Full immunisation for infants had been majorly hit in urban areas of Madhya Pradesh, more remarkably grappling with COVID-19, in April-July when the lockdown was in force and staff diverted to combat the pandemic, said the National Health Mission (NHM).

The district worst hit by the pandemic, Indore, is also the one to fare the poorest among 51 others. The State’s largest urban centre could provide full immunisation coverage (FIC) to merely 8,502 infants (up to a year-old), or 32%, of the proportionate service need or target of 26,547, for the period. The district had surpassed its target for the same period last year, and showed 76.1% FIC, according to the National Family Health Survey (NFHS-4), 2015-16.

Crucial months

This year the State has to immunise 19,83,161 infants but had achieved 81% of its target for April-July, crucial months for immunisation before the monsoon hits and restricts mobility, with Guna, Vidisha, Harda and Indore districts not even touching 70% coverage. It had achieved nearly 90% of its target for the period last year.

Closure of child-care institutions, diversion of staff for COVID-19 duties, putting off village health and nutrition days (VHNDs) and the inability of workers to visit the field had been major challenges during the lockdown, Saloni Sidana, Additional Mission Director, NHM State unit, told The Hindu. “But we are picking up and achieving 90% coverage now,” she said.

Nearly 50% of the staff, including auxiliary nurse midwives (ANMs) and accredited social health activist (ASHAs), were dedicated fulltime to COVID-19, more so in urban areas, said Dr. Sidana. “Diversion of the staff has been a great reason for drop in the immunisation coverage,” she said.

House-to-house surveillance

However, she said the State was shifting its focus relating to COVID-19 from house-to-house surveillance to community participation at fever clinics so that ANMs, ASHAs and anganwadi workers were available for their regular duties. “We have directed workers to hold VHNDs as usual on Tuesdays and Fridays, when immunisation sessions are organised too,” she said.

Restrictions on public transport had further hit immunisation, said Santosh Shukla, State Immunisation Officer. Still, he said deploying jeeps in 89 tribal blocks and mobilising Rashtriya Bal Swasthya Karyakram teams helped. “In fact, parents often refrain from bringing children to centres for the fear of contracting the infection,” he said.

In April and May, 26,000 immunisation sessions were lost. Whereas, there were 51,590 dropout sessions in March-May, planned but not held for various reasons. To make up for it, the State government undertook three catch-up sessions in May, June and July, vaccinating 2,56,103 children and 83,191 pregnant women.

Notably, Jhabua, Alirajpur and Sidhi districts had in April-July immunised more infants than projected for the period. Further, 11 districts, mostly tribal, had achieved at least 90% of their target.

“This is owing to the migrants who returned,” said Dr. Shukla. The first catch-up session vaccinated 1,03,174 children who’d returned along with their parents from other States, 56% of the target. “This is Madhya Pradesh’s unique feature. We had the foresight to identify children of migrants at inter-State borders across 35 districts requiring immunisation as they returned, and launched the first drive for them,” he said, adding the government would provide their details to other States as migrants returned.

Staggered sessions

Immunisation in Bhopal, the capital city racked severely by the pandemic, touched 96% in April-July as the administration opened ward-level immunisation centres allowing for staggered sessions and counselled families during surveys, said Dr. Shukla. “Whereas in Indore, the disease has spread to several wards, so setting up camps has been difficult,” he said.

Dr. Sidana said the government was focusing on improving logistics. “Transporting vaccines and maintaining cold storage was a problem during the lockdown,” she said.