Prime Minister Narendra Modi’s home state, Gujarat, which he propagated as the “model” for other states to follow, is facing a major challenge on the health front: If the World Health Organization (WHO) is to be believed, Gujarat’s immunization coverage of one-year olds is one of the worst among Indian states – 72.8% as against the national average of 78.8%.
Worse, out of 21 major Indian states, Gujarat’s immunization coverage is better than just three states – Assam, Uttar Pradesh and Rajasthan. Even Bihar, Jharkhand and Chhattisgarh and Jharkhand, known for extremely poor performance in social sector, have a better immunization coverage among the one-year olds than Gujarat, 80.6%, 82.2% and 91.7%, respectively.
A study of 10 countries, Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda, the 92-page
WHO report, “Explorations of inequality: childhood immunization”, released this month, seeks to analyze how things stand in each of these countries against the backdrop of the United Nations 2030 Agenda for Sustainable Development, which resolved to combat inequalities within and among countries.
Analyzing DTP3 (which stands for three doses of diphtheria, tetanus and pertussis vaccines) immunization coverage, the report states, in India, the “coverage was equal in boys and girls and female- and male-headed households, and there was little difference between coverage in urban and rural areas”.
However, it notes gaps when one takes into account factors like mother’s education level (less-educated subgroups showing lower coverage) and wealth quintiles (poorer quintiles showing lower coverage).“DTP3 immunization coverage tended to be lower among children of mothers aged 35–49 years, children belonging to scheduled tribes and children in certain subnational regions”, the report says, adding, “There was a weak, although significant, association for mother’s age at birth and mother’s caste/tribe as well as for place of residence.”
WHO continues, “Children with highly educated mothers aged 20–49 years who belonged to the richest 20% of the population had a 5.3 times higher chance of being vaccinated, compared with children born to teenaged mothers with no education, in the poorest 20% of the population.”
The report notes, “Sex-related inequality was non-existent, as male and female children presented the same level of coverage (79%)”, adding, “Looking at mother’s characteristics, the coverage of DTP3 immunization was the same for the 15–19 years and 20–34 years subgroups (79%), while coverage was lower in the 35–49 years subgroup (70%).”
Further, it says, “The gap between the no education subgroup and the subgroup with more than secondary education was 18 percentage points.”
Then, the report says, “There were small differentials in DTP3 coverage by mother’s caste/tribe: Coverage was higher among those in the scheduled caste, other backward class or other subgroups (coverage around 80%), whereas coverage was lower in the scheduled tribe subgroup (74%).”
It adds, “Coverage across subnational regions varied markedly. Nagaland and Arunachal Pradesh had the lowest coverage at 53%, whereas 9 out of the 36 regions reported coverage of 90% or higher”.
The report believes, given this framework, key challenges for India’s health policy for better immunization activities include “weak health information systems and low capacity for monitoring and evaluation (resulting in a lack of evidence for planning and research activities); and human resource shortages in management, research and operations at all levels.”
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