Session Site Monitoring Tool for Special Immunization Drive (SID)
Name of the district…………………Date of visit……………Name of Block………………………….Name of PHC/Planning Unit…………………… …Name of Village/urban area………………
Name of ANM/vaccinator……………………Area: Rural/ Urban; Name of the Monitor……………….……….Designation………………………. Agency: Government/WHO/UNICEF/ UNDP/Others…
1. Name of Session site: Anganwadi/ School/ Community hall/ PRI office/ Urban post/ PP center/private clinics/ Others (Please encircle)
2. Session held as per microplan (date and place) Yes /No; If No, Why?- ANM not present/Vaccine not delivered/change in location/change in schedule/ Others
Which of the following functionaries present at the session site? (Please encircle)
S No / Functionaries / Status3 / ANM/Vaccinator / Present: Yes/ No / If Yes, as per microplan - Yes/ No
4 / ASHA/ Urban area mobilizer(Link Worker) / Present: Yes/ No / If Yes, mobilizing children- Yes/ No
5 / AWW / Present: Yes/ No/ Non-ICDS area; / If Yes, mobilizing children- Yes/ No
6 / Supervisor health/MI (LHV/HS/MO/etc.) / Visited atleast once/ Did not visit (check supervisor signatures for number of visits)
7 / Supervisor ICDS / Visited atleast once/ Did not visit/Non- ICDS area (check supervisor signatures for number of visits)
8 / Member of VHNSC/PRI/Ward member / Present: Yes/ No / If Yes, mobilizing children- Yes/ No
9 / Whether ASHA present at session site has been oriented on SID / Yes/ No/ ASHA not present
10 / Whether ANM present at session site has been oriented on SID / Yes/ No/ANM not present
11 / Whether AWW present at session site has been oriented on SID / Yes/ No/AWW not present
12 / MCP/Immunization card is available at the session / Yes /No
13 / Counter foils of the MCP/Immunization Cards of the previous sessions are available at the session site / Yes available /partially available/No
14 / Updated Due list available / Yes/No
15 / Due list based on head count & last session vaccination / Yes/No
16 / Mobilizers using due list / Yes/No
17 Have you seen any IEC material related to SID at this session site- Yes/ No; If Yes; What all (tick ‘√’ for all seen)
Poster / Banner / leaflets / Public Display of beneficiaries / Pamphlets / HH Sticker / My Village My Home / others (specify) / others (specify)Observe immunization of two children and record your observations (Please tick)
S. No / Observe whether Vaccinator: (4 Key Messages) / Child 1 / Child 2Done / Not done / Not observed / Done / Not done / Not observed
18 / Explain what vaccine(s) will be given and the disease(s) prevented
19 / Explain potential side effects following immunization (fever/pain/swelling, etc.) and how to deal with them
20 / Explain when to come for the next visit
21 / Explain to keep the immunization card safe and to bring it along for the next visit
22 / Asks the caregivers to wait with child for 30 min after vaccination
Interview two care givers of children less than two years at session site (Exit interview)-Please encircle
S No / Questions / Caregiver 1 / Caregiver 2 / Caregiver 323 / Status of child before this immunization [If child received immunization (minimum one antigen) but not received immunization as per age with gap of more than one month then encircle drop out; if child not received any antigen till date (child age 2 months or more) then encircle left out and if child received all antigens as per age then encircle immunization as per age.] / Drop our/ Left out/Immunization as per age / Drop our/ Left out/Immunization as per age / Drop our/ Left out/Immunization as per age
24 / If drop out or left out; Reason of Left out or drop out before this session / 1/2/3/4/5/6/7/8 / 1/2/3/4/5/6/7/8 / 1/2/3/4/5/6/7/8
25 / How did you come to know about this immunization session (more than 1 options possible) / 1/2/3/4/5/6/7/8/9/10/11/12/13/14/15/16/17/18… / 1/2/3/4/5/6/7/8/9/10/11/12/13/14/15/16/17/18……. / 1/2/3/4/5/6/7/8/9/10/11/12/13/14/15/16/17/18…
26 / Who visited you in the last one month to give information regarding immunization services (more than one options possible) / 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9………./ 99 / 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9………./ 99 / 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9………./ 99
27 / Did you heard any miking/drum beating regarding immunization in your community / Yes/ No / Yes/ N0 / Yes/ No
28 / Have you heard or attended any mother meeting/ community meeting for immunization / Yes/ No / Yes /No / Yes /No
29 / Whether your house has SID sticker? / Yes/ No / Yes /No / Yes /No
Options for Q24: 1) Do not feel the need for vaccination; 2) lack of awareness regarding session site, ,immunization schedule, etc.; 3) Do not have time; 4) fear of side effects; 5) child not at home during previous sessions; 5) ANM absent
during visit; 6) Vaccines were not available; Vaccination site not convenient; 7) advised against immunization; 8) others……..
Options for Q25: (1) ANM, (2)ASHA, (3)AWW, (4)CMC, (5) PRI, (6) Miking, (7) TV, (8) Radio, (9) Religious site, (10) influencers, (11)announcements, (12) rallies, (13) neighbors, (14) street play, (15) Poster or banners, (16) wall painting,
(17) urban mobilizer(18) Others (specify……..)
Options for Q26: (1) ASHA, (2) AWW, (3) ANM, (4) CMC, (5) PRI, (6) USHA, (7) urban area mobilizer, (8) Influencer, (9) Others specify…….., (99) No body visited
Encircle appropriate options. For (*) marked questions, multiple responses may be marked
Microplanning and Conduct of session / 1* / Reason for planning and/orMonitoring MI session? / 1 Vacant SC, 2 Area with last three RI sessions not held, 3Low coverage area, 4 small unvisited area 5. Polio HRA 6. Other
2 / Plan for vaccination / Encircle plan for vaccination : a) Outreach session (RI site) b) Outreach session (New site) C)Fixed sessiond) Mobile team
3 / Is the session being held? / Yes / No / If “Yes” - Is the session being held at same location as per micro plan? / Yes / No
* If “No” - select reason(s) a) Early closure b) ANM absent c) Vaccine/logistics not available d) Others:
If “Yes” skip questions 4 & 5. If “No” inform Medical Officer, proceed for monitoring as per plan. Visit PHC / Planning unit at the end of days monitoring to ascertain reason(s) for Questions 4 and/or 5 as applicable and share feedback.
4 / Why ANM was not available at session site? / a) On leave b) Vacant post c) Assigned other work d) Started late e) Others (specify) :
5 / Reason for non-availability of vaccines / logistics at the session? / a) Not issued b) Not picked up c) Picked up but not delivered d) Others (specify) :
6 / Who delivered vaccines/logistics at the session? / a) Alternate Vaccine Delivery person (AVD) b) ANM c) ASHA d) AWW e) Others (Specify):
7* / Which mobilizers are included in micro plan? / a) ASHA b) AWW c) Link workers d) CMC e) Others(Specify:) f): None
8* / Which mobilizers are found working today? / a) ASHA b) AWW c) Link workers d) CMC e) Others (Specify:) f): None
9 / Influencer identified in SID microplan? / Yes / No (If “No” encircle NA in Q – 28)
Due List Quality / 10 / Is due list available for this SID session? / Yes / No (If “No” skip Q – 11 and 12)
11 / Is due list based on head count survey? / Yes / No
12* / Beneficiaries in due list? / a) New born b) missed in last session c) for first dose of OPV+ IPV + Penta d) for 2nd &/or 3rd dose of OPV+ IPV + Penta e) Measles & JE - 1 f) DPT&OPV booster g) Measles & J E-2 h) recent pregnant women
Vaccines/Diluents / 13 / BCG / Yes / No / IPV / Yes/No / TT / Yes / No
BCG Diluent / Yes / No / Pentavalent / Yes / No / JE / Yes / No
tOPV / Yes / No / DPT / Yes / No / JE Diluent / Yes / No
bOPV / Yes / No / Measles / MR / Yes / No / Diluent - Measles / MR / Yes / No
Open Vial Policy / 14* / Partially used vaccine vials received at the session today (if none in Q-14, select NA for Q-15 & 16) / a) OPV b) IPV c) Pentavalent d) DPT e) TT f) None
15* / Which of these partial vials supplied today had no date & time marked on them? / a) OPV b) IPV c) Pentavalent d) DPT e) TT f) None g) NA
16* / Any partially vials supplied beyond 28 days of opening as per date on such vials? / a) OPV b) IPV c) Pentavalent d) DPT e) TT f) None g) NA
17* / Reconstituted vial of BCG, Measles, & JE supplied to the session site? / If Yes encircle as applicable. If not “none”a)BCG b) Measles c) JE d) None
Logistics other than vaccines and diluents / 18 / AD (0.1 ml) Syringes / Yes / No / Vitamin A Solution / Yes / No / Amoxycillin Tab / Syrup / Yes / No
AD (0.5 ml) Syringes / Yes / No / Spoon for Vitamin A / Yes / No / Zinc Tablet / Syrup / Yes / No
5 ml Reconstitution Syringes / Yes / No / ORS packet / Yes / No / Red and Black Bags / Yes / No
Paracetamol Tab / Syrup / Yes / No / IFA Tablet / Yes / No / Tracking bag / Yes / No
19 / Status of hub cutter at the session site / a) Hub cutter is functional b) Hub cutter is not functional c) Hub cutter not available
20 / Is the number of 5ml reconstitution syringes equal to or greater than the total number of BCG + Measles + JE vials supplied? / Yes / No
ANMs Knowledge and injection practices / 21* / On which vials opened today, ANM did not mark date & time on them? / BCG / OPV / IPV / Penta / DPT / Hepatitis-B / Measles / MR / JE / TT /Not applicable
22 / Is ANM administering IPV injection as per guideline for state/UT in National Immunization Schedule (NIS)? / Yes / No / Not observed / Not applicable
23* / Any vial of BCG, Measles and JE (after reconstitution) in use beyond 4 hours / a) BCG b) Measles c) JE d) Rotavirus vaccine e) None
24 / Is ANM cutting each syringe with hub cutter immediately after use? / Yes / No / Not observed
25 / Status of marking of date/time on opening Vitamin A
bottle? / Opened earlier / a) date / time marked & within 8 weeks b) marked but older than 8 weeks c) not marked d) NA
Opened today / a) date / time marked b) date / time not marked c) Not supplied or not opened yet
ANM involvement/Supervision/Incentive for ASHA / 26 / Is ANM aware of any serious AEFI within the last three months? / Yes / No / Whether notified to MOIC? / Yes / No / NA / Give details:
27* / Which supervisor visited the session today? / a) Health Supervisor b) Medical Officer c) Others (specify)d) None
28 / For how many days ANM has planned to work for SID? (Find out from ANMs session wise micro-plan) / a)days b) session wise microplan not available with ANM
29 / ANM at session belongs to / a) same sub center/health post where posted b) different sub center / health post of the same block / planning unit c) different block / urban planning unit
30 / ASHA / other mobilizer aware of incentives for SID? (refer to Operational Guidelines for SID) / a) Line listing of households (survey for enlisting of beneficiaries) @ Rs.100 / session for ASHA/ AWW / link worker (ceiling of Rs 100) / Yes / No / NA
b) Preparation of due list of children/pregnant women for /session for ASHA/AWW/ link worker(ceiling of Rs 100) / Yes / No / NA
c) Mobilization of children @ Rs 150/= per session per ASHA/AWW/Link worker (if 2 mobilizers then @ Rs 75/= per mobilizer.) / Yes / No / NA
d) Full Immunization @ Rs 100 per child who has received all due doses within first year: / Yes / No / NA
e) For Complete Immunization, @ Rs 50/= per child who has received all doses due up to the second year. / Yes / No / NA