A Difference ....Differently
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.
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
only 21% children in the state fully immunized, SIFPSA decided
to pitch in its efforts to improve immunization coverage in
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.
immunization session underway in a village
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:
Funds were not made available by CMOs to MOI/Cs in many non-SIFPSA
Vehicles could not be hired at the prescribed rates in five non
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.
ANM reporting formats were not used in many districts due to gaps
Lack of initiative on part of CMOs hampered implementation of
project in 75% of non SIFPSA districts.
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.