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Figure 6.4
Percentage of 12-23 months old children, who have received specific vaccination
Source: National Family Health Survey-3, Ministry of Health and Family Welfare, GoI, page 232.
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The percentage of children, who are fully vaccinated, ranges from 21% in Nagaland to 81% in Tamil Nadu. Tamil Nadu, Goa, Kerala and Himachal Pradesh stand out in full immunisation coverage, with about three-fourth or more children in these States being fully immunised. The more populous States of Uttar Pradesh, Rajasthan, Assam, Bihar, Jharkhand and Madhya Pradesh report a much lower percentage of fully vaccinated children, as compared to the national average of 44%. (See Annexure 6C.3 for details on childhood vaccination by State.) In 11 States, there has been a substantial deterioration in full immunisation coverage in the last seven years, due to a decline in vaccination coverage for both DPT and polio. Particularly large decreases in vaccination coverage were seen in Maharashtra, Mizoram, Andhra Pradesh and Punjab. In contrast, there was major improvement in full immunisation coverage in Bihar, Chhattisgarh, Jharkhand, Sikkim and West Bengal. The other States with marked improvements in full immunisation coverage were Assam, Haryana, J&K, Madhya Pradesh, Meghalaya and Uttarakhand. These results have been achieved by promoting alternate vaccine delivery wherever required, providing incentives for immunisation sessions, conducting catch-up rounds like those organised in Jharkhand, and ensuring proper maintenance of the cold chain. With popularisation of the monthly health days at AWCs, routine immunisation has got a further fillip.1 (See Figure 6.5.)
Figure 6.5
Percentage of children 12-23 months old who have received full vaccination, by State,
2005-06
Source: National Family Health Survey-3, Ministry of Health and Family Welfare, GoI, page 232.
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The NFHS-3 reported that only 20% children received immunisation at AWCs.1 However, the mobilisation of children by ASHAs and AWWs together is helping to increase coverage and convergence of nutrition with immunisation.2
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To prevent the outbreak of JE, vaccination has been started. Ground work for expansion of Hepatitis-B vaccine to 11 States has been finalised. In order to achieve zero transmission of polio virus, the Government has strengthened its implementation strategy, which includes: vaccination of children at fixed booths and making house-to-house visits; coverage of children in transit at railway stations, inside long distance trains, major bus stops, market places, religious congregations, major road crossings, etc; immunisation of migratory population from Uttar Pradesh and Bihar in Haryana, Punjab, Gujarat and West Bengal; involvement of ASHAs as team member for mobilisation and vaccination of children; coverage of missed children during the monthly health days; and adoption of strategy to involve the leaders and opinion makers of the underserved community in Districts of western Uttar Pradesh.3
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There is a need to strengthen other interventions for maternal and child care, besides the Intensified Pulse Polio Immunisation (IPPI) Programme, which received 87.8% of the allocation for child health under the RCH-II Programme.4
6C.3.1.5 Integrated Management of Neonatal and Childhood Illnesses
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A new strategy has been adopted to shift child health intervention towards a holistic approach, through the IMNCI. This new strategy encompasses a range of interventions to prevent and manage five major childhood problems: ARI, diarrhoea, measles, malaria and malnutrition, as well as the major causes of neonatal mortality, prematurity and sepsis. In addition, the IMNCI promotes nutrition, including breastfeeding promotion, complementary feeding and micronutrients. It focuses on the preventive, promotive and curative aspects among newborns and children.5 The major components of this strategy are: strengthening the skills of healthcare workers; strengthening healthcare infrastructure; and involvement of the community.6
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According to the Third JRM of RCH-II, 2007, more than 100 Districts have indicated plans for IMNCI implementation. The IMNCI is being expanded to include larger number of Districts in Rajasthan, Orissa, Uttar Pradesh, Bihar, Gujarat and Madhya Pradesh. To accelerate implementation, more training sites at the national and State levels have been included and the National Institute of Health and Family Welfare (NIHFW) has been appointed as the nodal agency for coordinating IMN-CI training at the national level. Pre-service IMNCI in the teaching curriculum of undergraduate medical students currently involves nearly 50 medical colleges, and work has started with the Indian Nursing Council to finalise the materials for teaching nursing students and ANMs.7
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The IMNCI and Universal Immunisation Programme need to be strengthened with a comprehensive strategy that includes focus on improving health facilities for newborn and child health, promoting diarrhoea-control measures, focused behaviour change communication and enhancing essential and special care of new-borns. New policies and technical guidelines for simple measures (ORS/zinc, vitamin A, etc.) to be adopted across the country need to be widely disseminated with an emphasis on rapid implementation in IMNCI Districts.
6C.3.2 Integrated Child Development Services Scheme
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The ICDS is one of the flagship programmes of the Government of India and represents one of the world’s largest and most unique programmes for Early Childhood Care and Education. Since 2006, the care of pre-school children including pre-primary education component of SSA is being promoted as part of ECCE under ICDS. The ICDS is the visible symbol of the country’s commitment to its children and nursing mothers, and is also its response to the challenge of providing preschool non-formal education, breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and reducing the incidence of under-nutrition by laying the foundation for physical, psychological and social development of children and building the capacities of their mothers.
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The Scheme was launched with the primary objective of improving the nutritional and health status of children below six years of age and pregnant and lactating mothers. To achieve these objectives, a package of six services, namely supplementary nutrition, pre-school non-formal education, nutrition and health education, immunisation, health check-up and referral services is provided under the Scheme. Three of the six services viz. immunisation, health check-up and referral services are related to health and are provided by the MoH&FW through NRHM and public health infrastructure.
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The ICDS was expanded twice (in 2005-06 and 2006-07) during the 10th Five Year Plan period. Today there are 7,076 sanctioned ICDS projects, with 1.4 million AWCs, with about two million AWWs and Anganwadi Helpers (AWHs) reaching out to 86 million children and mothers with Supplementary Nutritional Support (SNP), and reaching out to 33 million children (3-6 years) with pre-school education. The progress on beneficiaries under supplementary nutrition and pre-school education has been substantial between the periods 2004-05 and 2008-09 (as on December 31, 2008), as depicted in Figure 6.6.
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