Mission to accelerate SDG implementation

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Mission to accelerate SDG implementation

Saturday, 08 February 2020 | Rakesh Kumar

Taking advantage of the platform provided by Mission Indradhanush and the Intensified Mission Indradhanush, a local area development approach will promote integration and inclusion of the most vulnerable, as mandated for sustainable development

There are several laurels in the basket of public health that India has achieved recently. We eradicated polio in 2014 and were successful in maternal and neonatal tetanus elimination (MNTE) a year later, two monumental achievements in consecutive years. Also, in a relatively short span of time, India has witnessed introduction of four new vaccines: Pneumococcal Conjugate Vaccine, Rota Virus Vaccine, Inactivated Polio Vaccine and Measles-Rubella vaccine.

To further ensure that we go beyond the 65 per cent full immunisation coverage (FIC), as in 2013, which potentially left out as many as nine million children and pregnant women from the ambit of routine immunisation (RI), a focussed Mission Indradhanush was launched on  December 25, 2014 to cover all neglected and partially immunised children and pregnant women.

These were largely the marginalised communities concentrated in deprived areas such as urban slums, unsettled populations, construction sites, riverbed mining sites, brick-kilns, forest and tribal populations, areas with low RI coverage and pockets with measles/vaccine preventable disease outbreaks. They were also the areas with vacant sub-centers (where primary health workers were not posted or were on long leave) and small villages, hamlets, remote villages/clusters that did not have independent RI sessions.

Intensified Mission Indradhanush (IMI) followed in 2017 to give a further fillip and fill in the missing gaps. These focussed programmes with sturdy implementation and monitoring frameworks have indeed yielded a significant improvement in FIC of approximately five-six per cent annually, compared to one per cent yearly increase during the pre-2013 period. Currently, IMI 2.0 version is being rolled out in 272 districts of 29 States, besides 650 blocks in Uttar Pradesh and Bihar from December 2, 2019 with four rounds planned till March 2020.

As Mission Indradhanush celebrated its fifth anniversary on December 25, maybe it is time to look at this strategy as a model of development which goes beyond an isolated strategy to improve maternal and child vaccination. When we analyse the areas of low immunisation coverage, we realise that these are typically the homes and communities which not only are excluded from the RI ambit but are also ridden with multi-dimensional developmental deprivations.

They would, in all probability, have poor hygiene and sanitation; lack of safe drinking water; safe housing; quality education; poor nutrition; a high disease burden and lack of access to quality healthcare, besides having very little access to employment opportunities. These would also be homes suffering from social-economic-cultural disabilities and, being on the margins of communities, they do not have easy access to various developmental and social security services. Such communities, with missed children and pregnant women from the vaccination ambit are now being used to provide the underlying blueprint for expanding the immunisation coverage.

However, the beneficiaries of Mission Indradhanush are also the proxy markers for providing a bouquet of multiple services, beyond vaccination and public health. In essence, we are moving from merely vaccines to public health onto a focussed point-of-care model of taking development to the doorstep of marginalised communities and deprived areas which probably deserve it the most.

Having earmarked such areas in each district by using the vaccination coverage as a proxy marker, we could saturate them with an expanded basket of services beyond public health. National and State Governments can roll out the schemes targetting multi-dimension poverty by creating an expanded basket of services from the schemes around agriculture, horticulture, rural development and employment-generation, skills development, social protection, financial inclusion, welfare services, nutrition, water and  sanitation, education, healthcare, housing, rural roads, and so on, for the earmarked areas of multiple deprivations.

This convergent local area development approach, or a 3D model (expansion of-services, coverage, and finances/funds) as it were, could contribute effectively towards multisectoral and sustainable outcomes by bringing together different vertical ministries and departments on one platform. Taking a leaf from our successes in public health programmes, just as there has been focussed implementation and monitoring of national programmes such as eradication of polio, MNTE, Mission Indradhanush and so on, we even for the other developmental schemes, need to formulate local area micro-plans with an expanded basket of services for implementation under the direct supervision of District Magistrates/Collectors with close monitoring, using robust monitoring tools for improved outcomes.

What also rhymes across in this strategy is that health and well-being are placed almost as a fulcrum in the Sustainable Development Goals (SDGs). The health goal (SDG-3) is broad: “Ensure healthy lives and promote well-being for all at all ages.”

In addition, health is also framed as a contributor to and beneficiary of sustainable development. However, what is also widely acknowledged is that SDG-3 being inter-linked with other goals, achieving its targets will also depend on the progress made in other SDGs related to poverty reduction; education; nutrition; gender equality; clean water and sanitation, sustainable energy and safer cities and housing.

Taking advantage of the platform provided by Mission Indradhanush and IMI, this local area development approach will not only promote integration and inclusion of the most vulnerable, as mandated for sustainable development, but will surely fast-track achieving SDGs by 2030.

(The writer is Chief Advisor, UNDP India and former Joint Secretary Ministry of Health & Family Welfare)

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