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POLIO ERADICATION PROGRAM IN INDIA BY P' K' SAHA , M'ScStat, CStatUK' FELLOW OF THE ROYAL STATISTICA

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1. POLIO ERADICATION PROGRAM IN INDIA. BY. P. K. SAHA , M.Sc(Stat), CStat(UK) ... duties of the ANMs at the SC and health workers in other health centers. ... – PowerPoint PPT presentation

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Title: POLIO ERADICATION PROGRAM IN INDIA BY P' K' SAHA , M'ScStat, CStatUK' FELLOW OF THE ROYAL STATISTICA


1
POLIO ERADICATION PROGRAM IN INDIA
BY P. K. SAHA , M.Sc(Stat),
CStat(UK). FELLOW OF THE ROYAL STATISTICAL
SOCIETY, UK. CHARTERED STATISTICIAN pkssaahhaa_at_hot
mail.com
2
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

3
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.

4
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

5
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.

6
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.

7
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.

8
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

9
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.

10
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.

11
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.

12
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?

13
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.

14
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.

15
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.

16
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.

17
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.

18
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.

19
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.

20
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.

21
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.

22
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.

23
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.

24
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.

25
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.

26
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.

27
POLIO ERADICATION PROGRAM IN INDIA
  • Thanks
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