Immunization against preventable childhood diseases is the right of every child. With a view to providing this right, the Government of India launched the universal Immunization Programme (UIP) in 1985, one of the largest health programmes of its kind in the world, to cater to a birth cohort of 2.6 crore infants and around 3 crore pregnant women every year. The programme provides vaccination against 8 life-threatening diseases such as Diphtheria, Whooping cough, Haemophilus Influenza Type B (Hib), Tetanus, Polio, Tuberculosis, Measles and Hepatitis B in the entire country. In addition, vaccination against Japanese Encephalitis (JE) is being provided in the selected endemic districts/states of the country.
India’s UIP has contributed significantly to ensure equity to children accessing the public health system. However, inequity still remain a challenge. The steady fall of infant mortality from 80 per 1000 live births in 1991 to 37 per 1000 live births in 2015 (SRs) showed India’s efforts under UIP to reduce child mortality and morbidity.
In spite of all positive changes, UIP has always been a challenge. Despite being operational for over 30 years, UIP has been able to fully immunize only 65% children. Evidence shows that unvaccinated and partially vaccinated children are most susceptible to childhood diseases and disability and run a three to six times higher risks of death as compared to fully immunized children.
Committed to improving immunization coverage and addressing the equity agenda, the Ministry of Health & Family Welfare, Government of India has implemented various intensification strategies including its flagship programme “Mission Indradhanush” launched in December 2014. Mission Indradhanush aimed to fully immunize more than 90% of newborns by 2020 through innovative and planned approaches to reach all children. It not only aimed to rapidly increase the immunization coverage but also focused towards strengthening health systems for equity issues in accessing to immunization. Under Mission Indradhanush all the vaccines provided under UIP are administered to children and pregnant women.
This programme focuses more on identified high risk populations with traditionally low coverage such as slum dwellers, nomadic populations and migrant families living in brick kilns and construction sites. The Mission also targets 400,000 high risk areas identified in the polio programme as well as other undeserved areas with inadequate health services, migrant populations recent measles/diphtheria outbreaks or high dropout rates. Based on reports, it is estimated that annually more than 70 lakh (70 million) children in the country do not receive all vaccines available under the UIP.
While acknowledging the impact of Mission Indradhanush in improving immunization coverage across the districts over the three phases, Hon’ble Prime Minister through PRAGATI platform emphasized the need of a supplemental aggressive action plan to cover all left outs and drop outs in select districts and urban cities with low routine immunization coverage in a specific time frame (December 2018).
Intensified Mission Indradhanush would be closely monitored at the district, state and central level at regular intervals. Further it would be received by the Cabinet Secretary at the national level and will continue to be monitored at the highest level under “PRAGATI”.
Keeping in view the importance of Intensified Mission Indradhanush, the Minister for Health & Family Welfare, Imkong L. Imchen officially launched IMI in the state at Urban Primary Health Centre Seikhazou on 9th October, 2017. Through IMI, the Government of India aims to reach each and every child under 2 years of age and all those pregnant women who have been missed out during the routine immunization programme. The special drive will focus on improving immunization coverage in select districts and cities to ensure full immunization to more than .
The districts/urban cities have been selected through triangulation of available data sets such as national surveys, HMIS data & WHO concurrent monitoring data. These datasets have been analyzed in consultation with the states and partners (WHO, UNICEF, UNDP) to identify the weakest 118 districts, 17 urban cities and an additional 52 districts in NE states.
The main objective of IMI strategy is to ensure reaching the unreached with all available vaccines thereby accelerating the full immunization and complete immunization coverage of children and pregnant women in the identified critical districts.
With the launch of the Intensified Mission Indradhanush strategy, the government aims to:-
One phase of IMI immunization drive consisting of 4 rounds of immunization will be conducted in the selected districts and urban cities. IMI immunization drive will be spread over 7 working day starting from 7th of every month. In case the 7th of the month is a Sunday/holiday, the drive may begin from the next working day. These 7 days do not include holidays, Sundays and the routine immunization days planned in that week.
The IMI strategy will require support from key ministers and department; strong leadership through meaningful collaboration between different arms of the government, working closely with the community, civil society and the youth. Other ministries agreed to provide support for IMI are:
The immunization drive will be implemented in all the identified districts and urban cities for ensuring 90% full immunization coverage. Low performing areas will be identified across the entire selected districts/urban areas for coverage under IMI.
Areas with vacant sub centre-Auxiliary Nurse Midwife (ANM) not posted or absent for more than 3 months.
Villages/areas with three or more consecutive missed routine immunization sessions.
High-risk area (HRAs) identified by the polio eradication programme. These include populations living in areas such as:-
(i) Brick kilns
(ii) Other migrant settlements (Fishermen villages, riverine areas with shifting populations
(iii) Undeserved and hard to reach populations (forested and tribal populations, hilly areas etc.)
The priority for conducting IMI should be areas with weak routine immunization coverage in the district. This will require deployment of ANMs to areas outside her own sub- centre and block. Special attention should be provided to urban settlements and cities identified under NVHM.
