INTEGRATED CHILD HEALTH AND IMMUNIZATION SURVEY (INCHIS) Report - Rounds 1 & 2 July 2016 Immunization Technical Support Unit, Ministry of Health and Family Welfare, Government of India i ii iii iv v vi vii viii Table of Contents List of Tables .................................................................................................................................................... v List of Figures .................................................................................................................................................. ix Acknowledgements .................................................................................................................................... xi Abbreviations .................................................................................................................................................. xiii Executive Summary ..................................................................................................................................... 1 1 Introduction ................................................................................................................................................. 9 1.1 Background ........................................................................................................................................... 9 1.2 Objectives of this Report ................................................................................................................ 12 2 Survey Design and Methodology ............................................................................................. 15 2.1 Selection of States ............................................................................................................................. 15 2.2 Sampling Design ............................................................................................................................... 17 2.3 Sample Size .......................................................................................................................................... 21 2.4 Questionnaires .................................................................................................................................... 23 2.5 Survey Implementation ................................................................................................................. 24 2.5.1 Houselisting ................................................................................................................................ 24 2.5.2 Recruitment, Training, Fieldwork .................................................................................... 25 2.6 Data Processing .................................................................................................................................. 27 2.7 Quality Assurance Mechanism ................................................................................................... 27 2.8 Survey Weights .................................................................................................................................. 28 2.8.1 Components of Survey Weights ...................................................................................... 28 2.8.2 Adjustment of Oversampling of MI Districts ............................................................ 29 2.8.3 Two Sets of Survey Weights .............................................................................................. 29 2.8.4 Weight Trimming .................................................................................................................. 30 3 Household Population and Housing Characteristics ............................................................. 33 3.1 Demographic Composition of Household Population ..................................................... 33 3.1.1 Age and Sex Distribution ..................................................................................................... 33 3.1.2 Marital Status ........................................................................................................................... 35 3.2 Household Composition ................................................................................................................ 37 3.2.1 Household Size ........................................................................................................................ 37 3.2.2 Religion ...................................................................................................................................... 38 3.2.3 Caste ............................................................................................................................................ 38 i List of Tables .................................................................................................................................................... v 3.3 Household Characteristics and Assets ................................................................................... 39 3.4 Wealth Index ....................................................................................................................................... 42 4 Immunization Coverage ................................................................................................................ 49 4.1 Need for Evaluation of Universal Immunization Program ............................................... 49 4.2 National and State-level Coverage Estimates from INCHIS ........................................... 49 4.2.1 Source of Immunization Related Information ........................................................... 50 4.2.2 Method to Calculate Coverage Rates .............................................................................. 50 4.2.3 Notations and Definitions .................................................................................................... 51 4.2.4 Availability of Immunization Card ................................................................................... 52 4.2.5 Immunization Coverage Rates ........................................................................................... 54 4.3 Mothers perception on Partial/No Immunization ................................................................ 59 4.4 Drop-out Rates ...................................................................................................................................... 60 4.5 Determinants of Immunization Coverage ............................................................................... 61 4.6 Impact of Mission Indradhanush ................................................................................................. 64 4.6.1 National-Level Comparison of Coverage Rates between MI and Non-MI 65 districts ..................................................................................................................................................... 4.6.2 State-Level Comparison of Coverage Rates ................................................................. 68 4.7 Sensitivity Analysis of Vaccination Coverage Rates ........................................................... 70 5 Sub-Centre: Functioning and Quality of Immunization Services .................................. 75 5.1 Information Collected from Sub-Centres in INCHIS ........................................................... 75 5.2 Sub-centre Catchment Area and Population Coverage .................................................. 76 5.3 Human Resources .............................................................................................................................. 77 5.4 Physical Infrastructure .................................................................................................................... 79 5.5 Availability of Equipment and Medicines .............................................................................. 81 5.6 Immunization and Other Related Services ........................................................................... 83 5.7 Planning, Monitoring and Supervision Activities at the Sub-Centre ........................ 84 5.8 Immunization Waste Disposal .................................................................................................... 86 5.9 Vaccine Logistics at the Sub-Centre ......................................................................................... 87 5.10 Knowledge and Practices of ANM ........................................................................................... 88 5.11 ASHA: A Link between Health System and Community ............................................... 89 6 Planning Units ................................................................................................................................. 97 6.1 Type of Health Facility Functioning as Planning Unit ...................................................... 97 6.2 Coverage Area and Workload of Planning Units ................................................................ 97 6.3 Human Resources at Planning Units ....................................................................................... 100 6.4 Training Status of Health Staff ..................................................................................................... 101 ii List of Tables .................................................................................................................................................... v 6.5 Planning Unit Infrastructure ....................................................................................................... 102