Emergency Preparedness and Response Planning risk analysis

Emergency Preparedness and Response Planning – risk analysis, actions taken in HR areas & preparedness status for mop ups : West Bengal 24 th Meeting of India Expert Advisory Group on Polio New Delhi 15 -16 March 2012 Dr Rashmi Kamal, IAS Addl State Mission Director, NRHM & Jt Secy to Govt of West Bengal

Outline of the presentation • Risk assessment • Sustaining high population immunity in HRAs – SIAs – Routine Immunization • Status of AFP Surveillance • Preparedness for responding to importations

Risk assessment

Risk assessment in West Bengal Location of wild polio cases (2002 to 2011) WPV cases HR districts

Sub district risk assessment (based on past epidemiology & performance) Howrah 9 districts 36 blocks/ urban areas HR Gram Panchayats/ wards identified in each district

Identification of High Risk Areas, WB Migrant sites = 10 Migrant site ~ 5, 200 Migrant sites High risk areas in settled population = 10 HR site ~ 10, 122 HR areas in settled population

Progress on Emergency Preparedness & Response Plan • EPRG constituted – Two EPRG meetings held since December to assess progress Dr Soumitra Roy Dr Kalyan Mukherjee Dr Amabasu Das Dr J K Mehta Dr Dipankar Maji Dr Prasanta Biswas • RRT members selected and trained • High Risk districts allocated to RRT members Dr S S Basu Dr Pramit Ghosh • EPRP prepared and implemented

• Sustaining high population immunity in HRAs – SIAs – Routine Immunization

Intensive Government Oversight • Regular video conferences by Principal Secretary for polio SIAs with DMs /Mayors & Chair persons of urban bodies and Health / ICDS officials • Senior state officials assigned to HR districts for monitoring • District, sub divisional and block task forces to review preparedness & supervise operations • Daily evening review meetings at districts & block PHCs District Magistrate Howrah monitoring activity Urban area task force meeting in progress at Maheshtala

Intensification of underserved strategy Polio advocacy at Urs • Endorsement from religious institutions • Compilation of appeals for teams working in HRAs Sensitization of Hajis • Announcement from mosques • Advocacy in religious gatherings • Inauguration by religious leaders Rally by madarsa students • Sensitization of Hajis before and after return from Haj pilgrimage • Rally by Madarsa students

Special initiatives to reduce missed children in HR districts of West Bengal Health camps : Murshidabad Impact of health camps : Khargram Clinic booths: Howrah Sick children vaccinated at clinic booths 123 clinic booths Remaining houses with reluctance to vaccination

Partner supported Social Mobilization / Advocacy • 1600 Field volunteers and supervisors from 23 NGOs deployed by Unicef in 6 HR district • Social Mapping is being done in HR areas for planning appropriate area specific intervention • Sensitization meetings with all PRI members and urban councilors – 24 Pgs South – Howrah • SIA inauguration and advocacy by Cricketers – Kolkata Knight Riders – West Indies team

Special immunization plans for Congregations • • Ganga sagar Mela Urs in different Mazars Eid congregations Other religious festivals Vaccination at Ganga sagar mela Vaccination at Urs ~ 20, 000 children vaccinated at various congregations in 2012

Social mobilization to overcome refusals Number of houses with reluctance to vaccination: 2011 vs 2012 North Bengal districts South Bengal districts

Vaccination of children in transit > 500, 000 children vaccinated in transit during each campaign in the state Children vaccinated at transit points: 2011 vs 2012

Other special initiatives to improve coverage • Targeted X-P conversion : Doctors from Medical colleges visit reluctant families (X houses) with medicines immediately after the round. • Distribution of Motivational items from booths Medical college doctors visiting an X house • ICDS feeding on booth day Trend in remaining X houses – Kolkata & Murshidabad Outcome : Reduction in remaining X houses ICDS feeding on booth day

Percent Northern districts, West Bengal N= 1, 371 4, 490 2, 996 4, 020 3, 515 6, 556 7, 574 7, 686 7, 065 10, 320 6, 461 6, 651 7, 996 6, 890 8, 924 Percent Southern districts, West Bengal N= 7, 525 6, 665 8, 193 11, 933 11, 027 11, 787 12, 602 11, 343 11, 816 10, 919 17, 450 Percent unvaccinated children End-of-round survey

Strengthening Routine immunization • Merger with SIA microplans in process – Identification of new RI/VHND sites through SIA microplan – Incorporating RI session plan in SIA microplan – Identification of newborns during SIA and their inclusion in RI • Training of MOs and Cold chain handlers • Quarterly review of RI performance at state level

RI sessions planned vs held – West Bengal May 2011 – January 2012 Reason for session not held (N=57) State N = 1, 582 Source: Session RI Monitoring data (May 2011 -January 2012)

Immunization status of monitored children, West Bengal, May 2011 - January 2012 Reasons for children not being fully immunized Not aware of need Fear of AEFI Unaware of session site N= 1, 629 Beneficiary not available Programmatic Reason Other Reasons State N (children 12 to 23 months of age)= 6, 223

• Status of AFP Surveillance

Status of AFP Surveillance - 2011 Non-polio AFP rate 87% 7. 18 AFP Surveillance is sensitive enough to pick any transmission in the state * data as on 3 March 2012 Stool collection rate

• Preparedness for responding to importations

Preparedness for responding to importation • Prepared to hold first mop up within 7 days of detection of transmission, as demonstrated in the past. Mop up conducted Vaccine & other logistics reach blocks • National level partners meeting • Media plan operationalized • Vaccine arrived in district • State & District Task Force Meetings • 14 additional SMOs arrive in districts • IEC plan developed • Marker pens & other logistics procured • Field Investigation (NCDC/NPSP/UNICEF) • National Technical Group Meeting • Decision on mop up Chief Minister & Chief Secretary WB informed by Go. I WPV notified Day 0 7 Feb 2011 Day 2 Day 3 Day 4 Day 5 Day 6 13 Feb 2011

Preparedness for responding to importation • Logistics plan • Running rate contract exists for marker pens – supplies expected to districts within 7 days of placing order • Printing of formats have been decentralized to districts – may be done in 5 days • Vaccine distribution to block PHCs (including hard to reach areas) within 4 days of receipt at state • Communication plan • Running rate contract exists for printing of banners/posters and delivery to districts • UNICEF is ready with the prototype IEC materials, will be updated in minimum time

Preparedness for responding to importation • Cold chain • Adequate vaccine carriers available in High risk blocks and urban areas • Repair of cold chain equipments has been decentralized to district level to minimize delay • Microplanning • Microplans of all high priority planning units are reviewed and rationalized before each round • Manpower & training • Training of all high priority teams will be conducted within 6 days of notification

Preparedness for responding to importation • EPRG & RRT – EPRG is meeting from time to assess ongoing activities for increasing / sustaining population immunity and maintaining sensitive AFP surveillance – can be activated within 24 hours • District, Sub division and Block / Urban area task force – will meet as soon as campaign is decided.

Highest level of political commitment to keep West Bengal polio free Thank You