POLIO ERADICATION PROGRAM IN INDIA BY P. K. SAHA , M.Sc(Stat), CStat(UK). FELLOW OF THE ROYAL STATISTICAL SOCIETY, UK. CHARTERED STATISTICIAN [e-mail]

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POLIO ERADICATION PROGRAM IN INDIA
BY P. K. SAHA , M.Sc(Stat),
CStat(UK).FELLOW OF THE ROYAL STATISTICAL
SOCIETY, UK.CHARTERED STATISTICIANpkssaahhaa_at_hot
mail.com
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POLIO ERADICATION PROGRAM IN INDIA

• BACKGROUND
• In India in Health Sector Pulse Polio
  Immunization PPI Program is the largest
  endeavor.
• PPI is a gigantic program to control
  Poliomyelitis which is one of the six vaccine
  preventable disease.
• PPI in India launched in December, 1995

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POLIO ERADICATION PROGRAM IN INDIA

• It is part of the global initiatives.
• It is to eradicate Poliomyelitis by the end of
  the year 2000.
• Progress Under PPI program progress in India is
  in zigzag fashion.
• Target of eradication has been revised several
  times.
• Entire program lacks Strategic Management
  framework.

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POLIO ERADICATION PROGRAM IN INDIA

• Under this program time target has been revised
  as below
• a) Started Dec., 1995
• b) Original Target 2000
• c) Revised Target 2002
• d) Further Revised Target 2007

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POLIO ERADICATION PROGRAM IN INDIA

• Organizational Arrangement
• Very Ordinary Management Mechanism.
• PPI Program is being implemented in collaboration
  with WHO.
• This agency is directly managing the program
  implementation.

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POLIO ERADICATION PROGRAM IN INDIA

• A Unit called National Polio Surveillance Unit
  NPSU established in 1997 is located in New
  Delhi.
• NPSU is headed by a Program Manager who is an
  incumbent of WHO.
• So, the entire information system on surveillance
  is under the control of NPSU.

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POLIO ERADICATION PROGRAM IN INDIA

• Parameters
• One of the main Parameter is the information on
  the number of Acute Flaccid Paralysis AFP cases
  which are regularly reported by this unit.
• It is very relevant to observe the information on
  number of AFP cases so far compiled and reported
  by NPSU.

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POLIO ERADICATION PROGRAM IN INDIA

• Year-wise AFP cases reported by NPSU are shown
  below
• Year Reported AFP cases
• 1997 3048
• 1998 9466
• 1999 9587
• 2000 8103
• 2001 7266
• 2002 9705
• 2003 8539
• as in March,04

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POLIO ERADICATION PROGRAM IN INDIA

• The reliability of the information depicted above
  is directly linked to
• the reporting strategy and system followed by
  NPSU.
• The decision of extending the PPI to 2007 has
  been taken.
• It is based on which categories of data not known.

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POLIO ERADICATION PROGRAM IN INDIA

• It is the fact that the entire PPI program has
  been further extended by a long period of 5 years
  up-to 2007
• This decision justifies that the reporting system
  of NPSU is having some infirmities.
• It questions the reliability of the mechanism of
  collection and validation of the information
  before finally generating the reliable
  information of AFP cases and other relevant data,
  e.g. Wild Polio cases.

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POLIO ERADICATION PROGRAM IN INDIA

• This information is unquestionably highly
  sensitive because the same information highlights
  the status of progress of the very sensitive
  program of polio eradication in India.
• The information collected, prepared and reported
  by NPSU has been furnished to the Government of
  India , all the State Governments, Union Minister
  of Health, Parliament of India, Press and Media
  in India and abroad.

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POLIO ERADICATION PROGRAM IN INDIA

• At the backdrop briefly described above, the most
  serious Question that arises is whether present
  set-up, strategy, system of information
  management, etc is capable of finally attaining
  the goal of eradicating Poliomyelitis from India
  by 2007?

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POLIO ERADICATION PROGRAM IN INDIA

• Certain issues and factors responsible for
  causing the slippage
• National Immunization Days NID Special
  National Immunization Days SNID are fixed by
  the Unit of WHO.
• The set-up is concentrating principally on
  ensuring supply of all the vaccines and other
  necessary materials to the States before a
  particular NID or SNID takes place.

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POLIO ERADICATION PROGRAM IN INDIA

• The set-up is, perhaps not fully geared up to
  ascertain the incidence of actual use of those
  materials.
• Providing all the materials to booths or service
  centers and ensuring quality of service delivery
  to the clients are two extreme components of the
  process.

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POLIO ERADICATION PROGRAM IN INDIA

• There are certain management factors
  administrative, social, religious, etc lying
  in the middle path of the chain which create the
  hurdles towards the proper utilities of the
  facilities provided by WHO and ultimately
  supplied by NPSU.
• Questions arise about the suitability of the
  monitoring and controlling systems.

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POLIO ERADICATION PROGRAM IN INDIA

• Therefore, till now many lacunae at the time of
  service delivery in the field are reported in the
  media.
• e.g. no proper cold chain, not maintaining
  temperature as per norm, no V.V.M. card is
  supplied to the health workers, etc.

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POLIO ERADICATION PROGRAM IN INDIA

• Sense of emergency and sense of commitment on the
  part of all the concerned health workers as
  observed in the first 4 or 5 years of PPI program
  are now on the wane.
• This is quite natural because it is too much
  taxing on the nerve of any human being to be
  continuously subject to such an emergency for
  years.

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POLIO ERADICATION PROGRAM IN INDIA

• It may be observed that there is symptom of
  fatigue in the entire system now.
• It is difficult to motivate the thousands of
  workers for the same type of dedication on their
  part as observed in the beginning of the program.

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POLIO ERADICATION PROGRAM IN INDIA

• So the moment the time target of PPI program has
  been revised to 2007, the entire issue of
  attaining polio eradication by targeted time
  schedule gets diluted.
• So naturally there is possibility of more
  slippages in the system to occur in future.

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POLIO ERADICATION PROGRAM IN INDIA

• PPI Program versus Routine Immunization Program
• One of the strategies of PPI program is to
  strengthen routine Immunization program.
• In reality this machinery of routine immunization
  program has been weaker now after PPI was
  introduced in 1995-96.
• PPI program is being implemented through vast
  networks of booths deploying all the health
  workers of SCs, PHCs, etc.

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POLIO ERADICATION PROGRAM IN INDIA

• In the occurrence of particular NID/SNID, all
  these workers get engaged entirely on PPI jobs.
• They also devote themselves to the second
  house-to-house visit after 4-6 weeks of NID to
  the children to be covered under PPI with the
  objective of mopping up the cases left out in a
  particular NID/SNID.

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POLIO ERADICATION PROGRAM IN INDIA

• This heavy extra job just for one disease affects
  regular immunization program for all the other
  five vaccine preventable diseases which is part
  of the important duties of the ANMs at the SC and
  health workers in other health centers.
• It is presumed that for each NID for Polio, the
  health workers remain occupied on PPI for about
  15 days if not more.

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POLIO ERADICATION PROGRAM IN INDIA

• The get engaged in organizing NID, collecting
  vaccines, etc, arranging cold chains,
  administering vaccines to children on NID and in
  second visits, preparing records, preparing
  reports, sending the reports and so on.

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POLIO ERADICATION PROGRAM IN INDIA

• Enhanced No. of NIDs
• In the beginning up-to 1999 there were two NIDs.
• In order to intensify PPI, no. of NIDs were
  enhanced to four from 2000 followed by two
  Sub-NIDs thus further affecting the regular
  program of immunization.
• It took away more man-hours and energy of the
  regular health workers.

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POLIO ERADICATION PROGRAM IN INDIA

• This is, therefore, a matter of serious concern.
• Facts supporting this observation relate to
  almost constant Infant Mortality Rate IMR in
  India for last so many years showing very slow
  decline in IMR.

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POLIO ERADICATION PROGRAM IN INDIA

• Suggestions
• Introduction of scientific Evaluation of PPI by
  experts other than those in medical science.
• Introduction of Operations Management Techniques
  is essential.
• Introduction of Information management by a
  Statistical expert experienced in Indian system
  of health system and in Monitoring Evaluation
  of RCH program.

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POLIO ERADICATION PROGRAM IN INDIA

• Thanks