There was a scare last October of a suspected polio-virus case in Bihar. To everyone’s relief, the World Health Organisation (WHO) confirmed it to be negative. After a prolonged struggle, Bihar has managed to keep itself polio-free for two consecutive years.

After a sharp spike in the number of cases in 2007 to 503, from 61 in 2006, there was a marked decline. In 2008, 2009 and 2010, the number of cases was 233, 117 and 9 respectively. For 2011 and 2012, not a single case was found, as per official data.

“It was a very difficult fight,” said N.K. Sinha, State Immunisation Officer. “We used Arjuna’s strategy and focussed fully on polio.”

Women’s role

Two important factors that worked well for the polio campaigns were the involvement of women around 2006 and of Accredited Social Health Activists (ASHAs) and Anganwadi workers.

“The idea behind getting women in the two-member immunisation teams was access to the house. Some Muslim pockets don’t allow male members. We began with two male-member teams, which later became one male-one female and finally only-women teams, barring in remote and sensitive areas,” he said.

Global support

The involvement of the WHO and UNICEF also made a huge impact. In an email response, UNICEF said: “We have been supporting the government with a robust communication strategy — community mobilization, mass media and media engagement. This has helped spread awareness on the need for polio vaccination even in the remotest and hard to reach corners. In Bihar, UNICEF has a 1,400-member Social Mobilization Network comprising mostly women. These mobilisers are positioned in high-risk blocks. They go house-to-house counselling parents on the need for polio immunisation. Now increasingly, they are also mobilising the community for routine immunisation, hygiene, sanitation, exclusive breast-feeding and diarrhoea management.”

Coverage deficit

Despite all efforts, at national-level meetings, it was noticed that two per cent of the children were still not being covered in Bihar. “Street surveys” also found a small percentage of “less than 0.5” children eluding immunisation. Four years ago, the government indentified 41 high-risk blocks, which were repeatedly throwing up polio cases. “We were missing children at brick kilns, migrants from neighbouring Jharkhand. So we put mobile teams at these kilns. We also got transit teams at bus stops to target the migrant population and others at congregational sites,” Mr. Sinha said.

As on November 6, 2012, Bihar’s estimated target for immunisation was over two crore children. The total ‘manpower’ was over 1.22 lakh. Seven polio immunisation rounds were conducted in 2012. Since Bihar is in the “elimination phase,” the number of rounds for 2013 and 2014 have been reduced to six and five respectively.

Focus shifts

The government has now shifted its focus on eradication of measles. As per independent surveys, the State has improved coverage of fully immunised children (12-23 months) from 11 to 67 per cent.

The State has set high targets for routine immunisation, but the health infrastructure is weak. “There is a huge vacancy for frontline workers such as ANMs [Auxiliary Nurse Midwife] and ASHAs. Plus, their recruitment is not commensurate with population increase. With many being diverted to the primary health centres, about 45 per cent of the sub-health centres are shut. There is a dearth of specialised medical staff at PHCs. The government is trying its best,” said Swapan Mazumdar of the Bihar Voluntary Health Association.

Unmet challenge

Kala azar, transmitted by bites from female phlebotomine sandflies, plagues north Bihar. “The government has good schemes for kala azar, but their implementation is not. Sometimes, medicines — a 28-day course of 56 capsules is prescribed — go out of stock at PHCs. BPL families with kala azar patients are eligible under the Indira Awaas Yojana. But many have not got houses,” pointed out Manoj of the Integrated Development Foundation.

Bihar’s victory against polio, though complete, is still monitored and continuous surveillance is under way to spot any sign of weakness in a child below 14 years. The challenge now is to sustain the high-cost of polio campaigns. Bihar realises that ‘It’s not over until it’s over everywhere.’

The challenge now is to sustain the high-cost of polio campaigns.

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