunization

    Establishment of a regular meeting calendar of the revised National AEFI Committee. The committee now boasts of increased membership from different medical specialties (paediatricians, public health specialists, Central drugs Laboratory (CDL) representatives, immunologists, pharmacologists, partners, etc.) spread across the country with a fixed calendar of meetings.

  • Evidence to Policy
    • In its capacity as the NTAGI secretariat, the unit has worked to strengthen the immunization policy formulation process at the NTAGI and its Standing Technical Sub-Committee (STSC). The unit has contributed to the standardization of operating procedures at these committees.
    • An active and functional NTAGI and STSC secretariat has provided a vital boost to immunization policy making and accelerated several immunization program decisions such as the nationwide roll-out of the Pentavalent vaccine post and the introduction of vaccines against Rotavirus, IPV and Rubella.
    • The unit coordinated the visit of an Indian delegation, comprising of technical experts from the NTAGI and representatives from the Ministries of Health & Family Welfare and Science and Technology to the Advisory Committee on Immunization Practices (ACIP) meeting at the Center for Disease Control in Atlanta, USA in February, 2015. The visit provided the delegation with an opportunity to observe and implement global best practices for strengthening evidence based decision making in the country.
  • Program Operations, Monitoring and Evaluation
    • Data Analysis and Dashboards: The Unit has undertaken data analysis for data received from evaluation surveys such as the District Level Health Survey, Annual Health Survey, service delivery data from the Health Information Management System, name-based beneficiary tracking from the Mother and Child Tracking System, vaccine preventable disease surveillance data from the Integrated Disease Surveillance Project and immunization monitoring data collected from other RI partner organizations.
      A monthly dashboard based on analysis of immunization data is developed and released by the PO&ME team for use by state program managers and acts like an effective tool evaluate the immunization.
    • Evaluation of MCTS program: To understand the programmatic, operational, and technical challenges at all levels, the MCTS cell at the MoHFW and the Immunization Technical Support Unit jointly conducted an assessment across six districts in three states: : Barabanki and Hamirpur in Uttar Pradesh, Alwar and Bundi in Rajasthan and Kodagu and Mysore in Karnataka. The MCTS assessment report has been published and is due to be released by the MoHFW. Based on the feedback from the assessment report, the PO&ME team was given the task of developing a detailed MCTS field manual as well as standard operating procedures.
    • Maternal and Child Tracking System field manual and standard operating procedures: A MCTS field manual is being developed to guide program managers and frontline health workers. A MCTS assessment was conducted in December 2012 in Rajasthan, Uttar Pradesh and Karnataka, which highlighted the need to develop a field manual for effective implementation of MCTS.
    • Immunization Coverage Improvement Plan (iCIP): A brainstorming Immunization Coverage Improvement Plan workshop has already been conducted in Bihar and Madhya Pradesh and a state-specific plan to strengthen the immunization coverage is under development. The state level workshop for Bihar was conducted in Feb 2014. In MP it was conducted in February 2015 in one of its high priority districts,, with the involvement of District Immunization Officers (DIOs) and immunization partners. This workshop was chaired by Mission Director, MP and was guided by Deputy Commissioner (Immunization), MoHFW, GoI. ITSU is supporting the state for follow up and implementation of the iCIP in Madhya Pradesh.
    • Data Quality Assessment (DQA): In March 2014, the Government of Haryana conducted I-DQA in Yamunanagar district wherein the PO&ME team of ITSU was the technical lead and contributed by development of tools for data collection, compilation and analysis. A dissemination workshop was conducted by ITSU in the state to discuss the gaps identified and to develop an immunization data quality improvement plan to bridge the gaps identified during the assessment. Subsequently the plan was circulated across the state in June 2014and thereafter the State Government of Haryana has been conducting DQA exercises in the rest of the districts with technical inputs by the PO&ME team.
      Recently a DQA exercise has been completed in Balrampur and Jhansi districts of Uttar Pradesh in February 2015 and a data quality improvement plan is being developed for the state.
    • Coverage Monitoring Tool: The coverage monitoring tool is a simple tool to help program officers at all levels to monitor the major coverage indicators at state, district and block level, based on HMIS data. This tool is an excel based utility and major indicators covered are monthly Routine Immunization performance dashboards which include antigen wise coverage, session planning, vaccine preventable diseases, AEFI cases, drop-outs (between any two antigens) and monthly comparison between projection and achievement of full immunization coverage. The performance is represented in tabular and graphical form. The tool has been approved by MoHFW for circulation to all states and development partners working in the field of immunization.
    • GIS-enabled web based Dynamic Dashboard: This is a web based dynamic dashboard application, which is enabled with the ITSU web portal to create automatic graphical GIS-based maps on different indicators and immunization surveys. This application can be utilized in online mode by the program managers and decision makers for graphical visualization of data of selected antigens.
    • Control Room for Mission Indradhanush: The Central Control Room for Mission Indradhanush has been operational in ITSU and is being manned by the staff from the PO&ME unit. The Control Room compiles, collates, and analyzes the monitoring data from national monitors deputed to the focus districts of Mission Indradhanush. It has been ensuring regular coordination with the selected districts for daily reports and feedback based on the data analysis of reports received on a daily basis. This is being compiled with other monitoring data to support the Immunization Division, Ministry of health and Family Welfare, to analyze the performance of the entire Mission.
  • Strategic Communication
    • National Launch of Mission Indradhanush on 23 March, 2015 by Minister for Health and Family Welfare Shri Jagat Prakash Nadda. Total of 500 people participated in the launch event including delegates from partner organizations and representatives from the print and digital media.
      Production of Mass and Mid- media creatives
      • 4 radio spots and 1 TV spot
      • Dissemination of creatives to all the states
      • Prototypes for banners, posters, flex-boards, pamphlets, standees were developed and shared with the states.
      Social media campaign
      • Live tweeting of the launch of the media campaign of #MissionIndrandhush
      • Release of Thunderclap Pledges to increase activities on social media. There was an increase of 727 followers on the day of the launch.
      The social media had almost 15 million impressions generated through live tweeting and reach of over 4 million accounts
      • Estimated Accounts Reached - 4,366,791
      • Estimated Impressions - 1,42,73,112
      • Total number of Conversations – 1,194
      • Total number of Users Tweeting – 624
    • More than 100 media houses attended the event and appreciated the vision of the initiative. We had representatives from 8 mainline and 36 regional publications; 10 wire services; 28 electronic, 4 trade, and 6 online media; and 12 photographers at the event.
    • Production of advocacy film on electronic Vaccine Intelligence Network (eVIN) - project at Bareilly and Shahjahanpur, Uttar Pradesh
    • Job-aids for cold chain handlers
    • Capacity building of more than 350 state level officials
    • Developed Communication Guidelines for Building Vaccine Confidence
    • Facilitators Guide for Spokespersons training of State and District Immunization Managers and State and District AEFI Committee members - how to engage with key immunization stakeholders, and media advocacy for routine immunization.
    • Designed a communication campaign on immunization for twitter handle of MoHFW, Government of India
    • Developed “Communication Action Plan- A Model Approach”
    • Revised the Vaccine Risk Communication Chapter in the National AEFI Guidelines
    • Revised the brochure on “Vaccines against the Forgotten Killers: Protecting Indian Children” in collaboration with IVAC and GHS
  • Strategic Planning and System Design
    • Comprehensive Multi-year Plan for UIP 2013-2017 (cMYP) ITSU led the development the national cMYP 2013-2017 under guidance from the Ministry of Health & Family Welfare and support from other Routine Immunization partners like WHO-NPSP and UNICEF. The plan document lays out the roadmap for strengthening RI interventions in the country with the overall goal of increasing immunization coverage and reducing inequities in coverage. It also includes a detailed monitoring and accountability tracking framework.
    • GAVI-Health System Support SecretariatThe SP&SD unit has played a pivotal role in supporting the Ministry in the development of the GAVI-Health System Strengthening grant for US$107 million. The main objective of the GAVI-HSS proposal is to strengthen health systems in the country so as to achieve quality immunization services with an optimum coverage, in line with national targets set by the Twelfth Five Year Plan (FYP)

      The SP& SD unit at ITSU hosts the GAVI-HSS secretariat, which supports the Ministry in project monitoring, reviewing of work plans and budgets and assessing the progress of all lead partners monthly and quarterly. Some of the initiatives coordinated through this secretariat are:

      • National Monitoring and Evaluation (M&E) Plan One of the stated objectives of cMYP 2013-2017 is health system strengthening for immunization, which includes the development of a robust national M&E plan. The national M&E framework, which is based on the monitoring and accountability tracking framework in the cMYP 2013-2017, is being coordinated by ITSU in collaboration with UNDP.
      • Information Management Platform: Immunization and Child Health Survey Current national level immunization and child health surveys vary in frequency, scope and detail. In order to address these gaps, a new survey called Integrated Child Health and Immunization Survey has been designed to produce selected national level immunization coverage and child health indicators. This will be a bi-annual cross sectional survey aimed at obtaining routine, actionable data to measure progress related to immunization coverage and health system determinants. This survey will also help to assess the impact of a new initiative called Mission Indradhanush launched by the MoHFW on 25 December 2014 to reach all children who are either unimmunized or partially immunized before their first birthday, in high focus districts of the country.
    • Vaccine Introduction Working Group (VIWG) Secretariat at ITSU. Following NTAGI’s recommendation to introduce four new vaccines in UIP, a need for Vaccine Introduction Working Group (VIWG) was felt by the MoHFW for development of an end-to-end plan with stakeholder engagement to introduce new approved vaccines in UIP. MoHFW has constituted a Vaccine Introduction Working Group with partner organizations in immunization, under the Chairmanship of Joint Secretary, Reproductive and Child Health for which ITSU is the convener. The objective of the working group is to review the level of overall preparedness at the national level for introduction of new vaccines and to periodically review the roadmap for introduction of new vaccines.
    • Cost of Delivering Routine Immunization Services in India - Strategic planning for immunization requires credible information about the cost to achieve the program objectives, estimate available funding, allocate funds within the program, avoid funding shortfalls and ensure sustainable financial resources at national, state and district levels. For this reason, analyzing the costing and financing of a comprehensive multi-year plan for immunization (cMYP) is a key step in the planning process.
      The study for determining the cost of delivering vaccines in the Routine Immunization Programme, aims to provide detailed cost estimates for India. Some of the specific questions that will be addressed include total cost of the program in different states and at various levels of the health system in India, the cost structure, incremental cost to the government for new vaccine introduction and other such factors. With NTAGI’s recommendation to introduce four new vaccines, this study holds even greater relevance in future.
  • Vaccine Logistics and Cold Chain Management
    • Deep Dive Study: Under the Vaccine Logistics and Cold Chain Management (VL & CCM) unit of ITSU, a Deep Dive exercise was carried out to document the current vaccine logistics management system and the bottlenecks associated with it. This assessment was carried out in UP, Bihar and Madhya Pradesh. The methodology involved visit to state, division, district and block level vaccine stores to document processes and interviews key stakeholders at all levels. The assessment outlined four key issues along with five root causes in vaccine logistics management.
      The four key issues identified in supply chain are:
      • Irregular and sometimes short supply of vaccines at regional warehouse
      • Poor distribution practices followed at regional/ divisional/district warehouses
      • High vaccine wastage at session sites
      • Issues in cold chain space and maintenance
      The five key root causes associated with it are:
      • Delay in procurement and loosely defined delivery schedule
      • Poor staffing and training of personnel involved in supply chain
      • Poor session planning and/or adherence of roster
      • Poor documentation of current stock and information sharing across levels
      • Insufficient and/or delay in release of funds
    • Feasibility Study: The Deep- Dive study was followed by an in-depth exercise of assessing the feasibility of involving the private sector in vaccine logistics management under the immunization program. ITSU commissioned a study to assess a complete chain of vaccine supply from the state up to last cold chain point and session site and the role that the private sector can play in upgrading the system. The study was conducted in Bareilly division of Uttar Pradesh and Bhagalpur division of Bihar. The primary objective of the study was to identify loose ends which can be tied up by the private sector so as to ensure quality vaccine logistics management at all levels up to the last cold chain point.
      The assessment recommended the following options for improvement under various heads:

      Three models through which the private sector can be involved in vaccine logistics management were presented to the ministry, including the cost estimates, both establishment as well as annual operating expenditure, for each model. All the models were reviewed by the ministry based on various factors like feasibility and sustainability, cost vs. benefit, impact on the existing system and its long term effects. It was then concluded that the private sector can support deployment of an IT solution for supply chain management and develop HR capacity to handle vaccine logistics and cold chain management.
    • Temperature Logger Pilot: A SMS based temperature monitoring device known as Temperature logger was designed by the Affordable Health Technologies (AHT) unit of PHFI to monitor temperature of cold chain equipment in diverse field conditions. These devices gather real time temperature of the cold chain equipment every 30 minutes and send across real time temperature data to the cloud server. The data can then be retrieved, viewed and evaluated. Any breach in the recommended temperature (e.g. 2 to 8°C for the Ice Line Refrigerators (ILRs) leads to an immediate SMS alert to the cold chain handlers. Cold chain points where a temperature breach is not corrected even after 10 or more breaches leads to escalation of the alert to higher level officials (District Immunization Officers) by SMS and in the end of day (EOD) reports.
      ITSU in collaboration with AHT piloted these Temperature Logger devices in selected cold chain points in Delhi, Haryana, Uttar Pradesh and Maharashtra. The pilot was fully rolled out in Delhi and Haryana will all cold chain officers and district immunization officers trained on the operational aspects. The SMS protocol was designed so that an instant SMS is sent to the CCH (Cold Chain Handler) on a temperature breach and corrective action could be taken in a sufficient window period to maintain vaccine potency and reduce vaccine wastage.
      Advantages
      • Real time visibility of the temperature of cold chain equipment
      • Use of information for timely response
      • Accountable and vigilant system with proper trail
      • Functional in limited resource setting
    • eVIN pilot: Based on the learnings from the Deep Dive and Feasibility study, ITSU designed a conceptual framework known as eVIN (electronic Vaccine Intelligence Network) to effectively address the gaps and challenges in Vaccine Logistics management. The conceptual framework was put to test with a field level implementation in two districts of Uttar Pradesh – Bareilly and Shahjahanpur – catering to a population of 7.4 million. The objective of implementing this pilot was to create a system which not only provides real time vaccine stock visibility at all levels of vaccine storage but also rationalizes distribution policies and ensures vaccine storage under recommended temperature.

      The eVIN system has three important attributes:

      • Processes - Standardization of existing records and reporting formats used for data on vaccine stock and distribution.
      • People - Introduction of a new cadre of managers (Vaccine and Cold Chain Managers-VCCM) for supporting the District Immunization Officer in better management of vaccines, syringes and cold chain equipments and to provide supportive supervision and regular on-site capacity building.
      • Product - A mobile based software platform for simplified inputs, intelligent analysis and rapid deployment and SIM based remote temperature monitoring devices for real-time temperature monitoring.
      Since the initiation of the eVIN system, it has maintained ~90% reporting rate and ~90% complete data reporting rate. The system has also demonstrated a reduction in stock outs, from 70-80% to <10% for different vaccines and has shortened the duration of stock out from four days to one day.
    • eVIN Scale up: The eVIN system has been reviewed and appreciated by the Government at both national and state levels and by national and international experts. This effort is being scaled up to all districts of Uttar Pradesh, Madhya Pradesh and Rajasthan by UNDP under the GAVI Health System Strengthening grant. The standardized registers and documentation process developed under this initiative have been adopted by the Government of India and are being translated and adapted for vaccine logistics management by different states.
    • eVIN Advocacy Film: A short advocacy film capturing the entire eVIN project, from its conceptualization to implementation has been developed. The film is of 10 minutes duration, demonstrating and showcasing ITSU’s pilot initiative in vaccine logistics management. The film is intended to be used during various immunization advocacy activities and across significant immunization platforms.
    • National Solar Cold Chain Assessment: ITSU was commissioned by the ministry to carry out an assessment of the installed solar vaccine refrigerators in order to review their current status, advantages, disadvantages and operational challenges. ITSU conducted a national assessment of the installed solar vaccine refrigerators in 16 states including the field survey in eight states. The study highlighted various issues related to training, dedicated HR, availability of spare parts, safety concerns etc. The study also made several recommendations which will help the ministry in designing future scale-up plans for the solar equipment.