ITSU provides technical support to the Immunization Division of the Ministry of Health and Family Welfare (MoHFW). It acts as an anchor between national and State teams to achieve the goal of improving Immunization coverage and strengthening of the public health system.
The Program Implementation (PI) unit within ITSU has gone through several rounds of rechristening, growing organically from being a “Program Team” to one assigned to ensure “Coverage and Equity” to finally be known as the “Program Implementation-PI”, since June 2017.
Core functions within Program Implementation
The PI vertical of ITSU provides techno-managerial support for scaling-up the Universal Immunization Program (UIP) and ensuring the provision of quality immunization services. The Unit works towards providing technical inputs to the Immunization Division of MoHFW and collaborates with immunization partners to help accelerate progress in achieving >90% full immunization coverage (FIC). It supports all states and UTs to address coverage, equity and health service delivery related barriers for Immunization, with focus on strengthening the urban immunization health system.
As part of its work in supporting Government of India in Health System Strengthening, ITSU performs functions, both within the domains of vaccine preparedness and capacity building of immunization personnel. Right from planning to end stage activities, it anchors national and state level implementation teams. It is responsible for formulating the immunization strategy and series of activities for the field. This includes:
- Developing guidelines, strategies and documents for new vaccines
- Providing guidance to states and Departments of Health for all stages of vaccine roll-out, from pre-assessment to launch and post roll-out
- During implementation phase, it actively monitors activities and suggests any mid-course correction, if required
In recent months, the PI team has supported the conduct of desk reviews of immunization data on Health Management Information System (HMIS), Reproductive and Child Health (RCH) Portal, WHO Concurrent Monitoring, UNICEF Communication Monitoring, AEFI, the Electronic Vaccine Intelligence Network (eVIN) and the National Cold Chain Management Information System (NCCMIS). Additionally, the Immunization Division, MoHFW has been guided on completing routine immunization (RI) reviews of states. Additionally, the techno-economic assessment of eVIN for 12 states was also completed.
Comprehensive UIP reviews have been conducted for the five high priority states of Bihar, Uttar Pradesh, Madhya Pradesh, Maharashtra and Rajasthan under guidance of the Immunization Division, MoHFW and in coordination with other Immunization partners. States have been supported with their comprehensive UIP reviews especially for developing the Immunization Coverage Improvement Plan (iCIP).
Another core function of the PI team is to manage M&E processes and systems with regard to data collection, collation and analysis of immunization data. This can be used by the government and immunization partners to inform, improve and innovate on programmatic performance. The ITSU M&E function is positioned to enhance data quality improvement and to support MoHFW to use data for decision-making and action in program coverage and AEFI surveillance.
A self-assessment checklist was developed to enable states to do a self-assessment of UIP and to support in the development of Icip based on certain measurable indicators. All stakeholders were also sensitized for regular monitoring of RI activities. The PI team leveraged its expertise to developed immunization calendars for the use of the AEFI Secretariat, also housed within ITSU. Further, developed Comprehensive Multi-Year Strategic Plans (cMYP) were developed for 2018–2022.
One of the most important functions within the PI unit hosted in ITSU is the Immunization Control Room. This provides critical information and real time data to MoHFW so that it can collate and analyze data from Mission Indradhanush (MI), other vaccination campaigns and new vaccine introduction. The team gathers relevant data from GoI portals (HMIS, RCH portal), reports from states/UTs for vaccination coverage of new vaccines, data from recent coverage evaluation surveys, concurrent monitoring data and communication monitoring data from partners and helps feed this information into Monthly Immunization Dashboards.
These Dashboards are prepared for six priority states of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh, Jharkhand and Maharashtra. These dashboards aim to improve quality and use of reported data on immunization to promote concrete programmatic actions for addressing challenges in strengthening UIP. The unit conducts data quality assessments to generate recommendations for data quality improvement and use of data for decision making and action while tracking programme reviews.
The PI unit has recently prepared monthly National Immunization dashboards (automated) and monthly immunization dashboards for six High Priority states. It has also completed the monthly Urban Immunization Dashboard for the National Urban Health Mission (NUHM) cities prior to sharing the same with States/UTs through MoHFW.
With regard to the Mission Indradhanush (MI)/ Intensified Mission Indradhanush (IMI) portal, the team manages it for data recording and reporting of MI/IMI rounds. These are conducted from time to time to reach left outs and drop outs. The team also helped facilitate national training of trainers (ToT) for states/UTs for campaigns like Mission Indradhanush (MI)/Intensified Mission Indradhanush (IMI) and introduction of other new vaccines.
Recently, the data management of immunization activities were conducted and related to MI/IMI/GSA/eGSA, campaigns like JE and MR and new vaccines like Pneumococcal Conjugate Vaccine (PCV), IPV, Rotavirus Vaccine (RVV), adult Diphtheria (Td). The IMI-Coverage Evaluation Survey (IMI-CES) was completed and its findings disseminated to states. Other immunization partners were supported in preparing Operational Guidelines and FAQs for MI/IMI and new vaccines like Td vaccine, PCV, Rotavirus vaccine (RVV) and Measles Rubella (MR) vaccine etc.
Increased urbanization is creating a pressing need for immunization strategies and guidelines specifically developed for urban populations. As part of its work in the area of urban immunization, the PI unit has provided technical assistance to states for prioritization of urban areas.
It has also formulated strategies for strengthening the urban immunization program based on pilot projects implemented in Rajkot (Gujarat) and Jabalpur (Madhya Pradesh). Strengthening urban immunization data mapping and updation for NUHM cities and generation of urban immunization dashboards is an ongoing process.
To achieve the goal of FIC, a holistic immunization package has to be considered where Adolescent immunization, Gender and equity are also covered. The PI unit has developed strategies to improve adolescent immunization for Td for 10 and 16 year olds. It has completed reviews on gender and equity in immunization in identified states.
The PI unit demonstrates innovations in vaccine safety
Several initiatives have been taken by ITSU’s PI unit including some noteworthy innovations to help mitigate the impact of the COVID-19 pandemic. Establishing the Control Room to provide technical assistance to the COVID-19 Vaccine Support Cell of MoHFW was a major innovation. The key domain areas of support within this included procurement and distribution of vaccine supplies: support on a daily basis for facilitating procurement and supply of stocks for the GoI free supply and private sector; technical support to the Co-WIN team at the MoHFW; and support to the National COVID Support Cell. As part of this support, the PI team disseminated reports on coverage on a daily basis (four times a day) with government stakeholders of Immunization Division, Press Information Bureau (PIB) and National Informatics Centre (NIC) which form the basis for routine performance analysis for all review purposes and updation of MoHFW website, press briefings, releases, tweets etc.
From time to time the unit is called upon to support the designing of strategies for vaccine introduction as per recommendations from NEGVAC including development of operational guidelines.
Ongoing support is also provided for the development of macro plans to ensure equitable access to COVID-19 immunization and to gather evidence to define the target population that needs to be vaccinated. In fact, ITSU has been supporting MoHFW in estimating target beneficiaries based on NEGVAC recommendations. Specific strategies have been updated on similar lines.
As part of training and capacity building, the PI unit has done some landscaping for newer modalities or channels of trainings. It has also prepared the training plan for the various cadres and developed these in collaboration with immunization partners.
Several national ToTs have been facilitated and trainings tracked at various level in coordination with partners.
Pilot testing of Co-WIN in the field was undertaken with ITSU conducting a dry run spread over two rounds (during December 2020) in select districts of three states. Rround I included selected districts of Rajasthan and Telangana and Round II covered select districts of Uttar Pradesh. Additionally, the team assisted in the regular review and analysis of coverage data with ITSU’s involvement in all review meetings conducted to review the coverage of vaccination in the states. The reviews are also supported through customized data analysis for various vaccines/age groups/categories etc.
Data Management and Analysis is at the core of the work being done by the PI unit of ITSU. Vaccine recording and reporting formats and protocols were developed for collating and compiling COVID-19 vaccination coverage. The unit also serve as a data custodian, hosting the control room for COVID-19 vaccination coverage data. Weekly coordination with state immunization cells helped validate all incoming data with each state and UT being assigned a Nodal Officer. Regular follow-up was done with the respective state for COVID-19 vaccination coverage and to ensure quality of data.
ITSU undertook extensive documentation of RI experiences in India during COVID-19 with all 37 states/UTs resuming routine immunization services. This was done in the midst of the pandemic while navigating extraordinary challenges and constraints. During this period, a blueprint/SoP was developed for resumption of RI services. Support was also provided to the GAVI secretariat. Another unique effort was a Situational Analysis that was undertaken with respect to the COVID-19 vaccination roll-out in the North-East States of the country.