Operating Cost of Immunization Programmes

1)

Situational analysis of the Routine Immunization:

a) Implementation Status:
Andhra Pradesh followed the 6-vaccine schedule and Hepatitis-B vaccine was
added to it. The prescribed Immunization schedule is to be completed before the
child completes one year. In A.P. State the Immunization is implemented as a part of
Routine Immunization. The Immunization is being provided to the children through
1570 PHCs / 12252 Sub Centers under the supervision of Medical Officers. At the
secondary level through hospitals i.e. area hospitals and district hospitals which are
functioning under the control of Vaidya Vidhana Parishad and specialized treatment
is being provided through teaching hospitals. The ANMs conducts a large
percentage of the Immunization in rural areas on designated days i.e. Wednesday
(SC headquarters sessions) and Saturday (outreach sessions) every week. Every
ANM is supposed to cover 5000 population. The expected pregnant women
(1741500) and infants (1493000) are going to be benefited by immunization
programme.
The performance on the Immunization front has been showing a steady
improvement due to the activities undertaken under NRHM. The ASHAs are also
playing vital role in mobilization of children to the Immunization sites to ensure timely
immunization and to sustain high coverage of immunization by contributing their
share.
b)

Cold Chain:

Nine walk-in-coolers have been established in the state to store T-series of vaccines
at 20C to 80C at state, and six regional vaccine stores. One walk-in-freezer is
functioning in the state for preserving vaccines. Every PHC is provided with twin set
of Ice-Lined Refrigerator and Deep Freezer to store the vaccines to be used in the
field, and district vaccine stores are supplied large ILRs and DFs with cold boxes to
store monthly stock of vaccines. Sufficient number of vaccine carriers made
available at PHCs and sub-centres to carry vaccine at the outreach immunization
session sites.
c)

Vaccine logistics:

All vaccines are supplied by the Govt. of India as per the indent of the state and the
vaccines received are redistributed to the districts as per the requirement through
regional vaccine stores. The stock received and issued registers are maintained at
all RVS and DVS duly making proper stock entries whenever vaccines are received
or issued which are monitored by the programme officers.
d)

District wise coverage levels of all antigens:

District wise coverage of all antigens for the year 2007-08 and 2008-09 (up to
August) are furnished in the enclosed statements.

The percentage reported coverage and UNICEF survey details during 200607 are given below:
Vaccines
BCG
DPT-3
OPV-3
Measles
Fully immunization
e)

Reported coverage
(%) (2007-08)
98.86
97.26
97.20
94.55
94.55

UNICEF survey
(2006) (%)
95.9
85.9
83.6
86.2
80.4

Reporting and incidents of VPDs:

There were no outbreak of Diphtheria, Pertusis, and Tetanus. The incidents of

Diphtheria, Pertusis, Tetanus and Measles have come down due to successful and
effective implementation of routine immunization activities. The incidents of VPDs for
2007-08 and 2008-09 (up to August) are furnished in the enclosed statements.
f)

Trend of IMR:

The present rate of infant mortality of Andhra Pradesh State is 53 per 1,000
live births (according to National Family Health Survey 2005-06 data). The
Government is taking all possible efforts for reducing infant mortality rates by

g)

Universalizing Immunization of all children under the age of two years.

Ensuring 100% institutional deliveries.

Expanding the cadre of Health Workers at community level.

Ensuring quality health services within reach.

Awareness on Infant/Child Health needs amongst Health Workers and care

givers.

Bringing awareness among the Ante Natal Mothers about the importance of
breast feeding.

Providing training to all the ASHA workers and Anganwadi workers for timely
referral and management of sick newborns.
Reporting and Response to outbreaks and AEFIs:

The state-level and district-level committees have been formed under AEFI.
Instructions were issued to convene district-level AEFI committees once in three
months. During the year 2008 eleven number of AEFI cases have been reported
from different districts. In every case the Expert Committees from medical colleges
formed as per the G.O.Ms.No.596 dt.14.12.2007 have been requested to investigate
the cause of death. Line Listing Formats on AEFI for the 2008-09 (up to August) are
furnished in the enclosed statements. In respect of the cases for which investigation
was made the cause of death was declared not due to immunization.

2)

Supervision and Monitoring:

The Joint Director (Child Health & Immunization) and State EIP Officer is the
state programme officer for implementing and monitoring immunization
activities under the head of Commissioner of Family Welfare.

All the Program Officers of this office have been allotted certain districts to
supervise and monitoring the Immunization Programs.

In all Health Campaigns such as PPI, Measles, Vitamin A, the monitoring

cells are being established in the districts. All Program Officers of this office
including RDs, SMOs, will be monitoring the Health Campaigns.

At district level the District Immunization Officer is implementing and

monitoring immunization activities in addition to the other programme officers
such as Addl. DMHOs, District Leprosy Officers, District Malaria Officers, etc.

The DIOs review meetings are being conducted almost every month and
reviewed the progress of Immunization.

Regional review meetings with DIOs are also being conducted as and when it
was felt necessary.

Reviewed in Video Conferences fortnightly along with other NRHM activities.

Medical Officers are implementing and monitoring immunization activities at

PHCs and sub-centre level by field visits and reviewing the progress in weekly
meetings of supervisors, ANMs, etc.

The District Collectors and DMHOs will review the progress of immunization in
the monthly medical officers meeting.

The ANMs are maintaining survey registers duly updating the information of
new cohorts for all vaccines and stock registers and conduct the immunization
sessions by carrying the vaccines and AD syringes as per the beneficiaries
available in survey registers.

The ASHAs and Anganwadi Workers also prepare a list of beneficiaries to be

mobilized for immunization sessions.

3)

4)

Status of RIMS implementation:

The RIMS data from the districts and state hqrs. could not be uploaded due to
technical problems in the software. This has been brought to the notice of GOI
by the district / state hqrs. authorities for rectification. The problem still exists.

The RIMS training was provided to all the DIOs, SO (UIP), Data Entry
Operators of all the districts during the year 2006. Many posts of DIOs and
SO (UIP)s are filled up by promotion and they are required training on RIMS.
If orientation training to the newly posted DIOs and SOs (UIP) and
reorientation training to other staff is provided that would be helpful in
uploading data of RIMS.
Trainings:

The proposals were submitted to GOI for releasing funds to under take
training to the Health Workers with an amount of Rs.86,00,000/- during 2007.
However this item is incorporated in the PIP 2009-10 also. The training
modules supplied by Govt. of India for Health Workers have been translated
into Telugu the regional language. Soon the budget is received the modules
will be got printed and training will be provided.

The GOI accorded approval in the PIP for the year 2008-09 for providing to
the Medical Officers with an amount of Rs.45,20,000/- which is under process.

5)

A Synopsis of Immunization of Strategy:

Reviewing the immunization activities frequently with DMHOs / DIOs and also
visiting the allotted districts by state officers for monitoring the immunization
activities in the districts.
Conducting village health day in the villages once in a month for providing
immunization and treatment for minor ailments.
Organizing immunization catch-up campaigns in tribal districts.
Organizing Measles and AFP surveillance campaigns.
Organizing bi-annual Vitamin-A administration in routine immunization.
PPI campaigns etc.,
By publicizing through IEC activities to bring awareness in all sections of
public about the immunization particularly in the SC/ ST and weaker section
areas, habitations and outreach areas.
In addition to the Health staff 70,700 ASHA workers are also actively involved
in mobilization of children and pregnant women to the immunization sites.
Service delivery support through Govt. Medical colleges, APVVP hospitals,
area hospitals, district hospital.
Hiring the services of retired / pvt. ANMs for conducting Immunization
sessions wherever the regular ANM post is vacant in sub-centres.
Hiring the services of retired / pvt. ANMs for conducting Immunization
sessions in slum and underserved in urban areas.
Hepatitis-B vaccination and Japanese Encephalitis vaccination is introduced
in routine immunization for which additional cold chain equipment are
required.
Hiring the services of Refrigeration Mechanics in the vacancies caused due to
death / promotion / removal of services etc.
To carry coverage evaluation survey on immunization by recognized
agencies.

Program Implementation Plan for the year 2009-10

1.

Mobility support for supervision at district-level:

Though the immunization coverage is satisfactory, the supervision and

monitoring is very much essential at district level by the DIOs in addition to other
supervisory staff. The DIO has to visit the immunization sessions and other health
campaigns in order to improve the immunization coverage and to maintain good
quality of immunization at different levels. The budget provided by DMHO is not
sufficient for the vehicle of DIO for monitoring the activity. Hence additional budget to
the DIOs to meet fuel charges for their vehicle for monitoring and supervising
immunization activities in the entire district is required. The districts are categorized
as Large, Medium and Small basing on the size of the district.
23 Districts x Rs.50,000/- = Rs.11.50 lakhs

Budget proposed under this scheme for 2009-10 is Rs.11.50 lakhs

2.

Mobility support for supervision at state-level:

Supervisory visits by State-level supervisors for monitoring and supervision of

routine immunization.

Budget proposed under this scheme for 2009-10 is Rs.1.00 lakh

3.

Support for review meetings at State level for R.I. and AEFI:

It is proposed to conduct four state-level review meetings for the DIOs to

review the immunization activities and to assess the service delivery at the field-level
which helps to know the shortfalls if any. The reasons for low performance and to
suggest the suitable steps to overcome the lapses. The budget required is calculated
below with a request to approve the item as the review of immunization activities is
essential at state-level.
No. of districts - 23;
No. of review meetings -4
@ Rs.1250/participant/day for 3 persons (CMO/DIO/Dist Cold Chain Officer)
For 4 review meetings a total amount of Rs.3,45,000/- is proposed.
Expected utilization of funds is 70% which is Rs.2.38 lakhs

Budget proposed under this scheme for 2009-10 is Rs.2.38 lakhs

4.

Repairs and maintenance of equipment:

A total number of ILRs and DFs 5315 (small and large) cold chain equipment
are available in the state. To ensure cold chain system function round the clock in
state vaccine store, regional vaccine stores, districts vaccine stores, immunization
planning units (PHCs, CHCs, UFWCs, PP Units, etc.) the above budget is proposed.
To attend to minor repairs by the Refrigeration Mechanic and expansion of cold
chain storage points in new PHCs.

7 Vaccine Stores (State / Regional) @ Rs.20,000/23 District Vaccine Stores @ Rs.10,000/2232 Immunization Planning Units @ Rs.500/(PHCs, CHCs, UFWCs, PP Units etc.)

Rs.1.40 lakhs
Rs.2.30 lakhs
Rs.11.16 lakhs

The total number of institutions existing in the state is 2556 which includes
PHCs, PP units, UFWCs, AHs, CHCs, etc. Hence an amount of Rs.500/- per
institution (2232 x 500) as per GOI norms may be released accordingly. Additional
requirement for maintenance of cold chain equipment at state and regional level (i.e.
WIC station) @ Rs.20000/- each amounting to Rs.140000/- may also be considered.

Budget proposed under this scheme for 2009-10 is Rs.14.86 lakhs

5.

Support for One Computer Assistant to State level:

As there is heavy work, the services of one Computer Assistant is required to

assist in day-to-day computerization of data on immunization activities, MIS and
preparation of reports. The remuneration is proposed @ Rs.10,000/- per month per
one Computer Assistant.
1 Computer Assistant x Rs.10,000/- x 12 months

Budget proposed under this scheme for 2009-10 is Rs.1.20 lakhs

6.

Support for Computer Assistants to District level:

The Computer Assistants will assist the DIO in day-to-day computerization of

data on immunization activities, RIMS software, preparation and submission of
reports to the state headquarters
23 Districts x Rs.10,000 x 12 months

Budget proposed under this scheme for 2009-10 is Rs.27.60 lakhs

7.

Alternative Vaccine Delivery:

Under AVD the amount is paid to the person towards transport ation charges
who carries the vaccine carriers by head, local available means, etc from PHCs to
the immunization sites viz. sub-centres, block-level, etc. on all session days.
Transportation includes taking the vaccine in the morning and bringing back in the
evening. The support of Govt. of India is required to facilitate timely commencement
and successful conduct of immunization session.
12522 sub-centers x 4 sessions/month/sub-center x Rs.50 person x 12 months

Budget proposed under this scheme for 2009-10 is Rs.300.52 lakhs

8.

Focus on slum & underserved areas in urban areas:

To carry out immunization sessions in urban areas viz. slum areas in

municipal corporation and municipalities by hiring the services of retired ANM/HV
etc. if necessary and to provide contingency amount to the existing ANMs to conduct
outreach sessions in the far off slums for which the support is essential from Govt. of
India to conduct immunization sessions in urban slums and in underserved areas for
hiring the retired ANM/HV.
145 units x (Rs.300 x 4 sessions + Rs.50 x 4 sessions) x 12 months

Budget proposed under this scheme for 2009-10 is Rs.24.36 lakhs

9.

Hiring services of ANMs in vacant places of SCs:

There are 300 ANM posts vacant in various sub-centres in the state due to
which the coverage of immunization sessions is poor. To improve the immunization
coverage the support from Govt. of India is required for hiring the services of private
ANMs in the places where the ANM post is vacant in SCs for conducting
immunization sessions.
300 MPHS x Rs.350/- x 8 sessions x 12 months

Budget proposed under this scheme for 2009-10 is Rs.100.00 lakhs

10.

Mobilization of children through ASHA etc:

Budget projected as per GOI norms to pay honorarium to ASHAs for

mobilization of children to session sites pertaining to the following:

Completing all doses of immunization for BCG, DPT, OPV and Hep-B
before 5 months of Age.
Completing Measles immn. and Vit-A administration for child before 1 yr.
of age.

Identification of Low Birth Weight baby less than 2000 gms of any
community in the village and giving health and nutrition counseling to the
parents and family members resulting in the child completing 3 months of
age in a healthy state.

Budget proposed under this scheme for 2009-10 is Rs.1272.60 lakhs

11.

Training of MPHAs at district-level:

Multi Purpose Health Workers (Female), MPHWs (M), LHVs, PHNs, MPHS
(F&M) MPHEOs, CHOs & other specialist are identified to be trained.

No. of batches 1067 @ 30 per batch

Tea & snacks Rs.2,13,400/DA Rs.64,00,000/Incidental exp. Rs.80,00,000/Venue cost Rs.85,36,000/Guest faculty (dist) Rs.1280400/Institutional exp Rs.3664470/-

Total budget requied is Rs.296.12 lakhs

The expected utilization of funds is 35% which is Rs.107.00 lakhs

Budget proposed under this scheme for 2009-10 is Rs.107.00 lakhs

12.

Cold chain Handlers Training:

Pharmacists and staff nurses are the identified staff for handling of cold chain
and maintenance of vaccines.
A total of 5112 staff now exists
1-day training is proposed.
No. of batches 174.

Budget proposed under this scheme for 2009-10 is Rs.50.74 lakhs

13.

Printing of immunization cards and registers:

Printing of 22.00 lakh immunization cards, 5000 each of temp. record books,
indent form books, vaccine stock registers, vaccine logistic form registers, and 250
each of sickness report of cc equipment, service report of cc equipment. As per GOI
norms expected expenditure is Rs.5/- per beneficiary. The approximate pregnant
women are 17.50 lakhs.

Budget proposed under this scheme for 2009-10 is Rs.20.00 lakhs

14.

Vaccine transport:

Vaccines and injection safety material have to be transported in time through

vaccine delivery vans and other vehicles for prompt and effective implementation of
immunization activities. The support of Govt. of India is required to meet the POL
expenses for the vaccine delivery vans and transportation charges for other vehicles
to distribute vaccines from state central stores to 6 regional stores, from there to the
23 district vaccine stores and from district stores to all the PHCs.

Central stores to regional stores Rs.16500 x 12 months = 1.98 lakhs

Regional stores to districts Rs.11000 x 12 x 6 = 7.92 lakhs
District stores to PHCs Rs.13000 x 12 x 23 = 35.88 lakhs
Cargo transport charges Rs.3.00 lakhs

Budget proposed under this scheme for 2009-10 is Rs.48.78 lakhs

15.

Cold Chain electricity charges:

Previously the funds for electricity charges were met from CSSM programe.
As CSSM is no more, funds are now required for this activity to run the cold chain
equipment since the budget released from other sources are not sufficient for this
activity.

Budget proposed under this scheme for 2009-10 is Rs.16.20 lakhs

16.

Minor repairs to vaccine delivery vans:

The vaccine delivery vans supplied to the districts long back and undergoing
frequent repairs. Sometimes the DMHOs are facing much difficulty to transport
vaccines in time to the planning units. To avoid sufferance of immunization work it is
proposed to provide Rs.20000/- per each vaccine delivery van available in the
districts, regional vaccine stores, and central vaccine stores for which the support of
Govt. of India is required. At CVS 2, RVS 6 and DVS 23.
31 vehicles x Rs.10000/-

Budget proposed under this scheme for 2009-10 is Rs.3.10 lakhs

19.

Special Catch-up Immunization Campaign:

Though efforts are being made to improve the immunization coverage in

remote, tribal and hard to reach areas the immunization coverage is still poor. To
improve the immunization coverage it is planned to conduct special catch-up
immunization campaigns in the tribal area, rural area, remote and interior villages.
The campaigns are planned to be conducted twice in a year with the support of Govt.
of India.

Budget proposed under this scheme for 2009-10 is Rs.19.00 lakhs

18.

Consumables:

For computers including provision for internet access for RIMS @ 400/ month / 23 District and 1 Headquarter x 12 months.

Budget proposed under this scheme for 2009-10 is Rs.1.15 lakhs

19.

Procurement of spare parts of cold chain equipment

The Govt. of India vide letter dated 24.05.2007 stated that the spare parts of
indigenous equipment including voltage stabilizers which are not being supplied by
the GOI may be procured directly by the states and funds for the spares can be met
out of either from the funds for cold chain maintenance or by making a separate
provision in the PIP. As there are no sufficient funds available in the cold chain
maintenance, the support of Govt. of India is required to procure the spare parts of
indigenous equipment to make all the cold chain equipment functional.

Budget proposed under this scheme for 2009-10 is Rs.34.50 lakhs

OPERATING COST OF IMMUNIZATION PROGRAMMES QUARTER-WISE WORK PLAN FOR THE YEAR 2009-10
Sl.
No.
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15
16
17
18
19

Intervention

Mobility support for supervision at District-level

Mobility support for supervision at state-level
Support for review meetings at State level for R.I. and AEFI
Repairs and maintenance of equipment
Support for One Computer Assistant to State level
Support for Computer Assistants to District level
Alternative Vaccine Delivery
Focus on slum & underserved areas in urban areas
Hiring services of ANMs in vacant places of SCs
Mobilization of children through ASHA etc
Training of MPHAs at district-level
Cold chain Handlers Training
Printing of immunization cards and registers
Vaccine transport
Cold Chain electricity charges
Minor repairs to vaccine delivery vans
Special Catch-up Immunization Campaign
Consumables
Procurement of spares parts of cold chain equipment
SRI Total

1st
Quarter
2.74
0.24
0.57
3.54
0.30
6.90
71.55
5.80
25.00
303.00
25.48
12.08

11.61
3.86
0.74

2nd
Quarter
3.57
0.31
0.74
4.62
0.30
6.90
93.42
7.57
25.00
395.59
33.26
15.77
20.00
15.16
5.04
0.96

473.40

34.50
662.72

3rd
Quarter
2.79
0.24
0.58
3.61
0.30
6.90
72.94
5.91
25.00
308.88
25.97
12.32

11.84
3.93
0.75
19.00
1.50
502.47

(Rupees in Lakhs)
4th
Total
Quarter
2.40
11.50
0.21
1.00
0.50
2.38
3.09
14.86
0.30
1.20
6.90
27.60
62.61
300.52
5.08
24.36
25.00
100.00
265.13
1272.60
22.29
107.00
10.57
50.74
20.00
10.16
48.78
3.38
16.20
0.65
3.10
19.00
1.15
34.50
418.25
2056.49