New Delhi: For India to achieve its target for health for all will depend heavily on grassroot healthcare providers like Anganwadi workers, ANMs (Auxiliary Nursing Midwives) and ASHAs (Accredited Social Health Activists). These foot soldiers fight against all odds not only to spread awareness about mother and child care during pregnancy and the first thousand days of a child, importance of nutrition but also to administer vaccination so crucial for the survival of the child and its immunity. To make it easy for health workers to increase the immunisation coverage especially in villages, an ‘Immunization Support Package’ also called as vaccine delivery kit has been developed by Vihara Innovation Network (VIN), a Delhi based organisation working on improving public healthcare in rural areas. Talking about the idea behind designing the vaccine delivery kit, Aditya Dev Sood, founder of Vihara Innovation Network said,
Vaccines save millions of lives each year and are among the most cost-effective health interventions ever developed. Immunization has led to the near eradication of diseases like smallpox and polio. Despite these great achievements, there still remains an urgent need to reach all children with life-saving vaccines. Since we have been working on various projects related to public health over the past few years, we decided to innovate a product that can help in increasing the pace of immunisation in the country. After speaking with many frontline workers, we found that the lack of adequate immunisation infrastructure is one of the major reasons for this gap and the person administering vaccination gets the extra burden of singlehandedly managing and taking care of all equipments, vaccines and personal stuff.
On being asked about the challenges faced by the frontline workers to administer one round of vaccination in an area, Usha Devi, a health worker in Singhwara in Bihar’s Darbhanga, said,
Most of the people in villages do not come to healthcare centres for vaccination. So we need to take the centre to them. We are given the duty to go to each house and see that all children, new mothers and pregnant women get vaccinated. And then because we are going door-to-door, we need to carry a lot of things this and for long distances too, because people in villages do not live in buildings like in cities. They live in small clusters that are separated and far from each other because of the farms. Many times we don’t even get a proper table to spread all things required like registers for record-keeping, needles, spirit, cotton, scissors, stethoscope, blood pressure measuring machine, haemoglobin testing kit, 10-15 packets of ORS (Oral Rehydration Solution) and zinc tablets, and Vitamin A.
She further said that it takes multiple bags and one big and heavy insulated vaccination box to carry all the necessary tools. However, she said, immunization support package has helped them carry everything in an organized manner in one box.
According to Mr. Sood Vihara Innovation Network, which was established in 2002, came up with the design of vaccine delivery kit in 2013 which they tested and piloted in few villages of Darbhanga, Bihar with support from Bill and Melinda Gates Foundation. After successful results, the organisation tied up with a few primary and community health centres in Bihar and Maharashtra where they have provided the kit to more than 200 health centres. The vaccination delivery kit includes – insulation jacket for safety and maintaining the required temperature of vaccines, soft padded slots to store the bottles, special slots to store tablets and ORS packets and immunisation cards for helping the health worker to maintain a track of vaccine cycles of the people.
Further explaining about the vaccine delivery kits Nida Yamin, a researcher at Vihara Innovation Network said that the kits also employ a set of innovations including portable workstation, mobilisation package, and village immunization status tracking dashboard. Portable workstation provides a hygienic space for quality care to the patients which, as per Nida, increases the trust of the people and ensures safety and efficacy during the vaccination process. Mobilisation package includes devices for announcements about the vaccination camps while the immunization status tracking dashboard tracks each vaccination in order to help people complete the immunization cycle.
The kit which costs a little over Rs. 4,000 and also acts as a guide for the health workers as all the contents are set in the correct order for administering the vaccine like rubbing spirit needed first to be applied before inserting the injection, then the syringes needed for the job are placed, followed by the adhesive band needed for compressing the nerve after injection, safe disposal mechanism.
While talking about how helpful the kit has been, Usha Devi highlighted that since it has become easily portable and comes with a built-in workstation and thus removing the constraint of lack of tables, it has become easier for them to cover all house in lesser time. She said,
When vaccination camps take place, I have to go to each house in the area assigned to me. I work as ANM in three villages. Earlier, it used to take the whole day to complete a set of 70-80 houses but with the help of the vaccine delivery kit, I am able to work faster and cover more houses in a day.
Mr. Sood who along with his team has been working on innovating solutions to problems faced by frontline workers in the public health sector asserted that technology can make delivery of health facility easy and can widen the coverage of the initiative. According to Dr. Vandana Anand, a paediatrician, in Delhi immunisation coverage in India among children is about 62 per cent, as per National Family and Health Survey (NFHS 4), but the central government aims to increase this to 90 per cent by the end of 2020. She further said that innovations like portable and easy to use vaccine delivery kits can be helpful in improving immunization coverage.