Improving Coverage of Newborn Vaccinations in India

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

From 2009 to early 2014 the USAID-funded MCHIP project in India supported government health services to improve immunization services in 5 low-coverage districts in the Jharkhand and Uttar Pradesh states. One program focused was on improving routine administration of hepatitis B, OPV 0 and BCG prior to discharge of newborns delivered in facilities. Although the Maternal Benefit Scheme (Janani Suraksha Yojna) had greatly increased the rate of institutional births in targeted districts, coverage of newborn vaccinations remained very low. A baseline assessment revealed multiple reasons for low coverage including lack of notation space in the register and no system for vaccinating during off hours. An intervention package was designed to increase administration of vaccines to newborns. Key actions included: on-the-job orientation for staff nurses and auxiliary nurse midwives in delivery rooms; developing procedures for supplying vaccine carriers with required vaccines and diluents to the delivery room on a 24 hourly basis; adding columns in the delivery registers to record vaccine administration; ensuring regular reporting of newborn vaccinations as part of the on-going daily reporting of deliveries under JSY; and routinely assessing newborn vaccination services during supervisory visits and review meetings. The intervention resulted in increased newborn vaccination for institutional deliveries in the selected districts. The average coverage for OPV 0 in Jharkhand (13 health facilities) and Uttar Pradesh (33 health facilities) rose from 37.8% to 79.7% from Jan-Jun ’11 to Jan-Jun ’13. Similar increases were seen for hepatitis B and BCG. Based on the results, guidelines explaining the steps to be taken for ensuring newborn vaccination prior to discharge were issued to all facilities in all districts of these two states, which have a combined population of well over 200 million people.