The National Immunization Programme (National Immunization Schedule), Nepal
The National Immunization Programme (NIP) is a priority 1 (P1) programme of the Government of Nepal. Launched as the Expanded Programme on Immunization in 2034 BS (1977/78), the National Immunization Programme has met several milestones, including Millennium Development Goal 4 (MDG 4) on reducing under-5 mortality. Eleven antigens are provided through the national programme to eligible infants, children and mothers through more than 16,000 outreach sessions, including in geographically and economically hard-to-reach and marginalized communities. The initiative of Reaching Every Child and declaring VDCs, municipalities and district as fully covered was initiated in 2012 to search for and vaccinate never reached and dropout children. Eighteen districts and more than 1,800 village development committees (VDCs) have been declared fully immunized. Mass vaccination campaigns on measles and rubella (MR) were integrated with one dose oral polio vaccine for 0-5 years and mass vaccination campaign of Japanese encephalitis in the reporting period. In the measles-rubella campaign 9 month to 5 year old children were vaccinated in 61 districts and 6 to 5 year children in 14 earthquake affected districts. Japanese encephalitis mass vaccination was conducted in 44 non JE introduced districts. Now onwards all 75 districts have introduced JE vaccine in routine immunization.
A successful Human Papilloma Virus (HPV) vaccine demonstration project was implemented in Kaski and Chitwan during the same period. The Comprehensive Multi-Year Plan of Action (cMYPoA for 2012–16) ended in 2016 and the new Comprehensive Multi-Year Plan (cMYP, 2017-2021) has been prepared.
Nepal has been polio free since 2010. It switched to bivalent oral polio vaccine (bOPV- P1 and P3) from trivalent oral polio vaccine (tOPV- P1,P2 and P3) on 17 April 2016 (5 Baisakh 2073). The elimination status of maternal and neonatal polio has been sustained since 2005. The reduced burden of Japanese encephalitis was successfully maintained during the reporting period. Progress has been maintained towards measles elimination and the control of rubella and congenital rubella syndrome (CRS) by 2019.
New guidelines on measles case-based surveillance and rubella and CRS control have been drafted with
endorsement awaited. The Child Health Division allocated adequate resources for vaccines, consumables and cold chain volume and closely monitors the immunization coverage and vaccine preventable disease surveillance status to ensure that the polio free status, the elimination of maternal neonatal tetanus and the control of other
vaccine preventable diseases are sustained. The Logistics Management Division (LMD) is responsible for the procurement of vaccines, cold chain equipment and for ensuring that beneficiaries receive high quality vaccines. The National Health Education, Information and Communication Centre (NHEICC) is responsible for developing and producing advocacy and IEC materials on immunization. RHDs monitor immunization activities, adequacy of vaccines and consumables as well as supply chain management. DPHOs and DHOs implement immunization activities through health facilities and private health clinics partnering in immunization.
Immunization services are delivered through static immunization clinics in health facilities, outreach sessions and mobile clinics in communities (VDCs and municipalities) throughout the country. Outreach sessions are periodically reviewed to increase the access of immunization services the number of 8 sessions varies usually from 3-5 held in a VDC/ month and more in municipalities. More than 16,000 immunization sessions per month or 192,000 per year are conducted nationwide. Private health facilities, hospitals, NGO/INGO and medical colleges run static immunization clinics to increase the access of immunization services and is based on needs and included in district micro plans.
A health facility generates data on vaccine usage, dropout and vaccine wastage rate. Most new and underused vaccines are expensive and hence the vaccine wastage rate is monitored for each antigen. The wastage rate of non-multi-dose vaccine vials (MDVP) (Bacillus Calmette-Guérin [BCG] and measlesrubella vaccine) remains high as the national policy allows opening at least one vial in each session, the other vaccines vials falling under ‘Multi dose vial policy’, allowed to use for 28 days in fixed sessions once opened (if the criteria of open vials are not violated) however at outreach sessions even these MDVP vaccines are used only for 3 days.
The HMIS section of the Management Division collects monthly data that it compiles and shares with CHD’s Immunization Section every three months. Vaccine-preventable disease (VPD) surveillance data collected through the HMIS are verified and feedback is given regularly to district health offices. The World Health Organisation’s (WHO’s) Immunization Preventable Diseases (IPD) collects information on acute flaccid paralysis (AFP), measles-like illnesses, maternal and neonatal tetanus and acute encephalitis syndrome through regular weekly zero and monthly reporting sites. Surveillance medical officers (SMOs), who are based in 11 places in country, regularly visit districts health offices and health facilities (public and private hospitals, clinics) to investigate VPD cases and outbreaks. In addition, they support the immunization programme and build the capacity of health workers on immunization and surveillance.
Goal, objectives and strategies
The National Immunization Programme has two main guiding documents:
- The Nepal Health Sector Programme-2 Implementation Plan (NHSP IP 2) focused on increasing access and utilisation of essential health care services, especially to reduce disparities in access to health care. It gave high priority to the immunization programme.
- The Comprehensive Multi-year Plan of Action (2012–2016) is the main guiding document for the national immunization programme. It was aligned with policy documents of the national immunization programme, World Health Assembly (WHAs) resolutions and the Global Vaccine Action Plan.
The overall goal of the cMYPoA (2012-2016) was “To reduce child mortality, morbidity and disability associated with vaccine preventable diseases.”
Targets and schedule
The target population of the National Immunization Programme are:
- under 1 year old children for BCG, DPT-HepB-Hib, OPV, IPV, PCV and measles-rubella1 (MR1) vaccine.
- 12 month old children for Japanese encephalitis
- 15 month old children for measles-rubella second dose (MRSD)
- pregnant women for tetanus toxoid and low dose diphtheria toxoid (Td) containing vaccine.