ILRs and Fixed Days
Eimi Watanabe
By then, India’s immunization programme, the Expanded Programme on Immunization (EPI) launched in 1985 was well underway with the full range of UNICEF support. EPI received a further fillip in 1987 when it was included as one of Prime Minister Rajiv Gandhi’s six Technology Missions, high-profile poverty reduction programmes designed to cut “red-tape” through extraordinary political and administrative backing. Pressure was on to deliver, as “State by state, the 1990 push towards universal immunization was planned with the precision of a military operation.” (Maggie Black p.52) .
My job as Representative focused on mobilizing the central and state governments at the political and administrative levels and other influencers, to ensure high level support. I was constantly on the road, mainly visiting state capitals to reach out to state level leadership and to support our colleagues in field offices.
There was also a need for internal mobilization of the nearly 500 staff of UNICEF in Delhi and field offices. Countless EPI meetings were held, and the regular gathering of chiefs of the field offices were key in keeping tabs on progress state by state, learning from each other, and encouraging a bit of friendly competition.
When we, the management team of myself and the two deputies, Tom McDermott and Lukas Hendrata had arrived, there was some unhelpful tension within the office. The urgent requests made by those directly leading the EPI charge were somehow personalized and regarded as demands of the privileged, and thus resented by others. This was not being helped by the claim made by some that the Executive Director had given a carte blanche to disregard internal regulations which they regarded as hindering the achievement of the UCI goal. I found this unacceptable, and I was also convinced that the 1990 goal could be met within existing UNICEF processes and regulations. Thus, it became our job to motivate and mobilize the entire team behind the corporate goal, and facilitate the resolution of issues as they arose.
As 1990 evolved, it was clear that extra effort was needed to support EPI in the states and districts that were floundering. Thus, every staff member in the Delhi office was assigned to an immunization task force, with monitoring responsibilities in specific districts which they visited regularly, checking whether the “fixed day” strategy (see below) was working, facilitating and reporting back if there were issues needing follow up. This task force not only contributed towards the UCI goal, but gave a significant boost to staff morale, with hitherto desk-bound staff participating directly in a corporate priority programme. For many, it was their first visit to the field.
Clearly, UNICEF contributed significantly in supporting the immunization infrastructure, not least in designing and operationalizing the “fixed day strategy”, that is, designating a given day each month as outreach day for every village with a population of 1000 or more and urban units for visits by the immunization worker, which in the past had been highly irregular and unreliable. Venue date and time was widely publicized through wall paintings, display boards, pamphlets, and interpersonal communication. This strategy greatly enhanced the reliability of immunization services increasing coverage. Another key support to the physical infrastructure was in the development and supply of Ice-lined Refrigerators (ILRs), which enabled vaccines to be supplied at the required temperature in locations closer to villages where electricity supply was intermittent and/or unreliable.
In reflecting on the intensity of those UCI years, I was probably not the only one who, while appreciating and supporting the rationale of the goal-driven approach, also questioned whether the achievements of UCI in 1990 would be sustained without the injection of the same level of resources and support from UNICEF. UNICEF, for example, had been undertaking the responsibility for the maintenance of cold chains in the Indian states up to 1990, when it was handed over to state governments. It would have been too simplistic to assume that thenceforth, the system would continue to function at the same level. Was it sufficient, then, to prove that it can be done?
For UNICEF globally, to simplify somewhat, the success of UCI 1990 led to the Children’s Summit and the adoption of the 27 goals for children, which was then followed by the series of development conferences of the 1990s. These in turn culminated in the adoption of the eight Millennium Development Goals in 2000, and subsequently, of the much broader seventeen Sustainable Development Goals in 2015. The SDGs has now gained greater currency globally, not just among governments and CSOs, but local authorities, business sector, academia , schools, public institutions, media etc. Googling SDGs produced nearly 500 million entries. These developments might be seen, in some measure, as a vindication of the goal-driven approach to development, which was central to Jim Grant’s vision.
Having left UNICEF after my India assignment, I have not followed UNICEF’s work closely enough to pronounce conclusively on EPI’s sustainability in India. But upon reading about the vital role being played by ILRs in India’s cold chain under the current, devastating Covid 19 epidemic, and learning that there are now over a dozen Indian manufactures of ILRs supplying to domestic and overseas markets, I felt some satisfaction that this was one area where UNICEF had made a significant, lasting difference.
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