Details for Reform Option "Catch-up Rounds to Increase Immunisation Coverage, Jharkhand"
When the new state of Jharkhand came into existence in November 2000 there was very little to rejoice about on the health front. Clearly, there was much that needed to be done. Routine immunisation coverage was only around 9%. More than 35% children did not receive any immunisation at all. It was also observed that complete immunisation (three doses of DPT and Polio, one dose of BCG and Measles) among the children aged 12-23 months was only 10%, and 8 out of 10 children suffered from anaemia. A base line survey found that there was a huge gap in infrastructure, skilled manpower and logistics.
Given the poor health infrastructure in the state, the government had to take immediate steps to reach routine immunisation and other preventive medicines to the maximum number of people, particularly infants, children and pregnant women. In July 2004, therefore, the Ministry of Health and Family Welfare conducted a pilot Catch-up Round in 7 of Jharkhand’s 22 districts. The Catch-up Round was conceived of to catch up with those who got left out in the normal course of health service delivery. It is a month-long drive that takes a basket of preventive and promotive healthcare services to make it available in the immediate neighbourhood of the community.
Catch-up Round is an additional effort over and above the normal routine immunisation and other RCH services. It is a bi-annual operation, each round lasting for one month, followed by subsequent doses of vaccines like DPT.
The first round was carried out from 1st to 31st July 2004, covering 75 blocks in 7 districts. It provided only 4 items—measles vaccine, Iron Folic Acid (IFA) tablets, deworming tablets and Vitamin A syrup to boost supplementation of the micronutrient among children and pregnant women.
In the second round, in December 2004, Tetanus Toxoid (TT) injection was added and coverage was extended to all 22 districts. The following year, from June 2005 onwards, the basket of preventive and promotive medicines included all antigens, IFA tablets, deworming tablets, measles vaccine and vitamin A supplementation; additional services like counselling for contraception, screening for malaria, sputum collection for tuberculosis were also included. This comprehensive package of services began to be provided twice in the year in a camp mode.
(i) Immunisation coverage increased to 38% in 2005-06 from 9% in 1999-2000.
(ii) Provides coverage to 140,000 children.
(iii) Provides coverage to 300,000 pregnant women and lactating mothers.
The total cost for each round is approximately INR 40 to 50 million.
The first Catch-up round was piloted in July 2004 in 75 blocks in 7 districts: Ranchi, East Singhbhum, Lohardaga, Seraikela Kharsawan, Gumla, West Singhbhum, Simdega. By the next round, in December 2004, the entire state was covered.
Planning the programme and programme logistics took around one year.
Package of services: Basic preventive and promotive medicines are provided to the community twice in a year.
Extensive coverage: The camp mode makes sure services reach the last house of the last village.
Cold chain: Especially during summer rounds; maintaining the vaccines at the desirable temperature is one of the most difficult tasks, more so when distances are long and road transport to interior villages almost non-existent.
Procurement: Estimation of the demand and getting together the supply of consumables including medicines is rigorous exercise for programme officers.
Mobilising the community: Raising the awareness of the community and mobilising them to avail of the services in their locality is also critical for wider coverage.
IEC/BCC: As literacy level is very low among the tribal population, they also face language and cultural barriers. Developing user-friendly communication material, to spread the right message, poses a great challenge to service providers.
Planning and reporting formats.
Training of the staff.
Stakeholder involvement like NGOs, private sector, faith based organisations.
Logistics and material management.
Who needs to be consulted
faith based organisations,
Community Based Organisations (CBOs)
Sustainable, as there are many donors and technical assistance agencies working in collaboration with the state government. NGOs, faith based organisations are also involved in the implementation.
Chances of Replication
Replicable in similar situations, where there is a history of low performance.
Camp mode Catch-up Round can be continued for only a limited period; it has to be taken over by routine immunisation over a period of time. Therefore, there should be a simultaneous strengthening of the routine process as well.
The presence of Angan Wadi Workers (AWWs) in the area gives an opportunity to reach the community and creates convergence with the Department of Women and Child Development.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics,May, 2006.