The health department of Tamil Nadu is in a dilemma over whether to stick to the revised strategy of conducting the immunization programme at the Public Health Centres or to revert to the earlier practice of holding rural camps at the villages for giving the shots. The perplexity is due to the incessant protest being held in the state by the nurses associations and other health workers, who are demanding the government to give up the revised strategy, as it does not fully cover the targeted population.
Commenting over the issue, Dr S Elango, director of Public Health and Preventive Medicine, Tamil Nadu, said the program is going on smoothly and for the time being there is no plan of reverting but is aiming to evaluate the new scheme by conducting a survey all over the state beginning by October this year. Some national or international agencies concentrating on healthcare, like UNICEF or WHO or any NGOs, would be assigned to examine the new system. According to that survey report, the Government will take a decision.
In May this year, the government had closed all immunization camps in the rural areas of the State and started conducting the immunization programmes at its Public Health Centres (PHCs) under the supervision of medical officers. The order was followed by the death of four ten-month-old infants in Thiruvalluvar and Dindigul districts on April 23, after being administered anti-measles vaccine at two immunization camps.
Dr Elango said, after the Thiruvalluvar incident a high level committee chaired by himself, the director of the Institute of Child Health, other paediatricians, NGO representatives, public health experts and village health nurses suggested that the immunization should be done in some health institutions under the observation of doctors. The government accepted their recommendations and shifted the vaccination program to the PHCs. Along with this the health department took initiative to combine vaccination with health check ups and parental counselling. He said for outreach services, mobile clinics supervised by a Medical Officer have been provided to all the PHCs.
"Previously the immunization was being held in as much as 38,000 camp sites, set up by the department, in the rural areas. Now we have 1421 PHCs in the state. So there will be no complication in the case of quality and quantity of vaccines also", he said. According to some other officials in the department, there is very good response from the public towards the new vaccination protocol and very good turnouts are being registered from morning onwards.
Even though the program is going on successfully, the new move of the department has sparked a dissent among the village health nurses and other health workers. Government held discussions with the Nurses Union leaders many a time, however no lasting solution was found so far.
The nurses and other health workers are holding agitations all over the state against this revised policy. They are of opinion that the policy of getting mothers and children to come to the PHCs for vaccination is clearly anti-women and anti-children and it takes services away from the nurses and instead force them to travel long distances to access healthcare.
The office-bearers of some nurses associations alleged that there were some kind of ulterior motives in transferring the load borne by the health sub centres at the village level to the PHCs and they demanded the policy should be given up immediately for the sake of both the nurses community and the poor children in general.
Dr Kanagasabhapathy, President of the Tamil Nadu Government Doctors Association said this revised strategy has reduced the significance of the universal immunization program and has become difficult for the people to manage in getting their children vaccinated, as most of the centres are 20-25 kilometres away from the rural areas. Not all of the village people are willing to take their children to the centre travelling a long distance. He said even if the immunization is held under the close observation of doctors, there is possibility to occur baneful incidents. For the smooth going and for the benefit of the rural people the program should be brought to the earlier position, he said.
Meanwhile the health department has introduced one more vaccine, Japanese Encephalitis (JE), for immunization from this Month. Dr Elango said, already there are six vaccines being used for the multi immunization programme namely BCG, DPT, OPV-3 (polio), measles, hepatitis-B (IV) and TT. The immunization programme has been continuing in the state on every Wednesday for the last four decades against six diseases.