National Immunisation Programme

During the last four dacades, since the athinment of Independence, considerable progress has been achieved in India in the promotion of the health status of its population. You know that small pax has been completely eliminated.  Plague is no I  longer a problem and the expectancy of life at birth has increased significantly. This progress could be achieved due to several steps taken by the National Government. 

Among such measures, one is implementation of number of health programmes. These programmes are normally referred to as National Health Programmes. These programmes arc financed by the Government of India. Several of these programmes are assisted by international health agencies such as WHO and UNICEF (United Nations Children's Fund). A brief discussion on the major health programmes is presented in the following sub-sections. 

The major causes of morbidity and mortality in children are infectious diseases. In addition to those who become ill or die, many children are disabled for life by the complications following these diseases. Neonatal tetanus remains a major cause of neonatal mortality in many parts of the country especially in the rural areas. Poliomyelitis is the single major cause of lameness in children below the age of five years. A large number of cases of diphtheria, pertussis, tetanus, tuberculosis and typhoid are reported annually. In India about 1.3 million children die every year due to diseases preventable by immunisation. A full course of immunisation which costs very little can protect a child against measles, diphtheria, whooping cough, tetanus, tuberculosis and polio, yet in the developing world 3 million children die and another 5 million are left disabled due to these vaccine preventable diseases of childhood, which can be saved by timely immunisation. 

Infrastructure : The Government of India, started the Universal Immunisation Programme (UIP)  in 1986, with the objective of reducing the mortality and morbidity in children by immunisation of all eligible children and pregnant women, against the common and dangerous infectious diseases, by the year 2000 A.D. The programme is being implemented in the rural areas through the existing infrastructure of primary health centres through the multipurpose health workers, trained dais, HG. The procurement of the vaccine and the other equipment is made from the District Health Authorities. 

Activities : Immunisation in the broadest sense consists of administration of the vaccine, immune response and for reduction of the diseases in the community. This requires a considerable amount of preparatory work in the community, planning the procurement of vaccines and the supplies, their storage and distribution, and development of the information system and the feedback. 

Strategies of Operation : This programme is an integral part of primary  health care and services are provided through the existing health infrastructure. There is no separate cadre of staff. Since it is a long-term programme, the services are continued even in the absence of the diseases in the area. Thus high levels of immunisation coverage arc to be sustained over the years. The National Immunisation Schedule followed is presented in Table

National lmmunisation Schedule

Immunisation services are provided by taking vaccines to fixed centres in the villages (outreach operations). In more difficult areas special teams are sent to cover children and pregnant women. 

Depending upon convenience and facilities available different strategies are adopted. Whatever be the strategy it is aimed to cover all pregnant women and children under one year. 

Vaccination sessions is organised daily, bi-weekly, fortnightly or monthly, depending upon the attendance at the clinics. All vaccines are made available at each centre so that the beneficiaries do not have to visit different places for different vaccines. 

The day and time of vaccination session are fixed and prominently displayed. All efforts are made to hold the sessions regularly as scheduled. 

The Government of India has set a goal of achieving about 85 per cent coverage of children under the immunisation programme by the year 2000 A.D. However, by the turn of the century 100 per cent of pregnant women are expected to be covered under tetanus toxoid immunisation. Currently only about 50-60 per cent of children are immunised. What are the reasons for poor coverage? Let's consider. 

Reasons for poor coverage 

I) Lack of Accessibility : One of the reasons for poor coverage is that villages are not within easy reach from the fixed centre, especially those with poor communication and transport facilities. In such cases arrangements need to be made for carrying vaccines and other supplies to the villages and organising sessions at site. The involvement of village health guides, trained birth attendants,  anganwadi workers and other field level workers is necessary for the success of the programme. 

The village leaders, elders, teachers and others should be encouraged to collect the eligible children, keep them ready at the vaccination site on the pre-fixed day and time. Arrangement for repeat visits must be made at an interval of 4 to 8 weeks. 

2) Lack of adequate Community Participation : This may be due to the lack of the knowledge of the masses about the diseases preventable by immunisation; cultural beliefs which decrease the acceptability; or the previous bad experience with the immunisation due to abscess or other complication. Sometimes the mothers may not be aware of the time, place, or day of immunisation or the lime may clash with the work at home or in the fields. Community participation is very  vital for a successful vaccination campaign and every effort should be made to elicit this. The community leader should be explained the urgency of early immunisation of pregnant women and children. Further, the worker should inform the beneficiaries well in advance, their fears and misconceptions be removed by health education and group discussion; sometimes the involvement of local leaders, mahila mandals, may prove to be useful. 

3) Inadequate Recording Systetn : An effort should be made to have a vaccination register at the worker level, on which the names of children, infants and the pregnant women should be entered and this should be updated every month. The worker should record the exact date of immunisation on the register. The mothers should also have a record of the immunisation and the immunisation cards should be given to them. 

4) Inadequate Equipment for Immunisation : Adequate supplies of syringes, needles, vaccine carriers, means of sterilisation of equipment are very vital for the success of immunisation programme. An ill-equipped worker can do more harm to the programme. The unsterilised injections given may result in complications.