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The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110 630 (US$ 36 877 per round). The performance of health centre and immunization sessions was evaluated using 43- and 28-point checklists, respectively, and demonstrated significant improvement during and following the two-year implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$12 760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit. Bulletin of the World Health Organization 2008;86:221-228. Resume Le modele de soutien a la prestation de services de vaccination (ISDS) a ete mis en place dans I'Andra Pradesh (Inde) en novembre 2003, dans I'objectif de renforcer les services de vaccination par une supervision de soutien. Le modele ISDS suppose I'existence d'un systeme de supervision bien etabli au-dessus de I'infrastructure sanitalre existante. Cette demarche a pour objectifs :(1) d'identifier les domaines ou les performances sont tres satisfalsantes et ceux exigeant des ameliorations, (2) d'alder le personnel a identifier et a corriger les pratiques inadequates, (3) d'ameliorer les competences du personnel, (4) de le motiver, et (5) de lancer des actions correctives a des niveaux appropries grace au partage d'informations. Une evaluation du cout et de I'efficacite du modele ISDS dans 16 districts ayant participe au programme a etabli que le cout differentiel pour trois tournees de visites de supervision de soutien se situalt autour d'US $110 630 (US $ 36 877 par tournee). Les performances du centre de sante et des sessions de vaccination ont ete evaluees a I'alde d'une liste de controle en 43 et 28 points respectivement et des ameliorations notables ont ete relevees au cours et a la suite des deux annees de fonctionnement de I'ISDS. En moyenne, la variation en pourcentage des scores de performances entre la periode de reference et la quatrieme tournee d'evaluation etalt d'environ 36 % pour le centre de sante et d'environ 9 % pour les sessions de vaccination. Les couts differentiels par pourcentage supplementalre d'augmentation du score de performances moyen du centre de sante et d'une session de vaccination ont ete estimes respectivement a US $ 3091 et US $12 760 pour la periode d'evaluation. Les ratios differentiels cout/efficacite sont relativement sensibles aux couts de main-d'oeuvre et de deplacement. D'apres les projections, I'integration de I'ISDS dans le systeme de vaccination de I'Andhra Pradesh pourrait entrainer une economie de 39 % sur les couts d'une tournee de visites de supervision. Resumen En noviembre de 2003 se puso en marcha en Andhra Pradesh, India, un modelo de apoyo a la prestacion de servicios de inmunizacion (APSI) con la finalidad de fortalecer ese tipo de actividades con medidas de supervision. El modelo de APSI integra un sistema de supervision consagrado creado a partir de la infraestructura sanitaria existente. Este sistema tiene por finalidad: (1) identificar las areas de alta eficacia y las que necesitan mejoras, (2) ayudar al personal a identificar y corregir las practicas incorrectas, (3) mejorar las aptitudes del personal, (4) motivar al personal, y (5) poner en marcha medidas correctivas en los niveles pertinentes mediante el intercambio de informacion. La evaluacion del costo y la eficacia del APSI en 16 distritos que participaron en el programa revelo que el costo adicional asociado a las tres rondas de visitas de supervision de apoyo fue de aproximadamente US$ 110 630 (US$ 36 877 por ronda). La eficacia de los centros de salud y de las sesiones de inmunizacion se determino mediante listas de verificacion de 43 y 28 puntos, respectivamente, que pusieron de relieve mejoras considerables durante y despues de la aplicacion del APSI durante dos anos. El cambio porcentual medio de la eficacia de los centros de salud entre la situacion basal y la cuarta ronda de evaluacion fue de aproximadamente un 36%, y la eficacia de las sesiones de inmunizacion aumento como promedio un 9%. El costo marginal por punto porcentual adicional de la eficacia media de los centros de salud y por punto porcentual adicional de la eficacia media de las sesiones de inmunizacion durante el periodo de evaluacion se estimo en US$ 3091 y US$12 760, respectivamente. La relacion entre costo marginal y eficacia es relativamente sensible a los gastos de personal y de viaje. Se calcula que la integracion del APSI en el sistema de inmunizacion de Pradesh Andhra puede traducirse en un ahorro del 39% por ronda de visitas de supervision., Introduction In November 2003, an immunization service delivery support (ISDS) model was launched in Andhra Pradesh, India, with the aim of strengthening immunization services through supportive supervision. Traditionally, supervision of [...]

Mumbai, India's second largest city, has one of the highest prevalences of drug-resistant tuberculosis* (DRTB) in the world. Treatment for DRTB takes longer and is more complicated than treatment for drug-susceptible tuberculosis (TB). Approximately 300 persons receive a new DRTB diagnosis each year in Mumbai's Dharavi slum † ; historically, fewer than one half of these patients complete DRTB treatment. As nationwide restrictions to mitigate the COVID-19 pandemic were implemented, a program to facilitate uninterrupted DRTB care for patients receiving treatment was also implemented. A comprehensive tool and risk assessment provided support to DRTB patients and linked those who relocated outside of Dharavi during the pandemic to DRTB care at their destination. During May 2020-September 2022, a total of 973 persons received DRTB treatment in Dharavi, including 255 (26%) who relocated during treatment. Overall, 25 (3%) DRTB patients were lost to follow-up, a rate substantially lower than the rate before the pandemic (18%). Proactive planning and implementation of simple tools retained patients on treatment during periods of travel restrictions and relocations, improving programmatic outcomes. This approach might aid public health programs serving migrant populations or patients receiving treatment for DRTB during public health emergencies., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Injection is a skin piercing event performed by a syringe and needle with the purpose of introducing a curative substance or vaccine into a patient. Dated back to 1657 with the first injection in animals the device is traced till 1991. The concern for proper management of injections is for occupational risk to the health worker, newer technologies to protect health workers is discussed including risk to patients and indirect risk via the environment to the community. Injection overuse is a cause of worry as it exposes the patient the risk of acquiring infections. In healthcare settings in India, most injections are unnecessary. Moreover irrational injection prescription is harmful. There also lies the misconceptions about injectable and oral medications. All professionals, in particular the doctors and nurses should become the advocates of safe injections.

Injection safety is one component of a major immunisation project being implemented in partnership with Government of Andhra Pradesh and PATH, an international NGO. Prior to the project wrong and dangerous injection giving practices were present among the staff which needed immediate attention. It was decided to introduce auto disable syringes along with safety boxes with high quality training to staff and make all these available to all districts along with hepatitis B introduction in the routine immunisation. The State of Andhra Pradesh became the first to implement 'bundling' concept in the immunisation project. Implementation was planned to be done in a phased manner to cover all the 23 districts over a five-year period. For routine immunisation sessions, smaller locally produced boxes may be more acceptable. The Government of India made a decision on 21st July, 2004 on implementing injection safety. Injection safety and proper disposal of used needles and syringes can be successfully advocated if medical associations, paediatric associations, key governmental bodies and international agencies come together. PATH established a group and holds the secretariat for the India injection safety coalition on similar basis as the Safe Injection Global Network of WHO (SIGN). Description of AP system for safe disposal of needles and syringes using manual needle-cutters and plastics recycling has been depicted in this article.