May 13, 2003	Tuesday	Rabi-ul-Awwal 10, 1424

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RAWALPINDI, May 12: Major changes in the strategy for Expanded Programme of Immunization (EPI) are in the offing as the programme has consistently failed to attain targets, a source said on Monday.

Under the proposed changes, the focus is being shifted from concentrating on vaccinators to enhancing awareness among the masses for EPI. The changes could see a reduction in the number of vacancies of the vaccinators and transfer of resources to the awareness campaign.

The theme of the proposed changes, the source said, was to pull the target population towards the EPI rather than making health workers run after the people to get their children vaccinated.

A study commissioned to evaluate the EPI identified the reasons for immunization failure as lack of information about the need, place and time of immunization, fear of side reactions, misconceptions about contra-indications, unawareness about subsequent doses, absence of motivation and faith in the exercise and rumours.

Certain obstacles like distant immunization place, inconvenient timing, absence of vaccinator, non-availability of vaccine, pre-occupation of mothers and family problems also contributed to the shortfall in coverage.

The report stated that this shortfall in the EPI coverage made health education by vaccinator doubtful.

The new strategy for EPI envisages that the fixed health facility like basic health units and rural health centres in any locality will be the focal point for vaccination and no outreach activity will be allowed in the radius of three kilometres of that facility.

The reason for attaching greater importance to fixed health centres for EPI in the revised strategy is because of the assessment report’s evaluation that immunization is being provided twice more by the fixed health centres compared to outreach teams.

Meanwhile, the catchment area of the health houses would be the lady health worker concerned. It has been further proposed that outreach activity would take place in areas falling beyond three kms and those which do not have health houses. Area located farther than 10kms would be catered for by the mobile teams.

The source said a master plan for action was being prepared, whereas training of personnel had already started.

Mentioning the examples of failure of EPI, the source said Rawalpindi, which has the best coverage rate in the province amongst the mega-cities, had almost 19.81 per cent of children of less than two years of age, who were either partially immunized or did not get any immunization at all.

It should be recalled that the EPI is being practised for over two and a half decades, but has been unable to achieve the desired objectives due to which the health department has been continuously revising its strategy.