Slackening field-level health activities, with little or no monitoring or supervision by health inspectors and medical officers, and complacency among the community about immunisation may cost the State dear at the year-end evaluation of its immunisation status, health officials fear.
Officials enquiring into the poor coverage of routine immunisation of children in the Vizhinjam area, following a case of diphtheria at Kottappuram, say they are concerned about the possibility of the existence of other such pockets of inadequate immunisation coverage in Thiruvananthapuram and elsewhere in the State.
“It is quite a frightening thought that we may have to start at the very beginning all over again. All the vaccine-preventable diseases that we thought we had eliminated are now being reported from all over the State,” a senior health official said.
The case of a three-and-a-half-year-old child with diphtheria was reported from SAT Hospital in the last week of August. A subsequent field survey in four sub-centres at Kottappuram found nearly 500 partially immunised children, throwing a big question mark on the efficiency of the Health Department's field-level immunisation activities.
“The child's family is from Tamil Nadu, which is why we could not trace the immunisation records. But the field staff will have to explain how such a large number of children at Kottappuram came to be left out of the immunisation activities,” the official said.
None of the health workers — junior public health nurses or junior health inspectors — has been making house visits in the area. The accredited social health activists — one worker has to cover only 200 to 250 families — have not been vigilant. Though the doctors and the field staff had been on strike for over five months, they had said that the immunisation activities were not disrupted. But verifications in three districts had proved that the doctors had boycotted immunisation activities also, the official said.
Special drive
The department has now planned a special drive in Vizhinjam area, with the cooperation of local political and religious leaders to sensitise the community to the need for full immunisation coverage for children. Four special immunisation camps are being organised in the locality from Monday to cover the partially immunised children identified now.
“It is quite possible that there may be many partially immunised children in many slums in the urban area also. We plan to conduct more surveys across the district to get a proper line-list of unimmunised or partially immunised children under five years of age,” Sunilkumar, Deputy District Medical Officer, says.
The Health Department feels that there is some amount of complacency among the community, both rural and urban, about completing the immunisation schedule. This is precisely where the health workers are expected to play a proactive role and ensure that no child drops out of immunisation, N. Sreedhar, Additional Director of Health Services (Public Health), said.
Dr. Sreedhar says the health system has a compact and time-tested system of tracing children under the age of five and that it is impossible to miss children. Almost all deliveries in the State take place in hospitals and all children have immunisation cards. Using the mother and child health registers, it is easy for ASHAs and the health nurses and inspectors to trace and prepare a line-list with address of every mother and child. “We have now put forth a proposal before the State government that the immunisation details of children in every family be added as the last page of the ration card. This will have to be certified by the health worker for the card to become a valid document,” he said.
