In these situations, beneficiaries should never be denied for vaccination. If MCP card is lost, then re-issue a new card after filling the old entries from their facility register. Please explain to parents/caregivers about importance of keeping MCP card safe for ensuring timely and complete vaccination. In case, parents have forgotten to bring the card, then refer to the records and give the next vaccine due to the beneficiary.

In such a situation, administer all available and scheduled vaccines to the child and advice to return in the next immunization session. Put the name of the child in “missed-dose tracking” and ensure that the child receives the scheduled vaccines in the next session. However, the parents/caretakers can also take their children to higher level health facility for getting the scheduled vaccines.

All these three cadres of health functionaries share responsibility to: generate awareness regarding benefits of immunization, remove false beliefs in the community concerning immunization and vaccines, and ensure that timely vaccination is given to all beneficiaries.

ASHA workers play a specific role by preparing due list of beneficiaries to be immunized during a session and updating it on a monthly basis, mobilizing them to come to the session site where immunization services are being provided, and support health worker in organizing the session. She maintains a record of all immunization beneficiaries and updates it by adding vaccines administered to individual beneficiaries on the session day.

The Anganwadi worker also plays an important role by mobilizing beneficiaries, supporting health workers in organizing sessions, and communicating important messages to parents and caretakers. Immunization of adolescent girls and boys is also a responsibility of Anganwadi workers. Health worker administers vaccines, maintains cold chain, ensures injection safety, updates records, and prepares reports for submission to higher levels. They are also responsible for providing support to ASHA, Anganwadi workers, and other frontline functionaries in fulfilling their responsibilities.

As per the national guidelines, the four key messages that need to be delivered to parents and caregivers are:

• What vaccine was given, and what disease it prevents
• When and where to come for the next visit
• What minor adverse event could occur, and how to deal with them
• To keep the immunization card safe and to bring along for the next visit

After vaccination, ensure that parents/ caregivers wait for at least 30 minutes at the session site. Parents should be advised to immediately inform ASHA/ AWW/ ANM/MO of nearest health facility, in case of any problem faced by the child or mother even after 30 minutes.

RI microplanning is the basis for the delivery of UIP services to a community. The availability of updated and complete micro-plans at a planning unit (urban/rural) demonstrates preparedness of a unit and directly affects the quality of services provided. Micro-plans are prepared for a one year period but must be reviewed every quarter. According to national guidelines for immunization programme, all government health facilities should prepare monthly plans for immunization service delivery to each and every outreach area (i.e. villages, slums, other habitations, etc.) situated within their catchment zones. These plans should be realistic, based on number of beneficiaries identified from house to house survey, developed jointly by health workers and frontline functionaries, and should be updated on quarterly basis. ASHA worker is given incentive for conducting a house to house survey.

These plans for immunization service delivery are known as micro-plans as they include specific details like – weekday and exact location of session, estimated number of beneficiaries, estimate of vaccines and syringe requirement for a session, names of vaccinator and other service providers (ASHA and Anganwadi worker), timing of session (from – to), name of person responsible for vaccine delivery, name of supervisor, etc.

These are important activities undertaken to improve immunization coverage. These activities provide details of all beneficiaries (children and pregnant women) in a specific area, ensuring that no beneficiary is missed out. This further helps in developing complete due lists for session days, and correct estimates of injection load, outreach sessions required, and requirement per session of different vaccines and syringes.

Vaccines are life-saving and involve lot of financial and human resources in purchase, distribution and administration. Therefore, monitoring of vaccine consumption and wastage, and matching it with the immunization coverage will help to ensure their optimum utilization.