Following charges of a drop in immunisation coverage and delayed immunisation, the government has decided to introduce an outreach programme in select areas, with Village Health Nurses (VHNs) taking the vaccines to children.
The State government revised its initial strategy of having outreach coverage soon after deaths were reported following measles immunisation in April 2008. From a system in which VHNs took vaccines to the health sub centres (HSC), the State decided to move to an arrangement under which all vaccines under the Universal Immunisation Programme would be administered only by doctors in Primary Health Centres (PHCs).
“This shift was agreed upon to ensure that the vaccine is administered safely, and in case of emergencies, the child be treated immediately,” Principal Secretary, Health, V.K.Subburaj, told The Hindu. Safety is the strength of the institutional immunisation programme, he added.
However, there were objections from various groups of people including doctors' bodies that this had resulted in lowering the immunisation coverage. A UNICEF survey conducted six months into the switch over to the new system indicated that coverage had dropped.
K. Vanaja, joint director, immunisation, said the UNICEF survey was conducted when the new system was in its nascent stages. “Subsequently, the National Institute of Epidemiology conducted a study which showed that there was not much of a difference,” she explained. The Public Health department will soon launch a study to gauge the exact extent of immunisation coverage in the State. However, there is a small percentage of children for whom the vaccination is delayed, Mr. Subburaj admitted. Vaccine doses have to be given within a specified period, and may have adverse effects if delayed, Dr. Vanaja said. It is estimated that about 2-5 per cent are in this category.
The problem arises directly out of the fact that the mothers are now required to bring the children to the PHC for immunisation. “They come when they are able to, especially those in the remote, hilly, and inaccessible areas,” Dr. Vanaja added. Earlier, when the VHNs used to go to the health sub centre (common for four or five villages), the distance to the farthest village would be only five to ten km.
However, under the present scheme, sometimes parents have to travel over 30 km to get to the PHC and meet the doctor.
It is primarily to target this group of children and to achieve 100 per cent immunisation coverage that the outreach programme has been proposed, in addition to existing institutional coverage. VHNs will once again be tasked with administering the vaccines (BCG, DPT, Polio, Measles and Hepatitis B) at the health sub centres that are easier to access.