Title: POLIO ERADICATION PROGRAM IN INDIA BY P. K. SAHA , M.Sc(Stat), CStat(UK). FELLOW OF THE ROYAL STATISTICAL SOCIETY, UK. CHARTERED STATISTICIAN pkssaahhaa@hotmail.com
1POLIO 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
2POLIO 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
3POLIO 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.
4POLIO 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
5POLIO 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.
6POLIO 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.
7POLIO 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.
8POLIO 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
9POLIO 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.
10POLIO 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.
11POLIO 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.
12POLIO 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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- 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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- 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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- 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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- 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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- 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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- 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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- 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.
20POLIO 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.
21POLIO 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.
22POLIO 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.
23POLIO 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.
24POLIO 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.
25POLIO 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.
26POLIO 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.
27POLIO ERADICATION PROGRAM IN INDIA