Completing Polio Eradication in Bihar

This is a draft document which includes planning for polio immunisation, monitoring, and tracking in the states of Bihar, India. From the introduction: "This document provides a situation analysis for the two polio serotypes currently circulating in Bihar (types 1 and 3), establishes objectives for 2008, and provides strategies for improving the quality of operations. It aims to supplement the technical recommendations made by the Indian Expert Advisory Group on Polio Eradication (IEAG) regarding the strategic use of polio vaccines so that taken together, a robust strategy will be in place to enable Bihar to lead India to success with polio eradication by the low transmission season in early 2009."


This 12-page draft document includes the following strategies resulting from the conclusions of the situation analyses and the objectives:


"In order to ensure that these goals are achieved, the Government of Bihar, along with support from its partners ([the World Health Organization] WHO, [the United Nations Children’s Fund] UNICEF, Rotary), proposes to:

1. Rapidly address remaining challenges in 72 recurrent transmission blocks.
2. Maintain quality operations in "polio-free" blocks to prevent reinfection.
3. Use monovalent vaccines judiciously based on evolving epidemiology and prioritization on eradication of remaining type 1 polio followed by type 3.
4. Accelerate improvement of routine immunization through support of Muskan [a recent state initiative]."

The document offers annexes that group locations based on the types of challenges for polio immunisation that each offers, based on available data and knowledge of the areas. It recommends convening a special task force of multi-sector government staff, particularly involving district and division officials, for a riverene area that is difficult to access. It recommends funding to decrease the immunisation team-to-supervisor ratio and to re-establish community health sub-centres, as well as fill vacant posts connected to the immunisation project. Further, it recommends that partnering organisations work with local health officials to establish "operational grids" within the compromised areas to ensure no area is missed, as well as increase monitoring of supervisors and teams, and liaise with community leaders to mobilise support.


In areas of community resistance or non-support of immunisation efforts, the document recommends meeting with officials from the areas, conducting detailed social mapping to identify community leaders, checking composition of teams for acceptability in their communities, and conducting interpersonal communication training of all vaccinators and supervisors working in these areas. It recommends recruiting additional community workers from areas of polio prevalence who are from underserved populations. For the areas with transit points shared with Nepal, while studies of reasons for recurrent transmission are in progress, transit post immunisation, as stated here, needs to remain robust.


In "polio free" blocks, the document calls for support by partners and government officials for current strategies including:

1. "High quality house to house vaccine delivery.
2. Transit teams coverage of major transit points
3. Focus on identification , immunization and tracking of newborns.
4. Revisit and immunization of X [non-vaccinated] houses during bi-phasic and B-team activities.
5. Mobilization of the population through Community level workers (CMCs)."

With the prioritisation of eradication of type 1 polioviruses, according to the document, epidemiological work will be taking place to guide the shift to type 3 prevention. Finally, the document recommends the support of a government of Bihar programme, called "Muskan", through review of microplans, training of vaccinators, tracking, monitoring, and mass communications support for this initiative.


Click here to download the complete document in MS Word format.