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Routine
Immunization in India
Delivering
effective and safe vaccines through an efficient delivery system is one of
the most cost effective public health interventions. Immunization
programmes aim to reduce mortality and morbidity due to vaccine preventable
diseases (VPDs).
Following
the successful global eradication of smallpox in 1975 through effective
vaccination programmes and strengthened surveillance, the Expanded Programme
on Immunization (EPI) was launched in India in 1978 to control other
VPDs. Initially, six diseases were selected: diphtheria, pertussis, tetanus,
poliomyelitis, typhoid and childhood tuberculosis.
The aim was to cover 80% of all infants. Subsequently, the programme
was universalized and renamed as Universal Immunization Programme (UIP) in
1985. Measles vaccine was included in the programme and typhoid vaccine was
discontinued. The UIP was introduced in a phased manner from 1985 to
cover all districts in the country by 1990, targeting all infants with the
primary immunization schedule and all pregnant women with Tetanus Toxoid
immunization (see schedule below).
The UIP
envisages achieving and sustaining universal immunization coverage in infants
with three doses of DPT and OPV and one dose each of measles vaccine and BCG,
and, in pregnant women, with two primary doses or one booster dose of TT. The
UIP also requires a reliable cold chain system for storing and transporting
vaccines, and
attaining self-sufficiency in the production of all required vaccines.
In 1992,
the UIP became a part of the Child Survival and Safe Motherhood Programme
(CSSM), and in 1997, it became an important component of the Reproductive and
Child Health Programme (RCH). The Cold-chain system was strengthened and
training programmes were launched extensively throughout the country.
Intensified polio eradication activities were started in 1995-96 under the
Polio Eradication programme, beginning with National Immunization Days (NIDs)
and active surveillance for acute flaccid paralysis (AFP). The Polio
Eradication Programme was
set up with the assistance of the National Polio Surveillance Project.
Routine
Immunization Monitoring Systems (RIMS)
India’s
Immunization Program is one of the largest in the world in terms of
quantities of vaccines used, numbers of beneficiaries, and the numbers of
immunization sessions organized, the geographical spread and diversity of
areas covered. Under the immunization program, six vaccines are used to
protect children and pregnant mothers against Tuberculosis, Diphtheria,
Pertussis, Polio, Measles and Tetanus. It is also proposed to include
Hepatitis B vaccine in UIP in phased manner.
For a complex and extensive programme like immunization an
efficient management information system is necessary to get timely reports at
State and National level. It is also equally important to provide feedback to
the States and Districts for undertaking management interventions. At present
the programme has to depend upon routine reports received as part of the
reporting under the Reproductive and Child Health (RCH) programme. This
system provides feedback on coverage data only. Important information
regarding the vaccines and cold chain logistics which are high cost areas
does not get captured in the present system and a lot of effort and time is
required in getting the critical data on these issues for planning and
forecasting requirements and monitoring the status of vaccine supply and
availability. To address these issues now and to collect data from
District/PHC level a computer based monitoring system (RIMS software) is
under development for implementation throughout the country. A prototype of
this software to assess practical applicability in the field has been
developed.
RIMS SOFTWARE
ROUTINE IMMUNIZATION MONITORING SYSTEM (RIMS) is a
computerized implementation, to enter data, generate reports and perform
queries. The system is presently developed in Microsoft ACCESS as a
standalone CD version. It is user friendly and no special training is
required to operate the system. Online system is under development in a
different platform using other database and programming tools.
The data are collected at district level from PHCs
/Reporting Units in the standard pre-designed UIP format and entered on five
broad categories namely (A) Immunization & Vitamin A, (B) Vaccine Supply,
(C) VPD Surveillance, (D) Status of Cold Chain Equipment and (E) AEFI
(Adverse Event following immunization).
The system is capable of performing data analyses and
generating useful reports for the use of UPI managers at all levels i.e.
district, state and national. RIMS will be very useful tool to monitor UIP
program as reports from all the 600 districts will be collected in a short
period and then analyzed automatically by the software.
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