Routine Immunisation – a promise of good health to children of Bihar
By Radhika Srivastava
Patna (Bihar), August 2005: Nearly 60 of every 1,000 children in Bihar – one of India’s poorest states – do not live to celebrate their first birthday primarily because 89 out of 100 children in the state do not get protection from vaccine-preventable diseases. Bihar reported a routine immunization of 11 per cent in 1998-99. However, on August 15, India’s Independence Day, Bihar made an enormous effort to free itself from its past. A massive statewide campaign has been launched by the Health and Family Welfare Department in partnership with UNICEF to ensure that deaths preventable by vaccine are actually prevented.
Newborns in Bihar can now expect to have a healthier future as the state government, in close co-operation with UNICEF, has launched a vigorous campaign to strengthen the Routine Immunisation programme. The reinvigorated programme will ensure that every child is vaccinated against six fatal and debilitating childhood infections. These include tuberculosis, diphtheria, tetanus, whooping cough, polio and measles. UNICEF State Representative Bijaya Rajbhandari said in a speech made before a 2,000-strong audience which included health workers, parents and top government officials, “The fact that children in Bihar have waited for so many years for this basic health assurance should give us a sense of obligation…I would like to assert that these deaths are preventable and they should be prevented, no matter what it takes,” he said.
UNICEF also arranged for the participation of Mr. Shekhar Suman, Bihar’s own celebrity television and film star, who made an emotional appeal to the people. “I keep ‘vaccinating politicians’. But now I want to ensure that every child in Bihar is vaccinated against childhood diseases,” he said in reference to his popular satirical television programme on politicians. Mr. Suman has promised to record tapes and messages to ensure that “people who love me also learn about routine immunization and other children’s programmes,” he said. His messages will be recorded and taken to every nook and corner of Bihar.
The current campaign is guided by a State Plan of Action, prepared by the Department of Health with UNICEF support. The Plan has definite targets ahead and is committed to achieving no less than 100 per cent immunisation by 2010 – a target which appears to be very distant from the present figures but one “that will be made possible” assured Health Secretary Deepak Kumar.
UNICEF and the Health Department are vigorously promoting Wednesday as the day of vaccination, and under the State Plan of Action, a vaccine delivery method has been devised by which vaccines will be provided to vaccinators who will set up centres in villages to provide easy access to parents of young children.
The problem of low immunisation rate is rooted in deeper systemic issues. For example, rural electrification rate is around 10 per cent and many of the state’s primary health centres (PHCs) do not have electrical connections. The ones that are electrified do not have adequate or assured electricity supply, making it difficult to preserve vaccines in order to maintain their potency.
Other problems include lack of training of vaccinators and use of safe syringes. Also, reports have indicated that people are not aware of immunization services being available. For instance, Rubina Khatun in Nalanda district of Bihar told visiting journalists two days before the launch of the campaign that she did not know that children could be protected from diseases through vaccination. “No one has told me…I only know of polio immunization because it is a service that comes to my doorsteps,” she said.
In many areas, in the absence of disposable syringes, vaccinations were carried out using old and blunt needles, making pricks very painful and prone to abscess, thereby making vaccination unpopular. UNICEF has introduced auto-disable (AD) syringes in the state which ensure safe and less painful vaccination. AD syringe can be used only once as these get locked after use, making reuse impossible.
To keep vaccines safe and effective, 3,000 cold boxes with shoulder straps for mobility, 65 deep freezers and one large walk-in freezer have been made available as part of UNICEF’s support. UNICEF is also providing technical support to train health workers “so that they know how to vaccinate and are also able to decide which arm or leg to give the shot in.” UNICEF is also supporting the Government in making systemic changes “so that routine immunization becomes routine and we do not have to re-launch another campaign”, adds Mr. Rajbhandari. Improving awareness levels is another area of UNICEF’s attention.
The most promising aspect of the programme is the sense of urgency with which activities are being pursued. Soon, an accelerated routine immunization campaign will improve the quality of life for the children by protecting them from deadly and often fatal infections.