The top delivery challenge in India
Coca-Cola and improved child health? The link is not obvious until you consider the logistical challenges of delivering millions of courses of fragile, temperature-sensitive vaccines to remote parts of India. The multinational corporation has solved its distribution problem, India’s health care system has not. However, it’s all changing. India counts 27 million births each year—the largest birth cohort in the world—and must deliver a series of vaccines to safeguard each child from deadly diseases. In 2014, 400 million vaccine doses were administered under the government’s immunization programme.
Nevertheless, 44% of young children don’t receive the full schedule of vaccines and are at risk of contracting life-threatening diseases (and causing disease outbreaks in their communities). Every year, one million children die in our country before they are five years old.
The Mission Indradhanush initiative aims to provide 100% vaccination coverage to more than 90% of newborns by 2020. These vaccines must be timed to a child’s development and given in a precise sequence. A complete course costs about Rs.200-250, a negligible price to save a child’s life.
Vaccine delivery requires more than just syringes and needles. The vaccines need to be kept in a cold chain from the moment they are manufactured until they are administered.
This is where Coca-Cola provides a model. Immunization programmes are now using technology to minimize breaks in the delivery system. To serve both the government’s routine immunization and Mission Indradhanush programmes, more than 27,000 cold chain points have been introduced. Each has refrigerators and deep freezers, many powered by solar energy and diesel generators, to keep the vaccines at optimum temperatures.
Innovations piloted by the immunization technical support unit of the UIP (universal immunization programme) include systems that track the vaccines electronically, allowing central administrators to monitor their condition and distribution. Refrigerators outfitted with temperature sensors send information to monitoring teams every half-hour. The high-tech monitoring ensures vaccines do not spoil en route to remote areas.
A final challenge arises at the point of last-mile connectivity. This is where the foot soldiers of Mission Indradhanush and routine immunization programmes are deployed. Auxiliary nurse midwives, ASHA and anganwadi workers help families understand the importance of vaccination. They collect the vaccines from health centres and carry them in ice-boxes for the last leg in the cold chain.
Smart technology, targeted resources and human resolve are required in equal measures. Though the first two often receive attention, front-line health workers are essential in the war against vaccine-preventable diseases and form the backbone of the immunization programme. The commitment of our front-line health workers to the implementation of latest technological solutions has helped to scale up the immunization programme to reach the remotest part of the country and to make sure that no child remains unimmunized.
The author is vice-president for research and policy at the Public Health Foundation of India that works towards strengthening education, training, research and policy development in the area of public health.