Revelations from monitoring polio immunization and their global implications, india

Kavi Mudgal and Karan Agarwal

Problem Existing gap between microplanning, execution and monitoring of immunization program is impeding progress towards polio eradication.
Approach This three day project began by reviewing microplans and picking high risk areas of Surat corporation of Gujarat state. East and South zones of Surat were selected and random teams were monitored from a total of 160 vaccination teams. Monitoring focused on every key aspect of the immunization work flow, from team composition, training, and visiting households to providing supportive feedback in order to solve ongoing issues in the same setting.
Local Setting There are only three polio endemic countries on the planet, Afghanistan, Pakistan and Nigeria1. India being a common neighbor to two of these nations, faces significant risks of cross-border polio virus transmission. Consolidating every round of immunization program is necessary to mitigate such risks.
Relevant Changes Apart from rectifying flaws in operational components such as inappropriate team composition, unsustainable individual team workload and improper handling of vaccine; house-to-house monitoring detected 4.76% (10/210) unimmunized children below 5 years of age, and 6.67% (14/210) unimmunized children of the same age group were detected in migratory and mobile sites. These children were subsequently immunized with polio vaccine drops and vaccination teams were sensitized to minimize these occurrences.
Lessons Learnt Adequately trained human resources need to be directed towards coverage of migratory, mobile and transit sites. Biphasic rounds of vaccination by separate teams will significantly improve immunization coverage, reducing probability of missing eligible children.

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