Immunization Programme : Making the World a Better Place to Live
Behchola is a small village on Mawana road near Meerut District in Uttar Pradesh. It might not be the role model of development but clean cemented pathways and hygienic neat huts clearly differed from the stereotypical image of a village that I had in my mind. Twenty kilometers from Meerut, this Dr. Ambedkar village has a population of 2099 and is inhabited by Hindu dalits, upper castes and Muslims. The village comes under Rajpura block PHC (Public Health Center)
and has a Public Health SC (sub-
center) which is headed by ANC (Auxiliary Nurse Midwife) Mrs. Shail Bala Sharma. There are 46 children between the age of 0 to 1 years who receive vaccination, 325 children between the age of 0-5 years to whom polio drops are given.
As I walked through the dusty lanes of Behchola with Mrs. Shell Bala Sharma, she explained to me how there has come about a major improvement in reach of UIP (Universal Immunization Programme). According to her, earlier there were supply side issues, no awareness and lack of interest in the people. The ANM who collected the vaccine container ice box from PHCs, carry it all the way to their villages and it was her job to call people from houses, educate them about the benefits of getting their children vaccinated and to take care of all the vaccinations. But now the ice-box is transported from PHC to all the sub-centres on bikes which saves ANMs ample time and unwarranted toil. She asserted that immunization reach has been on a gradual upward trajectory for the last 4-5 years after the inclusion of ASHAs in the programme. The job of an ANM was not only tiresome and hectic, she was overworked as well and this took a toll on their efficiency which reflected on the stastistics of their villages. Discrepancies were bound to occur between the actual groundwork done and the data on the records. She said WHO and UNICEF people observed this and they recommended for provision of ASHAs to ANMs done by the government. She asserted that in that particular village nearly all the children between 0-1 years
have been vaccinated with the exception of 2 families who are dropouts and according to her, are least interested to get their toddlers vaccinated.
Gulzana, a resident of Behchola and mother of 3, is a daily wager who works in the nearby fields and is also one amongst the two families who are dropouts from the programme. Kamlesh, the village ASHA accompanied me to her house. “How will I manage if they(children) contract fever after getting the vaccine, everyday I have go to the field and earn a living for me and my family; my husband works too but that alone is not enough to feed a family of five”. She said “will the government take care of my children in the event of them getting a fever, when I go to the field to work, these kids they trouble a lot when they get sick”. Her husband chips in “we’ll get them vaccinated when they’re alright, they’re sick most of the time”, Gulzana’s argument seemed credible but her husbands argument had me confused if they were making excuses and trying to rationalize their fear or mistrust for vaccinations. In the past, regional media carried reports that polio programme is rejected outright by some communities, while religious clerics gave statements that Indian government is trying to make their children infertile through these polio drops.
AEFIs
Both Mrs. Shail Bala Sharma and Mrs. Kusum (Lady Health Visitor at CHC, Daurala,Meerut) confirmed that there were no ‘adverse’ effects as such. Mrs. Sharma had just one case and that too 2 years back when the beneficiary child got a severe fever after getting vaccinated. But it was immediately taken care of by her. And therefore they didn’t have any records of the same. After-effects of vaccinations are seen after measels vaccination in the form of mild fever. They are reported to doctors and taken care of as and when brought to the notice of health workers. According to Mrs. Kusum adverse effects are rare and are one in a thousand. But there seemed to be no special records for AEFIs at least at sub-center level.
Drop-outs- Impediments to Full Immnunization
I also had the opportunity to visit CHC(Community Health Center, Daurala, Meerut) and spoke to LHV Mrs. Kusum. She explained to me that dropouts occur between 1st and 3rd dose and categorically outlined the reasons behind them. She explained that major reasons for drop-outs are migration, irregular supply of vaccine, psyche of targeted people, communication failure.
Migration – Migration proves to be an impediment in full immunization. Sometimes beneficiaries after getting the first or second dose migrate to some different region and this reflects in the data of the center where first dose was received.
Supply side constraint – Vaccines do not reach the centers at time. Sometimes supply of vaccines face logjams due to various reasons and this leads to discrepancies in Immunization programme reach. The programme was post-phoned last weekdue to vaccine shortage at both Daurala, CHC and Rajpura,PHC.
Psyche of people – Mrs. Kusum explained that sometimes the child gets sick after being vaccinated which might be completely co-incidential yet the parents tend to put the blame on vaccination for same. Mistrust of vaccination is thus imbedded in the psyche of people and no amount of assurance by health workers could change this.
Communication Failure – The dates for vaccination have to be changed sometimes due to some inevitable circumstances such as calamities or other unforseen events. And the same could not be communicated to the targeted beneficiaries, this communication failure in turn leads to drop-outs and incomplete immunization.
Suggestions
In my obervation I found out that vaccination camps are set up only on Mondays and Wednesdays. Two days in a week are not sufficient for achieving full immunization and there should be at least four days in a week to increase the reach of the programme.
Setting up of child day care centres in the village sub-centers could greatly reduce the drop-outs of those parents who don’t get their children vaccinated for fear of them getting sick as an afteraffect of immunization.
Conclusion
At the dawn of a new millennium, heads of states and governments met at UN headquarters in New York and passed the United Nations Millennium Decleration in September 2000. The Millennium Decleration recognized that although globalization offers great opportunities, its benefits are unevenly shared. The Decleration states that “As leaders we have a duty to all the world’s people, especially the most vulnerable and, in particular, the children of the world, to whom the future belongs“. And to this effect 8 goals were recognized and deadline to achieve them was set as 2015. The fourth goal stated in the decleration is ‘Reduce child mortality - Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate’. UNICEF and WHO are tasked with monitoring and assisting the governments around the world in their efforts towards the same.
India, despite being second fastest growing economy for the past two decades project a dismal scenario when it comes to human development indicators in general and child mortality figures in particular. According to a UN report on child mortality, one third of all the children dying before 5 years are from India and Nigeria. 30 per cent of all neo-natal deaths occur in India.The mortality rate of under 5 children in India is 63 deaths per 1000 live births which is much more than global average of 57. According to the report, the rate at which India is reducing under 5 mortality rate is a mearge 3%. India in order to achieve millenium goal has to bring down this figure to 38 which is an uphill task.
The leaders of our world in the millennium decleration have recognized that futue of our world depends upon a bright future for our children. And in a country like India where millions of children are still vulnerable to poor health, poverty and illiteracy, it is upto us to ensure them a better future. Inclusive growth demands immmaculate healthcare services for our blossoming teeming millions and as future generation they have every right to it.
[email protected] IGNOU, New Delhi
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