Laveesh Bhandari: Immunity to programmes

Both international and government of India guidelines specify that children should be fully immunised from the six serious but preventable diseases "" diphtheria, pertussis, tetanus, tuberculosis, poliomyelitis and measles "" by the time they are one-year old.

Therefore, children who have received one dose each of BCG and measles, and three doses each of DPT and polio (excluding polio 0) are normally considered to be fully immunised.

The expanded immunisation programme (EIP) by the government was started in 1978 to provide free vaccinations for all for the six diseases. In 1985-86, this programme was converted into a universal immunisation programme (UIP) aimed at 85 per cent coverage by 1990. Despite great achievements, the 85 per cent figure has as yet not been achieved.

One of the largest sample surveys "" the Rapid Household Survey conducted by IIPS, Mumbai "" surveys more than 1,000 households in each district of the country (which translates into 500,000 households) on several characteristics, the chief among them being reproductive and child health issues.

The RHS has now been conducted twice "" in 1998-99 and in 2002-03. The draft results indicate a worrisome trend. Not only are we nowhere close to the 85 percent mark, but that the immunisation levels in a large number of states are falling.

The data are from 2002-03 but have not been finalised yet. But they are based on a survey of more than 30,000 children between 12 and 23 months and are indication enough.

On an all-India basis, the percentage of children completely immunised has fallen by 7.4 points. In other words, by 1998-99 about 52 per cent of the children were completely immunised which is now down to less than 45 per cent.

The ministry of health and family welfare, on the other hand, is talking about the success of its immunisation programme, mentioning the rise in vaccination as well as a fall in reported cases.

Administrative data put up by ministries typically shows what the government is providing, whereas survey data such as RHS shows what the consumers recall receiving. The ministry may be right about the data on increasing provision but quite off the mark on their conclusion on continued successes in complete immunisation.

Ministries and departments have, for more than two decades, become used to working in the mission mode. A polio campaign today, a measles vaccination mission tomorrow, a BCG crusade the day-after and so on.

This mission mode has a significant advantage since it allows concentrated and focused efforts to be aimed at one single problem. And as experience has shown, great successes have been achieved "" the polio campaign is one such instance.

However the mission mode also works against the maturing of our basic health care delivery system. It is a one-time thrust that takes resources and efforts away from other services. It prevents health care providers from undertaking the range of activities that they are responsible for and, therefore, reduces answerability. All in all, missions and campaigns create wrong incentives.

The fall in immunisation levels is just a symptom. It is time we got down to the important part of strengthening the day-to-day functioning of our basic health care delivery systems rather than campaigns and missions.

(The writer heads Indicus Analytics, an economics research firm based in Delhi)