UNICEF activities on immunization in North East States

More than 70% children and pregnant women in northeastern states of India have either never been vaccinated with a single vaccine or are in various stages of partial vaccination (Household Survey RCH II 2004). Hence, Government of India planned to cover the backlog of beneficiaries through an intensified drive – known as ‘immunization weeks’ in 17 states of India, including the northeastern states.

UNICEF was requested by the Government to facilitate support for the northeastern states on ‘moving things in a challenging terrain’ – thus recognizing its institutional strength of working in difficult environments. Based on this request, a team of six UNICEF members was deployed to the seven northeastern states of India in early part of 2006. The states were Tripura, Mizoram, Manipur, Meghalaya, Nagaland, Arunachal Pradesh and Sikkim. The team was carefully selected with doctors having experience in the field of routine immunization with proven ability to ”make things work in a difficult situation”.     

Immunization week is a catch-up drive to vaccinate the never vaccinated or partially vaccinated beneficiaries - primarily infants and pregnant women. Three such drives of seven days duration each were implemented with an interval of one month between each drive. The task itself in the 17 states of India was a mammoth exercise as such an initiative of mammoth geographical area was unprecedented in the history of Indian Immunization Programme.

The specific activities of the UNICEF team included playing a catalytic role, facilitation and assistance to:

1. State level review and planning meeting on routine immunization
2. Providing directions from the state level to the districts.
3. Review of vaccine, AD syringes and cold chain logistics and requesting from GoI.
4. Advocacy with the Chief Secretary / Principal Secretary (Health) / Commissioner of Family Welfare / District Collectors / Health Minister / Chief Minister for bringing routine immunization on top of the agenda amongst various health programmes.
5. Managing IEC activities.
6. Monitoring IW activities and its feedback to enable corrective action
7. Transmission of coverage report from the district to state and its compilation
8. Preparation and finalization of state concurrent evaluation report and its transmission to the government
9. Preparation of state immunization plan for 2006 – 07.

In Sikkim, UNICEF facilitated in production of a documentary film on IW depicting the importance of RI., This film is telecast every week on the state governments slot on local cable TV for half and hour.

In Manipur, UNICEF facilitated telecast of messages on IW on cable two days prior to the start of IW 2 and IW 3. UNICEF also mobilized and motivated NGOs who in turn demonstrated very good involvement for miking at the session site.

The team had a catalytic role for initiation in preparation of State Immunization PIP. Technical support was provided to the SEPIO and his team on drafting the report, data analysis and interpretation, appropriateness and correctness of information. Four states finalized the report (Sikkim, Arunachal Pradesh, Nagaland and Meghalaya) and submitted to GoI. One state (Manipur) was in the process of finalization of the report when the assignment was over.

Field visits
Apart from the state level and district level assistance to the SEPIO and DIO, the visit of the team to the field added value in bringing back the experiences on discussion table. The team visited 19 districts / sub-districts / rural hospitals, 8 CHCs, 17 urban health facilities, 66 PHCs, 18 sub-centres, 115 villages (out reach sessions) for supportive supervision and monitoring. On the job training was always provided to the health workers.

As the north eastern states have a unique challenge of socio–political disturbance and proneness to natural disasters, it was ensured that every team member returns to state / district head quarter before dark. The team members were connected with each other through SMS messages on the whereabouts and warnings on impending problems.

The team traveled under security convoy in three districts of Tripura due to continuous disturbance. Critical security related updates were provided by the team on three earthquakes, strike by local health workers protesting against non receipt of salaries in Manipur, office and road picketing in Arunachal Pradesh, kidnapping of editors from local newspapers, riots in Bishnupur district of Manipur (when the consultant had gone there for monitoring – and had to some how escape) protesting against rape by security forces.



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