Routine Immunisation in India: Long Way to Go
By Damanjeet Kohli, Save the Children India
Mukesh Kumari has been working as a health worker in her village for the last 20 years. Every week, the 45 year old goes door-to-door urging families to get their children vaccinated. But even after so many years of persistence, her village has not achieved full immunization rate.
“The main reason is that many families don’t feel the need to get their children vaccinated. Some also think it will harm their kids,” she says.
Mukesh’s story is that of many health workers across India. Lack of awareness is the biggest barrier to achieving full immunisation rate in the country.
Immunization is one of the most effective methods of reducing child mortality. However, vaccine-preventable diseases still form a large part of the cause for under-5 deaths in India. At 54%, India still has a long way to go before attaining the ideal 85% full immunization rate.
Equity Gap
Often those children who are left out or drop out belong to the poorest and most marginalised areas.
According to Save the Children India’s research on routine immunization in the state of Uttar Pradesh, children belonging to wealthy households were four times more likely to be fully immunized as compared to their low-income counterparts.
Girls fare uniformly worse than boys and higher birth order infants have lower vaccination coverage. Also mother’s education level and the religion of the family negatively impact health-seeking behaviour.
“Panchayati Raj Institution’s (local governance body) involvement in the programme is limited, thus there is no ownership of closing the equity gap at the ground level,” says one of the development partner working with Save the Children in Uttar Pradesh, adding, “The uptake among communities is low as they are not even aware of where, when, why & what will be offered. Massive revamp of IEC for routine immunisation is needed, especially in local language.”
Learning from Polio Eradication
The success of polio eradication programme provides a ray of hope.
With sustained efforts and a decade long campaign to promote polio vaccine, the state of Uttar Pradesh has remained polio free for three years now.
A massive publicity campaign driven by local and national influencers ensured that parents came out to get their children vaccinated. The increased demand was met with dedicated immunisation booths set up at railway stations, inside long distance trains, major bus stops, market places, religious congregations, major road crossings.
But the real success of the campaign came from regular monitoring that ensured no child dropped out.
“We need to develop a model sub-centre in a village and showcase the best practices to other PHCs & districts for better performance of immunisation services”, suggests an Additional District Immunisation Officer. (ADIO)
“We need vaccines on timely basis (monthly basis with two months additional buffer stock), we need more vaccinators, planned implementation of programme and dedicated honest monitoring of programme,” adds the District Immunisation Officer of Uttar Pradesh.
2012 – Year of Immunisation
The government of Uttar Pradesh intensified its campaign by declaring 2012 as the year of immunisation in the state to cover left out and drop out children.
Concentrated were made through sensitisation workshops for the community and microplanning to cover high risk pockets. This was closely linked with firming up the supply side by providing alternate vaccine delivery through mobile vans and volunteers. Strong monitoring and session wise reporting ensured drop outs were mapped effectively.
The campaign has certainly shown promising results. And with solid political commitment, the state is building up the momentum towards full immunisation.
Recently to mark the state’s achievement of eradicating polio, the Chief Minister, Akhilesh Yadav promised to continue the fight for other vaccine preventable diseases as well. “Not a single polio case has been reported in UP in the last three years. I have urged my state’s health officials to sustain the momentum to guard the state against the virus and also scale up vaccination for other diseases,” he said.
“Integrating the campaign with present evidence based strategies can go a long way in improving routine immunisation coverage. Steps like improving women’s education, increasing awareness, conditional cash transfers and promoting institutional deliveries, antenatal care and post natal care will increase the uptake of vaccines,” says Kanika Singh, project director of the New Born Child Sruvival Campaign of Save the Children India, adding, “on the delivery side, we need to integrate and strengthen different health structures and have regular catch-up rounds for drop outs.”
Although India’s success has not been spectacular, it has indeed eradicated small pox, and now on the verge of eradicating polio. Immunisation coverage has improved in the last few years in the country. We now need to step up our efforts to reach the underserved population as well as invest heavily in R&D to achieve immunization’s full potential and a healthier nation.
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