Delivering immunisation to the last mile

India’s large and diverse geography poses a challenge to the delivery of essential public health services. It is important that public health interventions, which are medically and epidemiologically effective as well as represent excellent value for money, reach one and all, especially those living in remote corners of the country. Given the diversity, the key factor for health care services seems to be generating new ideas and focused implementation.

The government’s Mission Indradhanush campaign makes an excellent case for the efficient delivery of essential public health services, having managed to cover hard-to-reach and underserved populations and areas while enabling greater health equity as well as increasing coverage rates through special immunisation drives.

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During its three phases so far, provisional data shows that Mission Indradhanush has made progress. Over 22 lakh fixed and mobile sessions have been held, nearly half a crore pregnant women have been immunised and more than 1.5 crore children received critical life-saving vaccines. What’s more, over ten lakh children received their first immunisations, over 21 lakh women and 41 lakh children were fully immunised.

Projections assert that from the 1% rate of annual increase in immunisation coverage, Mission Indradhanush has made a 6-7% annual increase possible, a feat never achieved before by routine immunisation in the country and or elsewhere. The focus here is to target, locate and deliver services to such people who were hitherto left out.

This achievement is conceivable because of the highly adept operational planning done by officials at all levels as well as by the dedicated efforts of our frontline trinity — Auxiliary Nurse Midwife (ANM), Accredited Social Health Activist (ASHA), and the Anganwadi Worker (AWW). In addition to delivering critical vaccines, these personnel work tirelessly in high-priority districts across the country to boost awareness and demand for immunisation services. They also complement the mission’s accompanying mass media campaigns. The meticulously prepared micro-level plans have worked and are a lesson for the Indian health system to remember. Furthermore, by attempting to strengthen service delivery and vaccine logistics and supply chain, establishing state and district task forces for implementation coordination, toughening surveillance for quality of immunisation services, training and equipping frontline personnel to link communities to the health system, developing a pan-media campaign, and creating a programme logo, through Mission Indradhanush the government has gone ahead and built a brand for immunisation that the last mile recognises. With the resulting infrastructure and expertise that emerged from the Mission Indradhanush campaign, the government has demonstrated the feasibility of assimilating this experience and know-how into the Universal Immunisation Programme (UIP).

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Given that immunisation is smart and cost-effective way of investing in public health, the UIP needs to remain robust. Through Mission Indradhanush, the UIP’s capacity stands to be improved and the system for delivering essential health services has been strengthened. Routine immunisation efforts are now reaching the vulnerable and under-served across the country.

Apart from improving its outreach and infrastructure, another way to bolster UIP and routine immunisation efforts is by introducing new vaccines into the portfolio that can protect children from a greater number of diseases, including pneumonia and diarrhoea. In line with this approach, the government, last month, launched the rotavirus vaccine to help curb the burden of diarrhoea, which kills 120,000 children every year.

Pneumonia, the largest killer of children under the age of five, both globally and in India, however continues to contribute to the child mortality rates. The most common causes of bacterial pneumonia are Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type B (Hib). With a Hib (pentavalent) vaccine already in place, adding a pneumococcal conjugate vaccine will help to fight and reduce morbidity and mortality due to pneumonia. The National Technical Advisory Group on Immunisation has already cleared the vaccine for use in routine immunisation.

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Controlling the spread of these killer diseases by using a comprehensive approach built into routine immunisation, could go a long way to help India meet its Sustainable Development Goals (SDGs) for reducing child deaths and ensure universal health care for all. We are poised to deliver life-saving vaccines that will protect millions from the onslaught of a disease.

The infrastructure that Mission Indradhanush has raised is valuable not only for the UIP and routine immunisation but it also carries lessons for other public health operations that involve delivery of essential public health services to far flung areas in the country. By delivering vaccines and connecting frontline personnel to the health system, the programme has been beneficial for social development at large. It provides savings and gains for sectors other than health. It also helps families to save the exorbitant treatment costs by preventing the disease from occurring in the first place.

The sign of something great is turning adversity into opportunity. As far as public health campaigns are concerned, Mission Indradhanush has shown us how it is done.

CK Mishra is additional secretary, Ministry of Health & Family Welfare and the mission director, National Health Mission

Views expressed are personal