Many years ago, when polio drops still aroused huge suspicion in parts of India, I remember a conversation I had with a Muslim family on the outskirts of Moradabad in Uttar Pradesh. The family, which lived in a narrow by-lane flanked by open sewers, was convinced that a “geopolitical conspiracy” lay behind the persistent attempts to give polio drops to their children. I particularly remember what a mother of four told me. She was intensely suspicious of volunteers who knocked on doors trying to track children who have been “missed” during the regular polio vaccination drives. She angrily said that her four-year-old son had been “forcibly” given polio drops when he was out playing. The family made it clear that they would not let the other children be vaccinated.
I spent the day trying to understand the reasons behind their deep distrust of the government’s polio campaign. There were many underlying reasons, rational and irrational. But one sentence has stuck in my mind because it reflected the core of the problem. “We want to know why the government is so keen on protecting our children against polio when it pays no attention to other diseases that strike us. We have heard the polio drop makes male children impotent. There are many questions, many doubts, but no one cares to drop by when there is no official polio campaign,” the mother of four told me. Like many others, the family’s anger at what they perceived as a dysfunctional healthcare system spewed into rage, irrational fear, and complete wariness of “outsiders”, especially health workers and field operatives of international agencies.
India has been polio-free for the last two years because national and international agencies driving the campaign for polio eradication realised the value of taking on board the concerns of people like the young mother I had met. They realised that to “sell” the polio campaign to reluctant families and overcome the pockets of resistance, they would have to simultaneously respond to concerns which some communities felt were equally legitimate.
Last week, this message was brought home to me again while chatting with Dr Orin Levine, director- Vaccine Delivery, Global Development Programme of the Bill and Melinda Gates Foundation. Dr Levine had just got to New Delhi after a visit to Bihar and was extremely excited by what he saw in places like Saharsa district.
One of the standard early critiques of the government’s polio campaign was that it was a ‘vertical’ programme that led to the neglect of other health interventions including routine immunisation. For example, in 2005, the proportion of fully immunised children in Bihar was barely 19%. The state, once synonymous with backwardness, stepped up its routine immunisation efforts that year through special drives. This was formalised in October 2007 as the Muskaan Ek Abhiyan (the smile campaign). The initiative was spearheaded by the state government, UNICEF, WHO and the National Polio Surveillance Project. It leveraged money from the National Rural Health Mission and linked immunisation to the chief minister’s political agenda. The programme was regularly monitored by the state’s health secretary.
Now Bihar and its development-oriented chief minister have many suitors. Since 2011, the Gates Foundation has been partnering the state government to run a programme called Ananya which focuses on improving healthcare for women, new-born babies and children in eight districts for five years. “While polio was being eradicated, routine immunisation was going up in Bihar,” says Dr Levine. This linkage has shown big results. Bihar’s immunisation coverage has gone up from 41% in 2007 to 66.6% according to the latest official figures Dr Levine says a major reason is the state’s focus on monitoring teams which provided the ‘feedback loop’ and captured the coverage data on the ground. This data helped spur corrective steps wherever they were needed. The results are evident in a host of other human development indicators too. The state’s infant mortality rate (IMR) has dipped from 61 in 2005 to 48 today.
In political shorthand, this has been described as “The Nitish Kumar effect”. It boils down to the ability to learn from others and good governance. This has not only improved healthcare facilities and education but is also paving the way for Bihar’s economic revival. In a pre-election year, words matter. But action on the ground matter more. Will other backward states also take the leap forward?
Patralekha Chatterjee is a Delhi-based writer