Routine Immunization Session in Salem District, Tamil Nadu State, India

This article was written based on my duty travel to Tamil Nadu State, India on 15 February 2017

In addition to Measles Rubella Supplementary Immunization Activities (MR SIA) monitoring, I also visited routine immunization session in a hard to reach area in Yercaud, a hill station in Salem District, Tamil Nadu which is located 1,515 m above sea level. We visited Nagalur general public health center and RI session. A high quality micro plan on routine immunization was developed at block and session site. The micro plans were very detail and comprehensive. The Nagalur GPHC also has obgyn ward which provided BCG and Hep-0 vaccination to the new born.

State government of Tamil Nadu launched Dr. Muthulakshmi Reddy Maternity Benefit Scheme which provides conditional cash assistance to the pregnant woman belong to Below Poverty Line (BPL). The cash assistance will be given in three installments (Rs.4000) on conditional release and restricted for first two deliveries only. This cash assistance will be given to every pregnant woman

1. who avails all required Antenatal services during pregnancy in concerned PHC
2. Mother who delivers in the Government institutions(PHC, GH,Govt. TEACHING INSTITUTIONS)
3. Completion of immunization for the child up to 3rd dose of DPT/PENTAVALENT/ HEPATITIS-B/POLIO.

Additional to this Amma Baby care kit it worth Rs. 1,500 with 16 items including a dress, mosquito net, soap, shampoo, hand sanitizer, baby rattle, nail clipper among others will be provided to children.

From Central Government of India through Janani Suraksha Yojana scheme Rs 700 will be provided to all institutional delivery.

Cold Chain Management

Tamil Nadu has an innovation to make colored code boxes to store the vaccine in the iced line refrigerator (ILR) as seen below:

The temperature in the ILR and freezer in PHC was monitored twice daily event during holidays. Double check temperature monitoring is applied where the form should be signed by pharmacist/ vaccine handler and medical officer. Double check temperature monitoring signed.

Open vial policy is also applied nation-wide. This policy is to reduce vaccine wastage.

Reporting and recording

The immunization will be recorded in the child’s immunization card. The card has two parts to record the immunization. Main card will be kept by mother and the counterfoil will be kept by village health nurse (AVN)/anganwadi worker (AWW). The AVN will then report monthly coverage to the block.

There is defaulter tracking system in place. Tracking system bag is used to track the children who missed the vaccination schedule.

In addition, one day before the session, auto-generated due list can be generated using the Pregnancy Infant Cohort Monitoring and Evaluation (PICME) software.

Routine Immunization (RI) session

One RI session will consist of a vaccinator and AWW.  AEFI management kit will also be available at the session site. During RI session, supplementary food also given to the children

Fund Allotted for RI

• HSC Level Micro plan – Rs.100 Per Sub centre
• Block Level Micro plan – Rs. 1000 Per Block.
• Cold Chain Maintenance – Rs. 500 Per PHC / Year.
• RI Block Level Quarterly Review Meetings – Rs.2000 / Meeting.
• Mobilization of Children through ASHAs – Rs.75 Per ASHA.
• Alternate Vaccine Delivery – Rs.75 Per Session to VHNs for 52 Weeks.
• HRA – Rs. 150 Per Session to VHNs for 52 Weeks.
• District Level Quarterly RI Review Meeting – Rs. 25 Per Participants
• RI – ASHA Training – Rs. 50 Per ASHA (Honorarium).
• District Level Supervision – Rs. 13,000 Per Month.