A 22-year-old woman Sujata, who works at a brick kiln, had sacrificed a day’s wages and spent several hours walking in the blazing sun to reach an immunisation camp in Supaul district, Bihar.
Women like Sujata are smart enough to know the benefits of immunisation even at the cost of a day’s earning. However, the situation is not the same across society. Mobilising people working at brick kilns to bring children or pregnant women to the immunisation camps has never been a simple task. But the Mission Indradhanush (MI), the flagship programme of the Union government to ensure immunisation of children and pregnant women, has made it possible.
The immunisation camp is to compensate the dropouts and left out kids under this programme in the districts of Bihar. Chief Minister Nitish Kumar launched the state version of MI christening it as Mukhyamantri Saghan Tikakaran Abhiyan (MSTA), on May 26, 2015.
With utmost zest, the Government of Bihar announced that the four month drive would be reminiscent of MI, starting on the seventh of each month from June 2015 onwards. Preparations commenced well before the drive. The vaccine distribution was planned and the vaccines were made available to districts and then to the cold storage facilities at the blocks around the State.
“It was not easy to convince brick kiln workers to bring their children to immunisation camps. They used to cite reasons like after getting a child vaccinated he/she gets fever which requires proper care and they had to take a day off, resulting in loss of wages,” says Subhashree Dutta, who works for MSTA programme mission.
This was the core reason why the health ministry had launched the immunisation initiative in the area to target itinerant workers under Mission Indradhanush.
The continuous awareness drives by UNICEF and the health department who send mobilisers to the brick kilns to encourage the workers to immunise their children can’t be ignored.
“I had no idea what a vaccination drive meant. These social workers informed me about vaccine-preventable diseases and the benefits of immunisation. I took leave from work just to get my kid immunised,” says Sujata.
According to officials of the health department, many cases of ignorance or refusal come up which create hindrances in the immunisation process to an extent.
“Some cases of ignorance are still being reported. A few families refuse to bring their children or pregnant women to the immunisation camp because of various reasons. In such cases of refusal we call the doctors to counsel the family members regarding immunisation,” says Harish Singh, another member of MSTA programme mission.
Apart from normal Routine Immunisation schedule and contrasting the aim of 8,400 sessions of MI, additional 9,800 sessions were to be undertaken under MSTA in 24 districts depending on the need and the number of dropouts. The highest number of sessions were planned at Siwan (1,019) followed by Saran (665), Madhubani (593), Gopalganj (580) and Vaishali (531).
One of the momentous causes of the drive was to strengthen the rural fraction’s immunisation which till today is a challenge for the government and its partners in progress (primarily UNICEF, WHO, Rotary International, Care and BITAST). The other big agenda was to convince the community over the new kind of schedule for the catch – up rounds for intensification of Routine Immunisation in the name of MSTA.
Between 2009 and 2013, immunisation coverage has increased from 61 percent to 65 percent, indicating only 1 percent increase in coverage every year. To accelerate the process of immunisation by covering 5 percent and more children every year, the mission mode has been adopted to achieve full coverage by 2020.
In the first phase, high-focus 201 districts will be taken up for implementation. Of these, 82 districts are in four states of UP, Bihar, Madhya Pradesh and Rajasthan, and nearly 25 percent of the partially vaccinated or unvaccinated children are in these districts. In the second phase, 297 districts will be targeted.
While 2.7 crore children are born in India every year, approximately 18.3 lakh children die before five years. It is the low income families who lose the most children to these diseases. India records 5 lakh child deaths annually due to vaccine preventable diseases. Despite high childhood mortality rates due to vaccine preventable diseases, 30 percent children miss the benefits of full immunisation every year, which means an estimated 89 lakh children across the country either get only a few vaccines or no vaccines at all.
One of every three children in India do not receive all vaccines that are available under UIP (Universal Immunisation Programme). Around five percent of children in urban areas and eight percent in rural areas are not immunised.
Posters were plastered all around, hoardings were erected along with banners strung up across busy intersections and Bihar was all geared up to meet each and every challenge on the way of successful execution of MSTA.
Children’s rallies, school sessions, mother’s and influencer’s meetings were the major tools devised by the government to promote the drive and make people aware.
Many villagers are involved in the process in making MSTA successful in their villages. “We are not doing it because we have a lot of time. Nor to be a part of social class unlike others. We are doing it to immune every child. The awareness is to be spread and no dropouts and left out kids should be left in this mission,” says B Charan Kumar, a farmer by profession.
Thwarting the government’s efforts of successful implementation of MSTA among the 24 MSTA districts is Supaul, surrounded by the Kosi River, one of the state’s last refuges for challenges and hurdles due to the grid area and the district being exceedingly flood prone. The river rises and falls with the seasons and the population remains constantly moving.
The mobilisation work in Supaul was a tough job for government as well as partners in progress. Geographical conditions, poor literacy rate, misconception about the drive and protest in demand of additional services were the foremost challenges in front of the government while launching the drive in Supaul. On several occasions the vaccinators experienced rebuttal previously in Polio eradication drive and now this was the time for MSTA drive to meet resistance and refusal.
“It’s very difficult to understand the schedule of this vaccination drive. We already take immunisation session for our children at the anganwadi centre then why do we need additional session under MSTA’’, said Jamila Khatoon, mother of Gulshan Khatoon (one year) from Tharhi Bhawanipur.
Multiple strategies were employed to tackle these refusals. Mother’s meeting, community mobilisation through community meetings and PRI counseling.
Vaccines administered in this drive are pentavalent vaccine (combination of diphtheria, tetanus, pertussis, hepatitis-B and haemophilus influenza-B vaccines) and oral polio vaccine (OPV). A vaccine for Japanese Encephalitis (JE) is also given in selected districts.
Clearly, with all these efforts the health conditions in such areas are likely to improve.