The ongoing measles outbreak in Mumbai has outlined the problem of maintenance of vaccination records under the national immunisation programme. Tracing back the children years after inoculation turns into an uphill task in the absence of digital records, according to people in the know of the matter.
While local public representatives voice the need for a health card linked with a government identity card, vaccination data upkeep on the Centre’s portal suffers due to unavailability of internet and technological glitches.
The problem can be highlighted by the plight of Abdul Rahim Khan, father of Noorain Khan, 3, the first child to succumb to measles in Mumbai in October. Although the Brihanmumbai Municipal Corporation (BMC) stated that Khan didn’t vaccinate the deceased child, he said, “I have vaccinated all my children. I also had their vaccine certificates but during a demolition of illegal shanties, all the documents got destroyed.” To cross-check his claims, the BMC checked the documents at the Rafi Nagar Health Post but couldn’t find any record. “If he was vaccinated at this area, we would have found the certificate,” said Dr Upalimitra Waghmarem, medical officer of M-East ward. “If the child was vaccinated in another health post or ward, we won’t have the data as it is not maintained digitally,” she added.
Annually, around 1.40 lakh child births are reported in Mumbai. If the children get vaccinated in the public sector, they are given a “mother and child card” that records all the details of their vaccination along with the dates.
“Many a times, the parents lose their vaccination certificates or forget to carry it for follow-up dosages,” said Dr Mukesh Agrawal, former head of paediatric department at KEM hospital in Parel.
But none of these reports are maintained at the centralised server at the individual level. On a weekly or monthly basis, the data is updated in a group format, which doesn’t mention the name of the beneficiaries. Dr Agrawal explained that for instance, if anyone who is born on October 15, 2020 and doesn’t have the hard copy of the vaccination certificates, then the parents will have to provide the exact date and the name of the hospital where the child was inoculated. “It is an uphill task to track back the data after years. Also, as we have seen, the parents don’t remember the date of the vaccination, without which it becomes a more tiresome process,” he said.
Dr Bakul Parekh, past president of the Indian Academy of Paediatrics (IAP), said that if none of the documents are available to check vaccination status, the children can undergo disease-wise antibody tests. “. “But these tests are extremely expensive…so, it is better to get the vaccine again if in doubt as double doesn’t have any side-effects,” he said.
As a norm, the health department has the age-wise list of children who are eligible for vaccination. Then, calculating the number of doses used, the department calculates their vaccine coverage proportion. However, the process has one flaw: It fails to record the vaccination status of around five per cent of the children who are vaccinated by private practitioners.
Also, tracking the immunisation status of the migrating children in slums is not feasible in the current data maintenance process.
Taking note of it, Rais Shaikh, MLA, Bhiwandi has written to the BMC commissioner and National Health Mission demanding individual health cards linked with Aadhar card or birth certificates in physical form as well as digitized format so entire vaccination history can be accessed by Health department at any point of time.
“A digital health record for each Individual is must. It’s high time that we invest in newer technologies and build health records,” read the letter.
Meanwhile, the RCH portal which was launched years back and later upgraded for better maintenance of data starting from pre-natal and postnatal care along with the immunization of the children, has failed to solve the issue. “As there is no internet in remote areas, we have to maintain the data in ledger and then upload it on the portal in PHCs where internet is available. Sometimes, we have to walk for 10-12 kilometers just to update the data,” said said Ujwala K Paradeshi Auxiliary nurse midwife (ANM) who is responsible of 10 tribal-dominated villages in Jalgaon.
Similar problem is reported in Mumbai’s slums where the portal often crashes when the workers try to upload the data through the tablets provided by the government. “We are installing Wi Fi in the health posts. We have hired data entry operators but it would take some time to attain real-time status as we have a huge backlog,” said Waghmarem.