POLIO ERADICATION PROGRAM IN INDIA BY P. K. SAHA , M

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

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

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.

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

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

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.

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.

Year-wise AFP cases reported by NPSU are shown below: Year Reported AFP cases [as in March,04 ]

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.

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.

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.

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?

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.

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.

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.

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.

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.

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.

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.

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 PPI program is being implemented through vast networks of booths deploying all the health workers of SCs, PHCs, etc.

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.

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.

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.

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.

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.

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.

Thanks

POLIO ERADICATION PROGRAM IN INDIA BY P. K. SAHA , M

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