Chapter-1 District Reporting System Reporting of each health facility is to be submitted in DPHO by 7th of the following month. Each report should be complete, timely and consistent. The following Fig. shows the reporting status of different health facilities from FY 2070/71 to 2072/73. Fig.1 Reporting Status of different Health Facilities: 120 100 100 100 100 100 100 100 100 100 100 97 96 95 95 100 94 92 91 91 90 89 88 80 60 60 60 40 20 0 0 District Hospital PHCC Health Post PHC/ORC EPI Clinic FCHV Non Public Clinic HF 2070/71 2071/72 2072/73 Reporting status of District, PHCC, and HP is 100 % for all F/Y and the status of PHC/ORC and EPI clinic are like same as previous FY. The reporting status of Non Public Health facility is in increasing in trend and there is also problem of having complete report on time in regular basis. The reporting status of Bheri zonal hospital is 90% in this FY, it may need to be coordinated from regional and central level for regular reporting in newly revised HMIS formate. Table No: 1 Average Numbers of People Served by Health Facilities per day. FY PHCC HP PHC/ORC EPI FCHV 2070/71 47 34 29 24 38 2071/72 45 29 32 29 47 2072/73 36 21 28 32 40 Average number of people served by PHCC, HP, PHC/ORC and FCHV are in decreasing trend due to delay supply of HMIS tools which caused improper recording of service provided by Health faclity. In the same way this is due to improper management of health staffs. There are serious issues on management of inchargeship and work division within the staffs. Annual Report 2072/73 DPHO Banke Page 1 Chapter-2 National Immunization Programme 1. Background: The National Immunization Programme (NIP) is a high priority programme (P1) of Government of Nepal. Immunization is considered as one of the most cost-effective health interventions. NIP has helped in reducing the burden of vaccine preventable diseases (VPDs) and child mortality and has contributed in achieving the Millennium Development Goal (MDG4) on child mortality reduction. 2. GUIDING DOCUMENTS OF NATIONAL IMMUNIZATION PROGRAM 2.1.Nepal Health Sector Support Program- II (NHSP IP II): NHSP-2 focuses on increasing access and utilisation of essential health care services, especially to reduce disparities between the wealthier and the poor, vulnerable and marginalised populations. It has given high priority for immunization program. 2.2.Comprehensive Multi Years Plan of Action (2011- 2016) The comprehensive multi-year plan (cMYP) is a five years plan (2011-16) of national immunization program which includes the goal, objectives, strategies and activities are reflected with their time frame of implementation by the incurring costs of each activity. Each year review of cMYP is done and revision made so that the objectives mentioned could be met. The cMYP has been aligned with various policy documents on national immunization programs, the Millennium Development Goals (MDGs), Global Immunization Vision and Strategy (GIVS) and World Health Assembly (WHAs) resolutions and lastly vaccine action plan. Goal, Objectives and milestones of cMYP 2011-2016 are as follows: 2.2.1. GOAL: To reduce child mortality, morbidity and disability associated with vaccine preventable diseases. 2.2.2. Objectives and strategies Objective 1: Achieve and maintain at least 90% vaccination coverage for all antigens at national and district level by 2016 Key Strategies: • Increase access and utilization to vaccination by implementing RED strategies in every district • Enhance human resources capacity for immunization management • Strengthen immunization monitoring system at all levels • Strengthen communication, social mobilization, and advocacy activities • Strengthen immunization services in the municipalities Objective 2: Ensure access to vaccines of assured quality and with appropriate waste management Key strategies: • Strengthen the vaccine management system at all levels Objective 3: Achieve and maintain polio free status Annual Report 2072/73 DPHO Banke Page 2 Key strategies: • Achieve and maintain high immunity levels against Polio by strengthening routine immunization and conducting high quality national polio immunization campaigns. • Respond adequately and timely to outbreak of poliomyelitis with appropriate vaccine • Achieve and maintain certification standard AFP surveillance Objective 4: Maintain maternal and neonatal tetanus elimination status Key strategies: • Achieve and maintain at least >80% TT2+ coverage for pregnant women in every districts • Conduct Td follow up campaigns in high risk districts • Expand school based immunization program • Continue surveillance of NT Objective 5: Initiate measles elimination Key strategies: • Achieve and sustain high population immunity to reduce measles incidence to elimination level • Investigate all suspected measles like outbreaks with program response • Use platform of measles elimination for Rubella / CRS control • Continue case-based measles surveillance Objective 6: Accelerate control of vaccine-preventable diseases through introduction of new and underused vaccines Key strategies: • Introduction of new and under-used vaccines (rubella, pneumococcal, typhoid, rota) based on disease burden and financial sustainability Objective 7: Strengthen and expand VPD surveillance Key strategies: • Expand VPD surveillance to include vaccine preventable diseases of public health concern. • Strengthen and expand laboratory support for surveillance. Objective 8: Continue to expand immunization beyond infancy Key strategies: • Consider for booster dose of currently used antigen based on evidence and protection of adult from potential VPDs. 3. TARGET POPULATION 3.1. Under 1 years of age for BCG, DPT-HepB-Hib, OPV, and Measles/ Rubella vaccine. 3.2. 12-23 months children for JE vaccine. 3.3. Pregnant women for Tetanus Toxoid containing (Td) vaccine. 4. NATIONAL IMMUNIZATION SCHEDULE. TABLE 2: Immunization Schedule Type of Vaccine Number of Doses Recommended Age BCG 1 At birth or on first contact with health institution OPV 3 6, 10, and 14 weeks of age IPV 1 14 weeks of age Annual Report 2072/73 DPHO Banke Page 3 DPT - Hep B-Hib 3 6, 10, and 14 weeks of age PCV 3 6,10 weeks and 9 months of age Measles- Rubella 2 9 and 15months of age Td 2 Pregnant women (2 doses of Td) JE 1 12-23 months of age 5. Logical tools for measuring major indicators of EPI program 푵풖풎풃풆풓 풐풇 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅 1. Coverage percentage of antigen (BCG, DPT3, Measles and JE) = 푿 ퟏퟎퟎ 푻풂풓품풆풕 풑풐풑풖풍풂풕풊풐풏 풐풇 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅 풏풖풎풃풆풓 풐풇 푫푷푻ퟏ 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅−풏풖풎풃풆풓 풐풇 푫푷푻ퟑ 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅 2. Dropout rate of DPT1 Vs. DPT3= 푿ퟏퟎퟎ 풏풖풎풃풆풓 풐풇 푫푷푻ퟏ 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅 풏풖풎풃풆풓 풐풇 푩푪푮 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅−풏풖풎풃풆풓 풐풇 푴풆풂풔풍풆풔 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅 3. Dropout rate of BCG Vs. Measles = 푿ퟏퟎퟎ 풏풖풎풃풆풓 풐풇 푩푪푮 풊풎풎풖풏풊풛풆풅 풄풉풊풍풅 푵풖풎풃풆풓 풐풇푻푻ퟐ 풂풏풅 푻푻ퟐ+ 풊풎풎풖풏풊풛풆풅 풘풐풎풆풏 4. Coverage percentage of TT2 &TT2+ = 푿 ퟏퟎퟎ 푬풙풑풆풄풕풆풅 풑풓풆품풏풂풏풂풄풊풆풔 푵풖풎풃풆풓 풐풇 풗풂풄풄풊풏풆 풅풐풔풆풔 풆풙풑풆풏풅풊풕풖풓풆−푵풖풎풃풆풓 풐풇 풗풂풄풄풊풏풆풕풆풅 풄풉풊풍풅 풐풓 풘풐풎풆풏 5. Vaccine wastage rate = 푿 ퟏퟎퟎ 푵풖풎풃풆풓 풐풇 풗풂풄풄풊풏풆 풅풐풔풆풔 풆풙풑풆풏풅풊풕풖풓풆 6. Analysis of Service Statistics: Fig.2. DistrictCoverage of EPI Program FY 2069/70 to 2071/72: 120 2070/71 2071/72 2072/73 100 94 98 97 100 89 89 89 83 87 79 77 76 80 73 71 65 60 40 20 0 BCG DPT3/Polio3 Measles JE TT2 & TT2+ The above figure shows that all antigen coverage are decreased as compare to previous FY due to irregular antigen suply and impropor supervision and monitoring of EPI clinic operation and also incompatibility of target population. Table No. 3: Coverage of BCG, DPT III/Hep B III/Hib and Measles as HF wise: BCG DPT III/Hep B III/Hib Measles S.N. VDC/Municipality 2070/71 2071/72 2072/73 2070/71 2071/72 2072/73 2070/71 2071/72 2072/73 1 Bageswari 79 96 83 102 125 116 85 116 100 2 Belahari 117 144 132 108 151 127 107 151 133 3 Indarpur 83 96 67 79 104 67 75 77 68 4 Khajurakhurda 94 100 96 98 111 94 99 105 91 5 Radhapur 57 60 64 81 84 76 77 65 77 6 Banakatawa 84 81 77 81 91 77 81 89 70 7 Chisapani 83 67 61 83 74 70 76 74 76 8 Naubasta 78 95 68 83 101 74 87 96 70 9 Rajhena 47 169 182 50 130 116 47 139 113 10 Titihiriya 61 79 60 61 89 72 54 80 77 11 Kathkuiya 111 136 145 103 117 110 98 116 113 12 Laxmanpur 110 113 144 90 55 117 77 45 85 Annual Report 2072/73 DPHO Banke Page 4 BCG DPT III/Hep B III/Hib Measles S.N. VDC/Municipality 2070/71 2071/72 2072/73 2070/71 2071/72 2072/73 2070/71 2071/72 2072/73 13 Gangapur 94 103 106 102 97 97 88 98 93 14 Matahiya 106 109 91 84 91 78 73 83 68 15 Belbhar 78 74 69 79 76 77 85 67 51 16 Hirminiya 105 83 87 103 94 80 99 92 89 17 Jaispur 106 79 83 94 77 65 99 85 46 18 Paraspur 70 100 66 77 92 69 61 89 63 19 Piparhawa 83 85 82 85 76 59 85 79 61 20 Saigaun 106 99 99 113 103 99 109 105 85 21 Kachanapur 95 84 66 53 77 57 51 83 65 22 Khaskusma 85 74 72 91 86 79 80 82 61 23 Mahadevpuri 86 78 78 82 89 92 79 98 89 24 Kalaphata 90 102 80 74 72 65 56 55 38 25 Narainapur 144 146 148 123 174 139 120 143 142 26 Basudevapur 75 88 75 83 81 78 70 85 80 27 Kamdi 98 101 69 82 97 80 79 95 77 28 Khaskarkado 64 90 75 56 93 86 54 92 65 29 Nepalgung 16 188 190 16 118 90 14 85 80 30 Puraini 82 60 74 69 60 51 65 53 42 31 Bejapur 64 92 67 60 85 69 60 80 75 32 Binauna 70 87 78 64 91 82 63 80 80 33 Phattepur 81 86 84 69 88 71 62 76 63 34 Ganapur 92 125 120 101 114 98 111 78 106 35 Kohalpur 48 80 62 53 70 64 50 68 58 36 Manikapur 56 87 66 63 81 74 57 68 74 37 Shamsergunj 93 92 74 93 110 74 88 107 73 38 Raniyapur 87 98 88 73 100 87 89 100 87 39 Sitapur 78 91 67 87 106 85 88 94 89 40 Sonpur 107 101 86 113 92 87 121 75 99 41 Udharapur 99 91 79 64 93 69 53 75 57 42 Banakatti 97 81 79 87 75 62 77 63 61 43 Betahani 84 107 113 84 110 122 48 97 76 44 Bhawaniyapur 101 88 88 92 102 70 96 89 77 45 Holiya 104 72 89 103 77 86 83 94 79 46 Puraina 126 123 97 118 150 96 109 143 81 47 Udayapur 98 114 122 94 123 108 94 118 115 District Total 94 106 98 79 97 83 73 89 77 Table No.4: Coverage of JE, TT2 /TT2+ and dropout rate of DPT1 vs DPT3: JE TT2 & TT2+ Dropout Rate DPT1 Vs DPT3 S.N.