Mission Indradhanush: What makes India’s Immunisation Programme A Global Best Practice In Public Health

In 2014, the government launched Mission Indradhanush (MI) to significantly enhance India’s immunisation coverage by reaching out to the most vulnerable and inaccessible communities. Between April 2015 and July 2017, over 25 million children and nearly 7 million pregnant women were vaccinated under the programme. As a result, the full immunisation coverage increased by 6.7 per cent after the initial two phases of the programme, as opposed to a 1 per cent increase in coverage between 2009 and 2013.

You can also read this article in Hindi- स्वस्थ बनाता इंद्रधनुष- भारत की टीकाकरण योजना विश्व के श्रेष्ठ प्रयासों में से एक

To further accelerate progress and achieve 90 per cent full immunisation coverage in high-focus areas, Intensified Mission Indradhanush (IMI) was launched in October, 2017. IMI built on the progress made under MI and developed additional strategies such as involving sectors beyond health for reaching out to the highest risk populations in the last mile.

Immunisation received attention from the highest political office in the country with the Prime Minister himself communicating with all chief ministers to work towards achieving the goal of 90 per cent immunisation in their states as well as participating in review meetings. Crucially, the engagement of government ministries beyond health was sought with clearly spelt out roles and responsibilities. These included the ministries of Panchayati Raj, Women and Child Development, Human Resource Development and Minority Affairs, among others. Other ministries like Defence and Railways helped with transporting supplies and expanding the channels for delivery of vaccines.

A clear implementation process involving seven steps was developed. Staff at every level was provided requisite training, however, districts played the most important role in the management of the programme. Every district formulated an implementation plan that best suited its local context. For a country as large and diverse as India, with considerable inter- and intra- state disparities, such an approach is crucial. District magistrates and immunisation officers were responsible for mobilising resources from health and other sectors, boosting community demand and enhancing the communication around immunisation. Task forces at the district level helped to catalyse the participation of stakeholders across different sectors. Field workers including ASHAs and anganwadi workers were tasked with listing all households in their area to ensure that no child or pregnant woman in the target group was missed. The regular interaction among field workers helped to achieve greater synergy and efficiency in implementation.

Data was used at every stage of the programme, right from identifying the focus areas to monitoring progress. The use of different methods enabled data to be validated. IMI targeted districts and urban areas where the coverage of Diphtheria, Tetanus, Pertussis 3 (DPT3) was lower than 70 per cent or at least 13,000 children had missed the DPT3 in the previous year. Efforts were made to reach out to every pregnant woman and child up to the age of five years, while ensuring that all children under two years were fully vaccinated.

Data was also fed into e-dashboards on mobile phones which allowed vaccination data to be captured and aggregated on a real-time basis. The World Health Organisation and United Nations Development Programme carried out population-based surveys to assess the household coverage. Further, to capture the perspectives of the target groups, external monitors were brought on board to interview households from a sample of under-vaccinated children.

Another central pillar of the programme’s implementation strategy was mobilising the local community by informing them about the importance of immunisation, management of any side effects as well as dispelling the prevailing myths and misconceptions. Field workers imparted health education at the local level by engaging a range of stakeholders from within and outside the government including political leaders, religious leaders, mothers’ groups, chemists and ration dealers. The attempt to make route immunisation into a Jan Andolan is a strategy which is now being adopted by the POSHAN Abhiyaan as well.

So, what is the way forward?

The success of MI and IMI lies in the fact that they did not reinvent the wheel. Instead they leveraged the infrastructure and lessons learnt from India’s successful fight against polio. Similarly, going forward, we must incorporate the lessons from these programmes into our routine immunisation system and focus on the areas that need strengthening.

For instance, interviews conducted between October 2017 and February 2018 with caregivers of inadequately vaccinated children revealed that lack of awareness, concerns about side effects and resistance to vaccines remained important challenges in achieving the goal of universal immuniation.

Thus, while MI and IMI have helped to boost the community demand for and acceptance of immunisation, intensive mobilisation needs to be integrated with the route vaccination system. Platforms like the POSHAN Maah can also be effectively leveraged for the same. The first Rashtriya POSHAN Maah was celebrated in September, 2018. It reached out to over 32 crore people with messages pertaining to antenatal care, anaemia, growth monitoring, delaying age at marriage for girls and hygiene, among others. Over 33 lakh community-based activities were conducted during the month, including poshan melas, saas bahu sammelans and hand-washing demonstrations.

As recommended in NITI’s ‘Strategy for New India @ 75’ vaccines, including Rota Virus and Pneumococcal must preferentially be targeted at high focus districts. Capacities need to be strengthened at the district level, especially those of field workers for carrying out household listing, social mobilisation and engaging stakeholders beyond the health sector. Continued efforts also need to be made to expand the vaccination sites and ensure adequate infrastructure like toilets to create a conducive environment for the attendance of beneficiaries.

The progress achieved under MI and IMI has been spectacular. It is vital that the lessons learnt from the highly successful implementation of such a large-scale public health campaign are incorporated into the routine immunisation system. With a continued focus on data-driven risk mapping, meticulous microplanning, capacity development at every level, systematic multi-sectoral engagement and social mobilization, we will definitely be able to replicate the phenomenal feat achieved with Polio. No life should be lost due to a vaccine-preventable illness. With the launch of Mission Indradhanush, we have been set on a path where this dream can eventually become a reality.

Disclaimer: The views expressed are personal.