Making A Difference ....Differently

Concerned with the low coverage of the immunization programme in UP, with the proportion of totally immunized children stagnating at abysmally low levels (19.8% in 1993 to 20.2% in 1998), SIFPSA decided to pitch in its efforts to rejuvenate the immunization programme. The biggest challenge identified was to ensure immunization sessions in villages on an assured basis throughout the year. Increased client contact by ANMs visiting rural areas regularly together with better supervision, it was felt, would also improve family planning acceptance.
As part of this intervention, SIFPSA provided support to improve routine immunization in UP. It involved ensuring presence of ANMs along with vaccines and other consumables at sub-centres and at fixed sites in adjoining villages, every Wednesday & Saturday, as per the immunization schedule.

The Strategy

The project provided resources for hiring three vehicles on immunization days, that is every Wednesday & Saturday, in all 823 Block PHCs/CHCs of the state. These vehicles were used for transporting ANMs and their supervisors to villages along with vaccines, contraceptives and other supplies. A fixed route plan for each vehicle was prepared well in advance, to cover all villages in a month. The hired vehicles dropped ANMs at the road heads nearest to the immunization sites and at the end of the day transported them back to the Block PHC/CHC. This strategy facilitated the ANMs reaching villages and ensured that they spent time there for providing services. They were also expected to submit reports on the immunization sessions the same day.

The services provided included immunization of children & pregnant women, antenatal checkups, distribution of oral pills, condoms, ORS packets, & oral vitamin A solution to children. Follow up and counselling for family planning services was also done during and after immunization sessions. IEC material like printed handbills and posters were given out and placed at the immunization sites, informing the people about the visit of the ANMs. The ANMs were provided with printed reporting formats for reporting on the day of the immunization, which were compiled at the PHCs/CHCs.

An immunization session underway in a village

Feedback

This activity was closely monitored by SIFPSA PMUs. To assess the outcome of this intervention, a study was commissioned by SIFPSA through ORG Centre for Social Research, which involved random surveys in 4 SIFPSA and 4 non-SIFPSA districts. Further, visits by SIFPSA officers to 10 SIFPSA & 9 non-SIFPSA districts, chosen on a representative basis, also provided useful feedback. The study and survey highlighted the following:

1. Funds were not made available by CMOs to MOI/Cs in many non-SIFPSA districts.
2. Vehicles could not be hired at the prescribed rates in five non SIFPSA districts.
3. In about a third of the sites, vehicles were used only to transport vaccines as ANMs found it more convenient to reach villages directly using public transport.
4. ANM reporting formats were not used in many districts due to gaps in communication.
5. Lack of initiative on part of CMOs hampered implementation of project in 75% of non SIFPSA districts.

As is evident, the project was better implemented in the SIFPSA districts as compared to non-SIFPSA districts because of active support of PMUs, which was central for its success. The number of immunization sessions conducted in the SIFPSA districts were also much higher.
Though the initiative was appreciated and welcomed by ANMs and medical officers of PHCs, various problems hampered its effective implementation. Due to its high cost of about Rs. 1 crore per month and donor funds not being available for the same, this intervention could be continued for only three months. Though this was too short a duration for any impact, this pilot project helped identify some operational problems. This activity has been included in the RCH-II design for the state with modifications on the basis of field level suggestions.