What India can learn from its polio eradication programme
The World Polio Day is being observed across the globe today (October 24). The Polio Eradication Initiative (PEI) has been especially significant for India. Till late 2010, the country was among the four nations where polio was endemic. The three others being Nigeria, Afghanistan and Pakistan. The last reported case of polio in India hit headlines on January 13, 2011, in West Bengal and on March 27, 2014, the World Health Organisation (WHO) declared India polio-free.
The polio eradication programme in the country ran with excellent efficiency seldom observed in Indian implementation. It proved to be a joint effort of the government, the state players, the civil society such as the Rotary, international organisations such as the UNICEF and the WHO, the rural health workers like the ASHAs, aanganwadis and the rural polio programme workers, the teachers and the village influencers, and even the religious leaders and heads of communities.
Actors and politicians lent their voice to the campaign and India witnessed colourful and energetic polio drives and inoculation every Polio Day. On World Polio Day, let us look at the extensive plan and the amazing effort it took to eradicate the disease.
Booth activity
Booths were set up on the first day of the NID/SNID (National Immunisation Days/Sub National Immunisation Days) campaigns in prominent, easily identifiable, acceptable, crowded and convenient locations such as schools, hospitals, and religious places.
On an average, they targeted 250 children in the age group of 0 to 5 years with Oral Polio Vaccine (OPV) and mobilised other departments like panchayati raj (village council), schools, Railways etc for dissemination of information apart from immunisation. To reach the largest possible number IEC (information, education, communications) activities were carried out via media, broadcast using slow moving vehicles, conveyed through interpersonal communication by health workers and influential people from the community.
Door-to-door advocacy
This was followed by booth activity for two to five days to immunise children who might have been missed at the booths. Immunised children were marked with indelible ink. Each team comprised at least two people, of which one was a female and one a person from the local community.
In areas with strong resistance or misinformation, the local was usually a religious leader or doctor. While planning for rural areas it was ensured that hamlets and brick kilns were covered. In urban area, slums, pavement dwellers, construction sites and houses on upper floors were covered. Houses were marked to indicate whether or not children in them had been covered. A P/date indicated houses where children were immunised and X/date referred to houses where they weren't, with sub markings for the reason. These latter houses were revisited in the evening/afternoon when children were expected to be present.
Immunising children in transit
These teams were deployed at major railway stations, bus terminals, ferry crossings, highways, airports, important road crossings, roadside bus stands, toll booths on highways, important river bridges and moving trains etc on all days of the NID/SNID activities. Children were also immunised during festivals and at religious congregations.
High risk and underserved population
High-risk and poorly served populations included areas where a wild poliovirus had been confirmed in the recent past or areas where there were problems in surveillance, reporting, collection of stool samples, large immunity gaps and low-routine immunisation coverage. They included mobile tribes and populations, and children living at construction sites, brick kilns, boat people, isolated families living along river banks, river islands, people in urban slums and peri-urban areas. Here resistance was often high either because of low quality of services provided in the past or because of misinformation about OPV based on rumours. Thus these areas required intense IEC, supervision and micro-planning.
This extensive plan is no longer required but polio drops continue to be given as routine immunisation in India. PEI demonstrated excellent coordination between various actors and multi-pronged attack on the virus.
Indian children continue to suffer from a range of infectious diseases most of which are easily preventable with vaccines. India also has a dismally low immunisation coverage. Lessons from PEI can be extremely useful in this regard.