Bill & Melinda Gates Foundation

Polio Eradication in Action: Avoiding Complacency

January 27, 2012

Being in West Bengal, India on the anniversary of the country’s last polio case was extraordinary.  The state Ministry of Health is very happy but circumspect.  They know that much work remains until India can be certified polio-free along with the other countries in South East Asia. 

In the two years still needed to be eligible for certification, the government recognizes that they need to keep immunizing children in the routine system and through periodic campaigns.  They know they need to keep searching for cases. They know they have international borders where virus can come back unless they are vigilant. 

There is a well-functioning team here that joins the Indian government with the World Health Organization, UNICEF, Rotary International and CORE Group partners including  women’s groups and youth clubs. 

Traveling through West Bengal, I could see many of the 250,000 polio posters, banners, and decorations saturating the area.  In India, the first day of the campaign is a booth day, where a fixed-site immunization post is set up to give polio immunizations to as many children as possible. Booth day is followed by house-to-house immunization rounds where vaccinators search for children that did not go to the booth, especially newborns, sleeping or sick children and those who were away from home working in the fields or in school. 

I saw health workers at booths, looking very professional, with name tags, tally sheets and leaflets explaining all aspects of the campaign.  Each booth team immunized about a hundred children in a steady stream from 9am to 5pm.  Mobilizers were walking through communities reminding mothers of the campaign and letting the older children bring their brothers and sisters to the booth. 

For their participation, they might receive a whistle, plastic ball or a paper mask as a thank you, courtesy of Rotary International.  The mood was festive and the health workers were enthusiastic.  I was surprised that many of them did not know about the anniversary of the last polio case.

A visit to the local health center was also impressive – not only did the medical officer have a copy of the microplan on hand, but he knew all of the vaccinators personally and had the number of the surveillance officer posted prominently in his office. He expressed concern about the availability of vaccine supply for the routine immunization program and still too many families refusing vaccines for his liking.  He was optimistic that the momentum generated from the last polio case could be sustained – he did not want polio to come back after fighting so hard to get rid of it.

 The CORE Group Polio Project is a consortium of US and local non-governmental organizations dedicated to increasing community acceptance of polio vaccination, strengthening routine immunizations, raising awareness about good sanitation, hygiene, breastfeeding and nutrition, and identifying potential polio cases.  CORE is implementing innovative strategies to reach out to the community.

The day we were there, CORE partners had hired a magician, who is also a polio survivor to teach families about the importance of immunization. He visits villages with the lowest immunization coverage rates.

Drawing a crowd of over 50 people, I watched the magician request a coin for a slight of hand maneuver. He asked the people “What is more important, the coin or your child? A coin can be replaced, but if a child gets polio” - he said while pointing to his withered leg – “a child cannot be replaced – paralysis is for a lifetime.”  Querying the mothers after the show, they all could tell me why they should immunize their child. 

Behind the scenes, real-time data was being tallied from the day’s immunization activities to identify areas with less than expected coverage.  Phones were ringing as field supervisors called in preliminary results in the evening.  Plans were developed to visit houses where families had questions. 

One of the most impressive things I witnessed was the strong sense of local ownership and accountability. 

Youth clubs – which are very common in West Bengal – let booths be set up in their club houses and their members often helped find missed children.  The local women’s groups, who had been trained to mobilize communities , said it was critical to keep up the hard work and find every child, even the newborns. 

They pumped their fists in the air and proclaimed “No more polio in India.  We will fight to the end to make sure India is certified polio-free.”  

The US government has provided $2 billion dollars for polio eradication efforts since 1988 of the $9 billion spent thus far.  USAID has worked in partnerships with national governments, the United Nations and NGOs in the fight against polio in India.

 
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