I convey the gratitude of the entire country to Rotary International for its support in polio eradication, not only when India was an endemic country, but its continuing support in the entire battle against polio. In the phase we got critically stuck on the last mile, Rotary and other organisations came forward to be with the government.”
With these opening words Union Health Secretary C K Mishra conveyed the Indian government’s gratitude to Indian Rotarians for the Herculean battle they had waged, along with the WHO, UNICEF and the Central and State governments, to rid India of polio. The Health Ministry is again looking for strong and credible partners such as Rotary as “health care delivery cannot, and should not, be the business of the government alone, or else we can’t attain goals.” As Rotary had earlier effectively partnered the government, he urged Rotarians to continue the association as in polio “we learnt from you how to tackle and overcome obstacles. RI has a very strong presence, intellectual capacity and a wide network to aid the Indian health care delivery system.”
Partnerships are crucial
Mishra said partnerships were at the core of the redesigned national health mission; “stakeholders are part of most programmes, be it development partners, the doctor community or civil society. Rotary was an important partner and we’d like to carry this relationship beyond polio.”
In the phase we got critically stuck on the last mile, Rotary and other organisations came forward to be with the government.
– C K Mishra, Union Health Secretary
He said the Health Ministry had undertaken a very ambitious universal immunisation (UI) programme in Mission Indradhanush (MI). “The government found that nearly 90 lakh children are out of our UI programme and hence MI was launched. In the last two years we’ve reached out to 60 lakh of them. But when you start overburdening your lower level health care systems, you need substantial outside support and I seek your support not only in numbers. I know you have a repository of wisdom and knowledge in the field and a global connect that we can certainly use.”
He urged Rotarians to align themselves with national programmes. “One concentrated effort at one place is brilliant for that geography at that particular time. But unless it is scaled and sustained, it does not add value, so please ensure continuity.”
But this partnership need to be deepened and institutionalised with a follow up mechanism. “We in the ministry are extremely welcome of any new idea, no matter how critical it is to what we are doing. So please give us your ideas and suggestions,” the Health Secretary added.
Now the challenge is to take care of the Plus part, which include measles and rubella.
– Rajendra K Saboo, Past RI President
Addressing the meet PRIP Rajendra K Saboo, complimented Mishra for the crucial role he played in immunising the children of Bihar around the banks of the Kosi river during the floods. “If he hadn’t done that, we’d still be having polio in India.”
The ‘plus’ in PolioPlus
Explaining the ‘Plus’ in PolioPlus, of which many Rotarians had no clue, Saboo said that when Rotary signed an agreement at the international level with WHO, UNICEF, etc, “they said we just can’t talk only polio and it was decided that Rotary would take care of polio and the immunisation for 5–6 other diseases would be the ‘plus’. So now the challenge is to take care of the Plus part, which include measles and rubella. We are now going to sign an MoU with the Health Ministry,” he added.
He added that now that TRF had accepted to take on UI as a project in which Indian Rotarians would get involved, “we have to do it wholeheartedly. The Trustees are looking at India; if this succeeds they might start it in other countries too. Coming to the funds to do this, the money is there. It is there in your pocket, you just have to find it!”
He said some of the senior Rotary leaders were thinking of ways to propagate awareness on measles and rubella vaccination. And this could include, with help from Railway Ministry, two or three Railway coaches bearing messages such as ‘Make India measles and rubella free’ stationed for a few days in a place and then travelling to major stations.
Let’s become givers
RI Director Basker said that the biggest concern the RI Board had when Indian Rotarians were engaged in polio eradication was that “we were attempting to do the impossible. But we built partnerships with the government, sponsors, health workers, WHO, UNICEF and sought help from everyone. And made the impossible into possible and eradicated polio, making this one of the most successful stories ever written in the field of international health.”
But after India was declared polio-free Indian Rotarians had become a little complacent, but till polio lurked in our neighbourhood — Pakistan and Afghanistan — there was no room for any laxity. “Just imagine if polio returns, 23 years of our time, funds and the effort invested will have to be repeated. Those who attended the Atlanta Convention know we need $1.5 billion in the next three years to eradicate polio from the world.”
When my friend in WHO said in Bihar routine immunisation is beyond 73 per cent and in UP it is 68 per cent, I felt we can reach the goal of 85 per cent and more.
– Sushil Gupta, TRF Trustee
He added that till now India has been a receiver of funds for polio immunisation. “I have assured Trustee Sushil Gupta that this year the Trendsetter DGs are focusing on raising funds for the End Polio campaign. In the next couple of years our focus should be to collect money that others cannot imagine.” When this campaign started 25 years ago, Indian economy wasn’t doing so well. “Today we are the sixth largest economy in the world, second largest steel producer, fifth largest auto producer, sixth largest manufacturing country, and we have the third largest foreign exchange reserves in the world.”
Basker assured the Health Secretary that “with our field volunteers we will focus on the implementation of MI and prove we can do any job.”
TRF Trustee Sushil Gupta said today he could stand up with a sense of pride “because of what you and your predecessors have done in getting polio out of India.” He said when this proposal came up before the Trustees at their meet, “eyebrows were raised that when polio is still not eliminated from the world, why are we talking of something else when Pakistan and Afghanistan are still endemic countries. But we explained to them this is needed because it will strengthen the polio immunisation programme and keep polio out of India.”
He added that during a recent trip to Bihar he had checked the immunisation figures with a friend in the WHO and “he said in Bihar routine immunisation is beyond 73 per cent and in UP it is 68 per cent. That really made my day, and I felt we can reach the goal of 85 per cent and more. That time is not far; we can kick measles and rubella also out of India as we did polio.”
Recalling the first ever national rally for polio eradication in 1987 that was flagged off from the Rashtrapati Bhavan in Delhi by the President of India Giani Zail Singh, Gupta quoted a famous couplet from eminent poet Majhrooh Sultanpuri: Main akela hi chala tha janib-e-manzil magar. Log saath aate gaye aur karwaan banta gaya (I had started my journey alone, but along the way people joined me and the caravan materialised).
A bigger push required
In his opening comments INPPC Chair Deepak Kapur said: “Two million children, 7 lakh vaccination booths, 11 lakh vaccination teams, 1.5 lakh vehicles… you have done it, twice a year, year after year, every year, for 23 years. Indeed, our fight against polio helped Rotarians discover themselves and their true potential.”
But, he added, the past was always less important than the future. While Indian Rotarians did a great job with polio immunisation, the measles and rubella immunisation drive will be a different story. “We are talking about 30 million pregnant women, 26 million newborns, 9 million immunisation stations, 27,000 cold chain points… and this also includes protecting them against Hepatitis B and tetanus. Of course this is a mammoth programme, but let us do what we can.”
Introducing the new national committee members, to the group (See Box) he said they are “Rotarians who have done excellent work in Rotary activities and will stand by you, shoulder to shoulder.”
Underlining the need to continue to be vigilant against the return of polio, Kapur said the most important aspect of the vaccination programme, as in the past and “even more so today, is surveillance to ensure we don’t miss out on any child who has polio or polio-like symptoms.”
Giving an overview of India’s immunisation journey, Dr Balwinder Singh, National Programme Officer (Immunisation), WHO, said in 1978, “India and the world were struggling with smallpox, and there was no structured immunisation programme.” But once smallpox was eradicated, the entire world decided to have a proper immunisation programme.
In 1985, when the polio vaccine came on the scene, India decided that “we have to immunise every child”, and the age for polio drops was brought down from five years to a few months.
First the cold chain was established, next the capacity was shored up for manufacturing vaccines for six preventable diseases including polio. Our immunisation programme, he added, was “one of the largest public health programmes in the world. While in China 18 million children are born every year, in India, the number is 26.7 million. The numbers are huge, and even if we miss one per cent of the child population, it is a very big number.”
Singh disclosed that immunisation is done in nine million centres, which could be a hospital, a PHC, a sub centre or even a village chaupal, or anganwadi centre. Not all places have the necessary infrastructure. The vaccines are stored in the required temperature — 2–8 deg Celsius in nearly 27,000 centres.
He added that he was in Mewat in Haryana the previous day; “it is such a tough situation there. They challenged us to immunise their children. There is barely 18 per cent immunisation in Mewat; 90 per cent looks like a pipe dream.”
Pradeep Halder, Deputy Commissioner (Immunisation), the Health Ministry, said quite often at meetings, he is asked what has Rotary done to deserve so much credit and “I tell them puri ki puri train ke beech they got two wagons reserved for polio vaccines for Bihar! If anybody could do that or has done it, it is only Rotary to which credit goes for doing so only in 48 hours! Now once again, for MI we need you.”
Trustee Gupta expressed the confidence that Indian Rotarians could play a major role in UI, but reminded them that “we have only 16 months and not the long years we had for polio. So we need to change our strategy and course of action, make a new plan and implement it without thinking too much. As the Nike logo says… we have to just do it!”
As for the scary scenario projected earlier, where a large section of the minority was once again resisting taking polio vaccines, both Gupta and Saboo said this was a challenging scenario and would have to be tackled. Worse, Mewat might not be an isolated case, so Rotary would have to think and act on such resistance in other pockets of the country too.
Dr Singh added that MI comes under PRAGATI — Pro-Active Governance And Timely Implementation. “The Prime Minister himself monitors four or five programmes and MI is the only health initiative in this. His objective is to get over 90 per cent immunisation by 2018. So we’re looking for your support at all levels, particularly in high level advocacy as you have direct access to top people in the government.”
He added that MI has got so much clout, with the PM monitoring it that “11 ministries are asking ki hamey karna kya hei (what do we need to do). My appeal to Rotary is to get it cleared at that level… give them proposals and get them cleared. Money is not the issue. You have that power.”
New National PolioPlus Committee
PDG Deepak Kapur
RID C Basker
PRIP Rajendra Saboo
PRIP Kalyan Banerjee
TRF Trustee Sushil Gupta
PRID Ashok Mahajan
PRID Yash Pal Das
PDG Sushil Khurana
PDG Rajiv Pradhan
PDG Siddharth Bose
PDG Jogesh Gambhir
PDG Iqbal Singh Tomar
PDG E K Sagadevan
PDG R Badri Prasad
PP Ajay Saxena
Make sure you are there on the victory stand
Past RI President Rajendra Saboo told the participants at the Delhi Polio meet that Rotarians had dreamt of a polio-free world and there was concern in some quarters that at several polio events the Rotary logo was not there.
“Of course our role has been recognised by those who know of our work. But by the time the world becomes polio-free unless we make our presence felt, our contribution will be lost. When the world goes on the victory stand on that day, to ensure Rotary is there, it is important that we continue our efforts. Our work in measles and rubella vaccination will keep the name of Rotary alive in the minds of present leadership at the national and international level. So my appeal to the DGs, through the RI Director C Basker, is that when the final victory bugle is sounded, and you are not there, that will be disappointing. So you must ensure Rotary’s presence on that victory stand,” he added.
What the GoI expects from Rotary
In its ambitious goal to achieve over 90 per cent coverage of two doses of the PolioPlus vaccines — 9th and 18th month — to protect the child from polio, measles, rubella, TB, etc, this is what the Government of India needs from Rotarians, said Dr Balwinder Singh, National Programme Officer (Immunisation), WHO.
- High level of advocacy, total engagement with partners in the earmarked 118 districts and seven urban cities of India, most of which are in UP, Bihar, Madhya Pradesh, Maharashtra and Rajasthan.
- Identify and provide contact details of Rotarians at the State and District level associated with Mission Indradhanush (MI) so that government officials can approach the right people.
- A national-level task force with senior Rotarians who can be involved in important communications.
- Create awareness, raise visibility of the programme, support innovations.
- Constitute awards, as you did in polio.
- Political engagement; you have the reach.
- Get on board once again celebrities — cricketers and others sportspersons, film stars. Involve different State celebrities like Mithali Raj, Varnika Kundu who was stalked and got
huge media support… people who are trending on social media. Get badminton stars such
as Saina Nehwal, PV Sindhu; kabbadi league players who are huge in rural areas where
a big community watches them.
- Get Hindi, Bhojpur, Avadhi, Urdu and Punjabi speaking celebrities.
- Help the minority community where we are again facing a lot of problems. We need to get back the Rotary Ulema Committee for Immunisation, and the advocacy that Rotary did at the most critical phase of resistance to polio needs to be revived. Imams and Ulemas need to get on board.
- Power of the mobile phone. Let’s devise a plan to spread the message.
- Organise health camps, particularly in high risk areas.
- Engage community leaders, village pradhans. Get a competition going between sarpanches, even district magistrates. Institute awards or recognition in front of Chief Minister and other ministers.
- Brace up for more work; UI is huge, every week there is immunisation, it is not like polio camps. MI is fast tracking routine immunisation, and you’ll be going to those populations not visited before, where there is no service delivery.
- WHO is monitoring, so you will get authentic figures.
- Involve school teachers with an IT background. Spread the message through school and college bands, painting competition, etc.
- Organise events; Ek shaam immunisation ke naam at a good venue, and get numbers.
- Painting competition.
- Utilise school kids. Madrasas are changing, mindset is changing; if you give the message it will reach home. Last week we met a Bishop; we need help from them in the Northeast. Involve gurudwaras
- Organise walkathons, marathons, rallies as we did once upon a time.
- Acknowledge exemplary efforts.
- 1–2 minute video clips, maybe from the mother of an affected child.
- Messages on trains, flights.
- Link the immunisation card to Big Bazaar, giving a discount.. corporate can help and you can get them on board.
- Give them umbrellas, caps, banners. You have spoilt them in the polio programme!