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Alternate Vaccination Delivery System Reaches The Unreached

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Every Wednesday, autorickshaw driver, Purnachandra Saba, diligently delivers boxes of vaccines to anganwadi centres where ASHA worker Sushanti Bhoi patiently waits for the consignments to arrive. 

Drivers and ASHAs like Purnachandra and Sushanti are the back bone of the innovative Alternative Vaccine Delivery System (AVDS), that has reduced vaccine shortage, improved vaccine quality and ensured regularization of immunization of children and pregnant mothers in hard to reach areas in Orissa.

Implemented in 280 blocks of the state, AVDS is an improved programme intervention in vaccine distribution that has borne rich results for the State.

Photos Credit: UNICEF India/2014/Dhiraj Singh

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Every Wednesday, Autorickshaw driver Purnachandra Saba, diligently delivers boxes of vaccines to anganwadi centres where health worker, Sushanti Bhoi patiently waits for the consignments to arrive. His is a race against temperature and time as he drives through the narrow lanes of Chandanpur to Dologobindpur’s anganwadi center in Puri district in Orissa to deliver the box of vaccines which will save lives. As the vehicle crawls from the narrow lanes onto the highway, Purnachandra glances at his watch with an aim to keep time

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At that centre, ASHA worker Sushanti performs her duty and ensures that Purnachandra doesn’t waste any time as he has other stops to make. Within a matter of minutes, Purnachandra is back on the road after making the exchange “Thanks to Purnachandra, we get the vaccines we need on time. The mothers and our staff wait for him every Wednesday,” she says with a smile.

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Drivers and ASHAs like Purnachandra and Sushanti are the back bone of the Alternative Vaccine Delivery System (AVDS). The AVDS, launched in Orissa, to provide vaccines at outreach sites, is an improved programme intervention in vaccine distribution that has borne rich results in the state.

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Since 2009, the AVDS programme has manifested itself in the Teeka Express, where civil society organisations play an important part to strengthen the vaccine delivery logistics. This system has been implemented by State Government in 280 out of the 314 blocks of the state, and has reduced vaccine shortage; improved vaccine quality, timeliness of reporting and immunization waste management; and ensured regularization of immunization in hard to reach areas. UNICEF supported the pilot project in one of the districts in the State.

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In India, out of 27 million children born every year, 7.2 million - majority of them poorest and the most marginalized- are excluded because of challenges due to demography and access.

In Orissa’s 30 districts and 314 blocks, it is not easy for health workers to reach a population of 4.1 crore. 30 per cent of the areas are difficult to reach, 22 percent of the population belongs to tribal communities and 17 to schedule casts, and 48 percent people lives below the poverty line.

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The concept of AVDS is that vaccine and logistics should be delivered to health workers at the immunization session sites so that they can start the immunization session on time and spend adequate time with antenatal mothers and children. Further, after the completion of immunization sessions, the vaccine carrier with unused vaccines and the report of the vaccination coverage are returned to the primary health centre on the same day.

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AVDS involves the participation of civil society, NGOs, porters, rickshaw drivers and volunteers. Each unit in a village has an AVDS map, route chart, vaccine delivery details, contact persons’ name and telephone number to aid in the timely delivery of the vaccines and bring back unused vaccines by afternoon. Grass root-level workers play a pivotal role in the implementation of this system that promises to penetrate the heartland of the country.

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Healthcare workers believe that before the AVDS was put into place, there would be delays in starting immunization sessions, late submission of reports and huge amounts of wastage as unopened vials were not returned. Also, vaccination waste was not being returned post-immunization.

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The success of the AVDS lies on the reliable shoulders of health workers like Purnachandra and Sushanti. With Puri’s 30,512 projected infants from 11 blocks, the state has held 12,586 AVDS sessions in 2013-14. With such success stories, Orissa has reached 62.3 percent immunization. Though, still 37 per cent of children have not been immunized, the dropout rate is 20 per cent.

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Block programme manager from Chandanpur community health centre, 14 km from Puri, who has known Purnachandra for many years, says he is one of the first few people to take part in the AVDS programme. “Each box has ice packs which help maintain the vaccine temperature and potency. So much depends on the skills and dedication of drivers like Purnachandra. We have four drivers in this centre who cover 93 sq. km. each driver takes five boxes every Wednesday.”

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This system has also generated employment opportunities for rural unemployed youth who often volunteer for the AVDS programme. Purnachandra’s last stop before afternoon is at Alikia village, where one-month-old Supriya is waiting with her aunt Meenanti Pradhan (41) for her shots. “My sister was busy, but we wanted to make sure Supriya receives her vaccines on time. We are waiting out of turn,” she says, pointing to the door of the crowded sub centre.

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Purnachandra’s work is done for the day and he heads to the community health centre to handover vaccines wastage. “I feel good helping people. My duty is done for the day, so now I will go and drive my rickshaw for passengers,” he says, taking off his blue overcoat that says “Teeka Express”.

 

 
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