MEMBERS' REFERENCE SERVICE LARRDIS LOK SABHA SECRETARIAT, NEW DELHI REFERENCE NOTE No.47/RN/Ref./November/2016 1 For the use of Members of Parliament NOT FOR PUBLICATION MISSION INDRADHANUSH Prepared by Smt. Sunanda Das Mohanty, Additional Director (23035036) and Shri Rajkumar Patton, Junior Library Assistant of Lok Sabha Secretariat under the supervision of Smt. Kalpana Sharma, Joint Secretary. The reference material is for personal use of the Members in the discharge of their Parliamentary duties, and is not for publication. This Service is not to be quoted as the source of information as it is based on the sources indicated at the end/in the text. This Service does not accept any responsibility for the accuracy or veracity of the information or views contained in the note/collection. contained in the note/collection.MISSION INDRADHANUSH INTRODUCTION The objective of Mission Indradhanush is to ensure high coverage of children and pregnant women with all available vaccines throughout the country, with emphasis on the identified 201 high focus districts. It was launched in December 2014 as a special drive to vaccinate all unvaccinated and partially vaccinated children under Universal Immunization Programme (UIP).1 The mission focuses on interventions to improve full immunization coverage in India from 65% in 2014 to at least 90% children in the next five years to be done through special catch-up drives. OBJECTIVES With the launch of Mission Indradhanush, the Government aims at Generating high demand for immunization services by addressing communication challenges; Enhancing political, administrative and financial commitment through advocacy with key stakeholders; and Ensuring that the partially immunized and unimmunized children are fully immunized as per national immunization schedule. 1 Universal Immunisation Programme (U.I.P.) is one of the largest in the world in terms of quantities of vaccine used, the number of beneficiaries, the number of Immunisation session organised, the geographical spread and diversity of areas covered. Universal Immunisation Programme (UIP) was launched in 1985 in a phased manner. The measles vaccine was added in 1985 and in 1990 Vit A supplementation was added to the program. 2 AREAS UNDER FOCUS Under Mission Indradhanush, in Phase I2, the Government had identified 201 high focus districts across the country that have nearly 50% of all unvaccinated or partially vaccinated children. Four States of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh account for 82 of the 201 high focus districts and nearly 25% of the unvaccinated or partially vaccinated children of India. In Phase II3 of Mission Indradhanush 352 districts have been selected including 279 mid priority districts, 33 from the North East States and 40 districts which commenced from 7 October 2015 for a week. In Phase-III of Mission Indradhanush 216 select districts in 27 States/Uts conducted for seven days in each between April and July 20164. Key areas reached through Mission Indradhanush: Areas with vacant sub-centers: No Auxiliary Nurse Midwife (ANM) posted for more than three months. Villages/areas with three or more consecutive missed Routine Immunization (RI) sessions: ANMs on long leave or other similar reasons. High Risk Areas (HRAs)5 identified by the polio eradication programme. Other migrant settlements (fisherman villages, riverine areas with shifting populations) 2 A list of 201 high focus districts under Phase I has been provided in Annexure I. 3 Coverage Report (Phase-1 & 2) shows in Annexure II 4 The States/UTs-wise details of the number of districts covered are given in Annexure III 5 These include populations living in areas such as Urban slums with migration, Nomadic sites, Brick kilns Construction sites. 3 Underserved and hard to reach populations (forested and tribal populations, hilly areas etc.). Areas with low RI coverage, identified through measles outbreaks, cases of diphtheria and neonatal tetanus in last two years. Small villages, hamlets, dhanis, purbas, basas (field huts), etc., clubbed with another village for RI sessions and not having independent RI sessions. HIGHLIGHTS Mission Indradhanush is a nationwide drive, with focus on 201 identified high focus districts on Phase I 352 districts have been selected including 279 mid priority districts, 33 from the North East States and 40 districts in the Phase II of Mission Indradhanush done on 7 October 2015. 216 select districts in 27 States/UTs conducted for seven days in each between April and July 2016 carried out in Phase-III. STRATEGY The broad strategy6, based on evidence and best practices, includes four basic elements- Meticulous planning of campaigns/sessions at all levels: Ensure revision of micro plans in all blocks and urban areas in each district to ensure availability of sufficient vaccinators and all vaccines during routine immunization sessions. Develop special plans to reach the unreached children in more than 6 The Ministry of Health and Family Welfare is working in collaboration with other Ministries, ongoing programmes and international partners to promote a coordinated and synergistic approach to improve routine immunization coverage in the country. 4 400,000 high risk settlements such as urban slums, construction sites, brick kilns, nomadic sites and hard-to-reach areas. Effective communication and social mobilization efforts: Generate awareness and demand for immunization services through need-based communication strategies and social mobilization activities to enhance participation of the community in the routine immunization programme through mass media, mid media, interpersonal communication (IPC), school and youth networks and corporates. Intensive training of the health officials and frontline workers: Build the capacity of health officials and workers in routine immunization activities for quality immunization services. Establish accountability framework through task forces: Enhance involvement and accountability/ownership of the district administrative and health machinery by strengthening the district task forces for immunization in all districts of India and ensuring the use of concurrent session monitoring data to plug the gaps in implementation on a real time basis. ACHIEVEMENT OF GOALS PHASE I The first round of the first phase started from 7 April 2015-World health Dayin 201 high focus districts in 28 States and carried for more than a week. This was followed by three rounds of more than a week in the months of April, May, June and July 2015, starting from 7th of each month. The 201 high focus districts account for nearly 50% of all unvaccinated or partially vaccinated children in the 5 country. Of these, 82 districts account for nearly 25% of all unvaccinated or partially vaccinated children of the country. Within the districts, the Mission focused on 4, 00,000 high risk settlements identified as pockets with low coverage due to geographic, demographic, ethnic and other operational challenges. PHASE II In the second phase of Mission Indradhanush, 352 districts have been selected including 279 mid priority districts, 33 from the North East States and 40 districts from phase one where large number of missed out children were detected. The second phase commenced from 7 October 2015 for a week and followed by weeklong intensified immunization drives for three consecutive months, starting from 7 November and 7 December 2015 and 7 January 2016. PHASE III Phase 3 of Mission Indradhanush was carried out in 216 select districts in 27 States/UTs. Four intensified immunization Rounds were conducted for seven days in each between April and July 2016, in these districts. These 216 districts have been identified on the basis of estimates where full immunization coverage is less than 60 per cent and have high dropout rates. ACHIEVEMENTS UNDER MISSION INDRADHANUSH Till June 2016, the Mission has covered 195.5 lakh children and 51.1 lakh pregnant women from various States/UTs. The Mission has covered 497 districts across 35 States/UTs. 6 CURRENT STATUS Mission Indradhanush aims to increase full immunization coverage in India to atleast 90% children by 2020. Till June 2016, the Mission has covered 195.5 lakh children and 51.1 lakh pregnant women. It has covered 497 districts across 35 States/UTs. The States/UTs-wise details of the number of districts covered are given in Annexure III. As part of the Adverse Event Following Immunization (AEFI) surveillance and monitoring system, the Ministry of Health and Family Welfare constantly monitors the programme. SOURCES CONSULTED 1. Mission Indradhanush : Aiming to Expand Full Immunization Coverage to more than 90%, PIB dated 23.10.2015 2. Union Health Minister launches Phase 2 of Mission Indradhanush in 352 Districts targeting Full Immunization, PIB dated 05.10.2015 3. Shri J P Nadda announces start of 3rd Phase of Mission Indradhanush from 7th April in 217 select districts in 27 States/UTs, PIB dated 04.04.2016 4. Mission Indradhanush, Lok Sabha (Starred Question No. 92) dated 22.07.2016 5. Achieving a New Milestone towards Expanding Full Immunization Coverage in the Country to reduce Child Mortality, PIB dated 26.03.2016 6. Achievement of Goals under Mission Indradhanush, Rajya Sabha (Unstarred Question No. 543) dated: 28.04.2015 Annexure I List of 201 High Focus Districts S No State S No District S No District 1 East Godavari 2 Guntur 1 Andhra Pradesh 3 Krishna 4 Kurnool 5 Visakhapatnam 1 Changlong 2 East Kameng 2 Arunachal Pradesh 3 East Siang 4 Lohit 5 Upper Siang 1