Transcript POLIO ERADICATION PROGRAM IN INDIA P. K. SAHA , M.Sc(Stat), CStat(UK).

POLIO ERADICATION
PROGRAM IN INDIA
BY
P. K. SAHA , M.Sc(Stat), CStat(UK).
FELLOW OF THE ROYAL STATISTICAL
SOCIETY, UK.
CHARTERED STATISTICIAN
[email protected]
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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
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1999
9587
•
2000
8103
•
2001
7266
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2002
9705
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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
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India and abroad.
POLIO ERADICATION PROGRAM IN INDIA
• At the backdrop briefly described
above, the most serious Question
that arises is whether present setup, 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
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