The Intensified Mission Indradhanush (IMI) campaign in the northern most frontier of the country Jammu, primarily focused on urban slums. The campaign focused on reaching the unreachable and to overcome the challenges faced in immunizing children and pregnant mothers.
While IMI house-to-house monitoring in rural areas revealed that beneficiaries were keen to get their children vaccinated and were aware about immunization and its schedule, urban areas in Jammu presented several challenges.
Very far from their homes, migratory Rohingya populations disowned by Myanmar, were found in small pockets in Jammu. Living as refugees in parts of India, this migratory population does not have immunization cards or any other past records. Encouraging child-birth by a mid-wife at home instead of going to a hospital thus make tracing of vaccinations of new-borns almost impossible.
With many of the mothers aged between 14-18 years, a lot of these children in these urban slums were also undernourished and under-weight.
During the October round of the IMI, in the slums of Maratha Basti, Nanak Nagar and brick kilns in Bawa Da Talab, immunization teams were faced with the challenge of tracking infants/children from these communities as the population were constantly shifting. Another challenge that the immunization teams faced was language – as the Rohingya speak their own dialect. Also, evident in the urban areas was resistance to vaccination/immunization due to lack of adequate information or religious belief. When probed, the community said they mostly feared the consequences/repercussions of vaccination.
To overcome these major challenges faced in the urban primary health center’s and in the block, daily review meetings were conducted at the chief medical officer’s office following the activity in the evening. These meetings were attended by Block Development Officers, District Immunization Officer and other key state health officials and they sought to find solutions to the situation that this population faced.
Migratory worker, Rahima brought her to child to vaccinate under IMI Mobile sessions in brick kilns, Bawa Da Talab, Kot Bhalwal Block-Jammu, Jammu and Kashmir
There is a face that the women in the Rathod family – Anuradha, Chhaya and Shyma are very familiar with. During the November round of the Intensified Mission Indradhanush Shyma said, “Whenever there is a vaccination session on, she comes and reminds us. We leave everything we are doing and get the children who are due - vaccinated.’’
Meet Javitri - local UNICEF community mobilization coordinator of the Durga Nagar Planning Unit of Bareilly. Shyma whose children are older, remembers that her Mausia Saas (an aunt in law) would remind her to get her children vaccinated. For her other sisters in law, Anuradha and Chhaya, who were emphatic that they did not get any news from the radio, television, and did not have access to phones and SMS, for their children’s vaccination schedule they were depended on Javitri. While there are three children in the house who are due beneficiaries under the Universal Immunization Programme, there are total of seven children in the house.
Chhaya, who has just returned to Bareilly from Ludhiana, talks about the vaccination system saying, “I opted for the private clinics - because Government facilities always seemed crowded and often there is no place to sit. But I do know that the same things that I paid Rs 1, 800 are available here for free.”
Anuradha’s son Annirudha is five years old and her daughter Ridhi is three months old. Only recently says Anuradha, “Ridhi had pneumonia, when she was two months. She could not breathe and we had to admit her to private hospital where an X Ray was taken and she was administered oxygen and medicines.” This affected the family and for five days the Anuradha’s husband had to keep his small grocery shop closed.
When asked if they remembered the name of the woman who came to remind them that their children were due for vaccination – all three drew a blank – saying ‘we know her by face’. Having worked in the area for more than five years – it’s not a surprise that people may forget Javitri’s name. What is important is that they trust her enough and follow her to the session site, whenever she stops by to remind them.
IMI was launched with an objective to increase full immunization coverage to at least 90 percent by 2018 instead of earlier set target of 2020; focus on urban areas as there was sluggish pace of improvement; to integrate the sessions of IMI into Routine Immunization (RI) microplans to sustain the gains of IMI. The ultimate goal of the IMI is to protect all children and pregnant women in India against vaccine preventable diseases.
During the four rounds of IMI, 5.40 lakh sessions were held, during which 141.89 lakh vaccine doses were administered to the children and pregnant women. During these immunization rounds, 53.44 lakh children were vaccinated and a total of 12.75 lakh children were fully vaccinated.
Also, a total of 10.75 lakh pregnant women were vaccinated with tetanus toxoid vaccine during the three rounds.
IMI, aims to reach out to areas where children have not been fully immunized. These are also the areas where basic health facilities are not available. To address a situation in India where children may die of diarrhoea due to lack of health facilities zinc tablets and ORS packets have been distributed freely to all the children to protect them against diarrhoea. A total of 10.25 lakh ORS packets and 36.11 lakh zinc tablets were distributed to the children during the three rounds of IMI.
These three IMI rounds covered large parts of the country, there was no shortage of vaccines in any of the states and all health workers did a stupendous job in mobilizing children and pregnant women to the session sites and vaccinating them. With the completion of three rounds in the country it is evident that there are some states that still need to plug gaps before the last rounds.
(Data updated as on 18th January 2018)
‘Main Bhi ASHA’ video has been created to showcase a day in the life of a health worker’ under Mission Indradhanush. The video features a social activist, twitter influencer and a mother of three, Natasha Badhwar, who lived a day with an ASHA worker to tell the urban audiences about the hardships the health workers go through in their endeavor to #FullyImmunizeEveryChild and pregnant mothers.
India’s health system is a complex web of untiring individuals doing their bit to provide health services to those most in need.
At the grassroots this system is upheld by three key people – the 3 A’s
- ANM (Auxiliary Nurse Midwife)
- ASHA (Accredited Social Health Activist)
- AWW (Anganwadi Worker)
Like soldiers on the front line, these three figures are the last line of defense between disease and good health for most of India.
Mission Indradhanush will consist of special immunization drives that will be driven by these three A’s. For the mission to be a success, their role is paramount.
Planning the Immunization Session
The ANM (Auxiliary Nurse Midwife) does the micro planning for holding immunization sessions, with the help of the ASHA (Accredited Social Health Activist) and AWW (Anganwadi Worker). This is done methodically by tallying the names of all mothers and children in the area, preparing a map of the sub-center area including all villages and hamlets.
Since the AWW and ASHA are chosen from among the residents of the village, they maintain valuable records about immunization status of expectant mothers and children. Based on these records, a ‘due-list’ is prepared before each session.
The ANM further enlists the help of Panchayat members, school teachers and village elders to motivate the families and mobilize them to attend the session.
Maintaining Cold Chain at Immunization Site
Under the UIP, the best safety protocols are maintained and one of the key factors in ensuring this is a meticulously maintained cold chain.
The ANM ensures that the vaccines are brought in a vaccine carrier with four conditioned ice packs, placed in shade and are not opened frequently. This helps maintain the temperature which ensures the efficacy of the vaccines.
The ANM checks the labels for expiry date and VVM label of the vaccine vials before use.
Conducting the Immunization Session
‘ On the assigned day of the week, when the immunization session takes place, the ANM sets up the immunization work area.
She greets the mothers, verifies the immunization record and age of the child and informs them about the vaccine that will be given and the disease it prevents. As part of the stringent safety protocol, the ANM uses auto-disable (AD) syringes for each shot and collects the used needles and syringes for safe disposal as per guidelines.
The child is kept under observation for the next half hour and before letting the mother and child go, the ANM educates the mother about any minor event post immunization like mild fever and how to deal with it. She writes the next date for vaccination in the immunization card and informs her when to come for the next visit.
Recording, Reporting and Tracking
Along with immunizing children, the ANM maintains meticulous records, recording and tallying all immunizations against the due list, sharing the dropouts with the AWW and ASHA so they can track them, maintaining a monitoring chart at the sub center and reporting all suspected cases of any diseases to the Medical Officer.
Some people leave their mark on the sands of time by treading on the path which has been left untouched. Betul district was a new introduction to the Mission Indradhanush and when I went there as a national monitor, I was in for a unique and a beautiful surprise. I have always appreciated the passion and dedication of the health department in MP, but the way in which all the departments in Betul put forth their helping hands was awe inspiring. Setting an excellent example of camaraderie, the health department in co-ordination with other departments in the district mobilized the people and escalated the bench mark of the Mission Indradhanush to a much higher level.
The first thing that struck me as a great initiative was a route chart! Yes, this route chart prepared for Vaccine delivery and for miking by the District Immunization Division and District Collector ensured that no session site went without vaccine stocks and made certain that the IEC effort of miking had its optimal reach. Sceptic as we always are, I could not believe that the other departments are lending support to the Mission Indradhanush without any incentive or financial support. So, I decided to take a road journey to see for myself how the Mission Indradhanush is progressing.
I was impressed at the innovation and commitment of the entire district in utilizing all the resources to etch a success story for the mission. The NGOs; Gram Bharti Mahila Mandal and Jann Abhiyan Parishad involved themselves in endorsing Mission Indradhanush. It was endearing to see children being trained as “Bulava Toli” for Mission Indradhanush. I came across the passion and commitment of the Immunization Division when I witnessed the oath taken by a core team comprising of members from different departments like Integrated Child Development Services, Tribal council, PRI, Forest Department, Customs & Excise and Education.
It was heartening to see how everyone worked towards strengthening the mission, raising the awareness, mobilization and giving visibility to the campaign. I was told by the District Immunization Division that the Customs and Excise department ensured the broadcast of Mission Indradhanush messages at the local movie theatres and on local cable channels; the RTOs used their own budget to print the banner and posters and display them on all the major bus stops and on rickshaws and buses; forest department assisted the ANM to reach those families that live in forest villages by accompanying them through the difficult terrains, populated with wild animals. While travelling through the district, I could even hear the MI slogan being played on loudspeakers in the busy market places.
I also came across OPD paper works with MI seal and was informed that the MI seal was also printed on ration cards and invitations of Anjuman Islamiya function. The district didn’t fail to surprise me even once and I was pleased to see the creatively decorated session sites with hand painted posters and wall paintings. When I met a nursing student who was specially trained to share duties with the ANMs; it is needless to say that I was clearly impressed by the managerial skills of the Immunization Officers.
With the setting sun, as I forced my feet back towards my hotel, my heart and mind was silently applauding the exemplary leadership of the District Immunization Division and District Collector and the unwavering efforts of Panchayat Sachivs & the frontline health workers.