Addressing Equity and Reaching the Underserved and Unreached in India

Background: Sustained efforts by the government and development partners in Jharkhand State (total population approximately 32 million) in India have resulted in significantly increased routine immunization (RI) coverage; with adaptation and application of the Reach Every District (RED) approach as the cornerstone intervention to improve and ensure immunization service delivery.

Design: Key components of the RED approach were utilized to bolster immunization coverage in Jharkhand. Comprehensive RI microplans were developed to reach target beneficiaries - especially unreached and vulnerable populations - with a focus on optimal use of available human resources. Continuous monitoring (through a revised RI monitoring checklist) and hands-on training and mapping of immunization performance at cold chain points and session sites through the Regular Appraisal of Program Implementation in the district (RAPID) (formerly referred to as supportive supervision -SS) activity have had positive impact on service delivery quality. In addition, capacity building of health staff (Medical Officers and Auxillary Nurse Midwives) has been implemented through regular RI trainings and provision of tools and job-aids.

Results: Full Immunization Coverage in Jharkhand increased from 34.2% in 2005-06 (National Family Health Survey III) to 59.7% in 2009 (Coverage Evaluation Survey). Access to services has improved, as reflected by a 14.7% increase in BCG coverage from 2005-06 to 2009; DPT1 – DPT3 dropout rates decreased by 23% over the same period, showing increased utilization. 94% of planned sessions were held in April-November 2011, 779 Medical Officers were trained from July 2009 to date, and the SS model developed and piloted by Immunization Basics and MCHIP has been adopted by the state for all 24 districts, with fund allocations of US$1868 per district every year for this activity.

Conclusion: Successful adaptation of the RED approach to strengthen service delivery and quality resulted in improved immunization in Jharkhand, as validated by various indicators.