3/25/2017 CASE STUDY ON

Importance of
mission
Indradhanush
TABLE OF CONTENTS
1. INTRODUCTION
2. WHY IS FULL IMMUNIZATION ESSENTIAL?
3. OBJECTIVES OF MISSION INDRADHANUSH
4. STRATEGY OF MISSION INDRADHANUSH
5. IMPLEMENTATION
6. AREA UNDER FOCUS
7. CONCLUSION
 INTRODUCTION

Mission Indradhanush is a health mission of the government of India. It was launched

by Union Health Minister J. P. Nadda on 25 December 2014. It aims to immunize all children
under the age of 2 years, as well as all pregnant women, against seven vaccine preventable
diseases.

The diseases being targeted are diphtheria, whooping cough, tetanus,

poliomyelitis, tuberculosis, measles and Hepatitis B. In addition to these, vaccines
for Japanese Encephalitis and Haemophilus influenza type B are also being provided in
selected states. 201 districts will be covered in the first phase. Of these, 82 districts are in
the states of Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh. The 201 districts
selected have nearly 50% of all unvaccinated children in the country.

Full immunization against preventable childhood diseases is the right of every child. With a
view to provide this right to every child, the Government of India launched the Universal
Immunization Program (UIP) in 1985, one of the largest health programs of its kind in the
world.
Despite being operational for over 30 years, UIP has been able to fully immunize only 65%
children in the first year of their life and the increase in coverage has stagnated in the past 5
years to an average of 1% every year.

To strengthen and invigorate the program and achieve full immunization coverage for all
children at a rapid pace, the Government of India launched Mission Indradhanush in
December 2014.
Mission Indradhanush will ensure that all children under the age of two years and pregnant
women are fully immunized with all available vaccines.
 WHY IS FULL IMMUNIZATION ESSENTIAL?

Simply put - because children are dying due to entirely preventable diseases.
Every year in India, 5 lakh children die due to vaccine-preventable diseases.
Another 89 lakh children remain at risk, because they are either unimmunized or partially
immunized against vaccine-preventable diseases.
Partially immunized and unimmunized children are most susceptible to childhood diseases
and are at a much higher risk of dying as compared to fully immunized children. If that were
not reason enough, immunizing children can go well beyond saving individual lives. It can
help in preventing large-scale outbreaks of diseases as well as keeping the disease under
control in an area, thus reducing the stress on an already burdened health system.
Thus, full immunization is critical if we want to reduce child mortality and progress on socio-
economic indicators.
 OBJECTIVES OF MISSION INDRADHANUSH

The government intends to cover 201 high focus districts in the first phase of year 2015.
These districts have nearly 50% of all unvaccinated or partially vaccinated children. Out of
these 201 districts, 82 districts lie in just four states of India namely, UP, Bihar, Madhya
Pradesh and Rajasthan. Nearly 25% of the unvaccinated or partially vaccinated children of
India live in these 82 districts of 4 states. Furthermore, another 297 districts will be targeted
in the second phase of year 2015.
The Mission Indradhanush aims to cover all those children by 2020 who are either
unvaccinated, or are partially vaccinated against vaccine preventable diseases. India’s
Universal Immunisation Programme (UIP) provide free vaccines against 11 life threatening
diseases, to 26 million children annually. The Universal Immunization Programme provides
life-saving vaccines to all children across the country free of cost to protect them against
Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis
due to Haemophilus Influenza type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and
Rotavirus diarrhoea. (Rubella, JE and Rotavirus vaccine in select states and districts).
The goal of Mission Indradhanush is to ensure full immunization with all available vaccines
for children up to two years and pregnant women.
The Mission is strategically designed to achieving high quality routine immunization
coverage while contributing to strengthening health systems that can be sustained over
years to come. In the last few years, India’s full immunization coverage has increased only
by 1% per year. The Mission has been launched to accelerate the process of immunization
and achieve full immunization coverage for all children in the country.
The Government has identified 201 high focus districts across 28 states in the country that
have the highest number of partially immunized and unimmunized children.
Mission Indradhanush will target these districts through intensive efforts and special
immunization drives to improve the routine immunization coverage in the country.
 STRATEGY OF MISSION INDRADHANUSH

Mission Indradhanush will be a national immunization drive to strengthen the key functional
areas of immunization for ensuring high coverage throughout the country with special
attention to districts with low immunization coverage.
The broad strategy, based on evidence and best practices, will include four basic elements-
Meticulous planning of campaigns/sessions at all levels: Ensure revision of microplans in all
blocks and urban areas in each district to ensure availability of sufficient vaccinators and all
vaccines during routine immunization sessions. Develop special plans to reach the
unreached children in more than 400,000 high risk settlements such as urban slums,
construction sites, brick kilns, nomadic sites and hard-to-reach areas.
Effective communication and social mobilization efforts: Generate awareness and demand
for immunization services through need-based communication strategies and social
mobilization activities to enhance participation of the community in the routine
immunization programme through mass media, mid media, interpersonal communication
(IPC), school and youth networks and corporates.
Intensive training of the health officials and frontline workers: Build the capacity of health
officials and workers in routine immunization activities for quality immunization services.
Establish accountability framework through task forces: Enhance involvement and
accountability/ownership of the district administrative and health machinery by
strengthening the district task forces for immunization in all districts of India and ensuring
the use of concurrent session monitoring data to plug the gaps in implementation on a real
time basis.
The Ministry of Health and Family Welfare will establish collaboration with other Ministries,
ongoing programmes and international partners to promote a coordinated and synergistic
approach to improve routine immunization coverage in the country.
 IMPLEMENTATION

Focused and systematic immunization drive will be through a “catch-up” campaign mode
where the aim is to cover all the children who have been left out or missed out for
immunization. Also the pregnant women are administered the tetanus vaccine, ORS packets
and zinc tablets are distributed for use in the event of severe diarrhoea or dehydration and
vitamin A doses are administered to boost child immunity.
Mission Indradhanush Phase I was started as a weeklong special intensified immunization
drive from 7th April 2015 in 201 high focus districts for four consecutive months. During this
phase, more than 75 lakh children were vaccinated of which 20 lakh children were fully
vaccinated and more than 20 lakh pregnant women received tetanus toxoid vaccine.
The Phase II of Mission Indradhanush covered 352 districts in the country of which 279 are
medium focus districts and remaining 73 are high focus districts of Phase-I. During Phase II
of Mission Indradhanush, four special drives of weeklong duration were conducted starting
from October 2015.
Phases I and II of the special drive had 1.48 crore children and 38 lakh pregnant women
additionally immunized. Of these nearly 39 lakh children and more than 20 lakh pregnant
women have been additionally fully immunized. Across 21.3 lakh sessions held through the
country in high and mid-priority districts, more than 3.66 crore antigens have been
administered.

Phase III of Mission Indradhanush was launched from 7 April 2016 covering 216 districts.
Four intensified immunization rounds were conducted for seven days in each between April
and July 2016, in these districts. These 216 districts have been identified on the basis of
estimates where full immunization coverage is less than 60 per cent and have high dropout
rates. Apart from the standard of children under 2, it also focussed on 5-year-olds and on
increasing DPT booster coverage, and giving tetanus toxoid injections to pregnant women.

Overall, in the first three phases, 28.7 lakh immunisation sessions were conducted, covering
2.1 crore children, of which 55 lakh were fully immunised. Also, 55.9 lakh pregnant women
were given the tetanus toxoid vaccine across 497 high-focus districts. Since the launch of
Mission Indhradhanush, full immunisation coverage has increased by 5 per cent to 7 per
cent.

Phase IV of Mission Indradhanush was launched from 7 February 2017 covering the North-
eastern states of Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland,
Sikkim and Tripura. It is to be rolled out in rest of the country in April 2017.
The Ministry is being technically supported by WHO, UNICEF, Rotary International and other
donor partners. Mass media, interpersonal communication, and sturdy mechanisms of
monitoring and evaluating the scheme are crucial components of Mission Indradhanush.
 AREA UNDER FOCUS

The following areas are targeted through special immunization campaigns:

1. High risk areas identified by the polio eradication programme. These include populations
living in areas such as:
 Urban slums with migration
 Nomads
 Brick kilns
 Construction sites
 Other migrants (fisherman villages, riverine areas with shifting populations etc.) and
 Underserved and hard to reach populations (forested and tribal populations etc.)
2. Areas with low routine immunization (RI) coverage (pockets with Measles/vaccine
preventable disease (VPD) outbreaks).
3. Areas with vacant sub-centers: No ANM posted for more than three months.
4. Areas with missed Routine Immunisation (RI) sessions: ANMs on long leave and similar
reasons
5. Small villages, hamlets, dhanis or purbas clubbed with another village for RI sessions and not
having independent RI sessions.
 CONCLUSION

The main pillars of implementation of Mission Indradhanush are micro-planning and

activities supporting IEC (Information, Education & Communication). Meticulous planning
was done based on counting of children who were either left out or dropped out of the
immunization schedule. Sessions were planned keeping in mind the aim and strategy of the
Mission to reach poorly covered areas. Strong emphasis has been laid upon communication
and social mobilization efforts, to generate demand for immunization amongst the
population otherwise covered poorly.
Personnel engaged with different aspects of the immunization program were specifically
trained for the implementation of the Mission’s goals including Medical Officers, frontline
health workers, data handlers, cold chain handlers, finance officers and IEC nodal persons.
The long-term goal of Mission Indradhanush is to strengthen the health system through
collaboration of central and state governments and development partners, identification
and levelling of the gaps in existing routine immunization program, development of human
resource, and a sustainable effort in expansion of micro-plans for routine immunization.