Pressure Cookers and Computers
July 1983. James P Grant, The Executive Director of UNICEF had this audacious vision of Growth Monitoring, Oral Rehydration, Breast Feeding, Immunization, Female Literacy, Food Supplementation and Family Spacing (GOBI-FFF) as the seven interventions to spearhead a Child Survival and Development Revolution worldwide. If the revolution was to happen, it was clear that it had to happen in India, the country with the largest child population after China.
On the immunization front, UNICEF Middle and North India Office (MNIO) had tried a mass immunization strategy in Dewas, with some success but more impactful and visible strategies and projects were needed to galvanize a possible accelerated national programme. Dr Wah Wong, the head of UNICEF MNIO had gone on home leave and his deputy Ernesto Siliezar was the Officer in Charge. Instead of just holding the fort, Ernesto decided to demonstrate a significant impact of a immunization strategy in two areas of Delhi - Trilokpuri, a resettlement Urban area and Khanjawla, a rural area close to Delhi.
I was introduced to Ernesto in July 1983 and tasked with developing a plan of action for accelerated immunization and achieving very high levels of immunization coverage in these two areas of Delhi, hopefully setting up a model that could be replicated in other parts of the country.
I developed a detailed plan of action and got technical agreement from Dr R N Basu, the head of India Immunization Programme, Ministry of Health, Government of India and Dr Robert Kim-Farley, the head of WHO Immunization Programme in South East Asia Regional Office in New Delhi, to go ahead and try it out in two areas of Delhi in close consultation with the Delhi Administration. Delhi, at that time, had a unique infrastructure of Anganwadis through its Integrated Child Development Services Scheme (ICDS) with Sreelakshmi Gururaja as the Project Officer for the scheme in UNICEF MNIO and Mrs Kiran Dhingra (IAS) as the Secretary in-charge of the Social Development Programmes in Delhi. MNIO also hired Rina Gill as the Communications Officer and she spent full time planning the communication campaign for the planned Immunization Campaign.
The programme was unique and different from the very beginning. It used Anganwadi workers who were marginally educated, most having 6 to 8 years of formal education but key frontline workers of a great community network. To track the immunization beneficiaries of a highly mobile and migrant population, with the help of Dr Negi, we used mainframe computers of Council for Social Development - a first for a health programme in those days. Money was always in short supply. So we used household pressure cookers to sterilize syringes and needles needed for vaccination. This was so successful that the post vaccination abscess rate was extremely low, a big thing in those days in a large scale public health programme. There was a large scale scepticism within UNICEF as few believed that use of high technology (computers) made sense in a public health programme, that women with basic education would be able to use and maintain computer printouts, that household pressure cookers could be used to sterilize syringes and needles and that Rina Gill’s communication campaign would convince and motivate mothers to bring their children for vaccination.
Were they convinced that this crazy 26 year old medical doctor (me) was going to be the author of the biggest public health disaster and pose a major risk for UNICEF? Not really. So everyone was very cautiously supportive but ready to retreat and deny support if things didn't go well. I was informed that as my contract was ending in December, I should start winding up as others, if needed, will manage the programme in future.
It was December of 1983 when the immunization campaign was launched. As destiny would have it, James P Grant, the Executive Director of UNICEF, had a mixup with his schedule and had to stay in Delhi for a couple of days on his way to Pakistan. As is customary, he had to be shown some projects nearby and so he was taken to Trilokpuri to see what we were trying to do in the area of immunization.
In Trilokpuri, Mr Grant saw hundreds of women getting their infants immunized, the barely educated ICDS anganwadi workers using computer printouts as if it was what they did all their lives, he saw more than 90% of expected children being vaccinated, center after center. He felt that what was happening was important and revolutionary enough to be shared with the Prime Minister of India, Mrs Indira Gandhi.
The next day Mr Grant met Mrs Gandhi and shared what he witnessed and urged the Prime Minister of India to see if it could be replicated in the rest of the country. The Prime Minister of India agreed and that was the start to the largest Immunization programme in the world. In closing, let me add that Trilokpuri and Khanjawla areas became the first areas in India to achieve 96% full immunization coverage of infants in a period of 4 months.
Comments
Post a Comment