All vaccinations in Andhra Pradesh are now given with autodisable syringes. For more information, visit PATH’s Vaccine Resource Library.

The Government of Andhra Pradesh, India, and PATH celebrate a successful model for excellent immunization services

Every year in Andhra Pradesh, India, more than two million women and children are now getting the protection they need from deadly diseases, thanks to progress made by the Government of Andhra Pradesh, with help from PATH.

We worked side by side with government officials to build a dependable, long-lasting immunization program where coverage rates nearly reach those in the United States. In fact, the program has proven so successful that ten other states and the national government are emulating it and are planning to deliver protection to millions more.

A better shot at a healthy life

Health care is often out of reach in developing countries. For example, many of the 80 million people living in Andhra Pradesh live more than a day’s walk from services, and some families simply cannot afford to see a doctor, even when they’re sick. Children, especially, are vulnerable. However, several of the diseases that most threaten children can be prevented in the first place—if immunization services can reach them.

From 2000 to 2006, the Government of Andhra Pradesh and PATH collaborated to build and improve immunization services and protect the state’s children against diphtheria, hepatitis B, Japanese encephalitis, measles, pertussis, tetanus, polio, and tuberculosis. A survey of 16,000 households conducted in 2006 confirmed the project’s success. Health workers with updated skills are working smarter, using simple but creative methods to make sure more women and children receive the vaccines that will give them the best chance at a healthy life, whether they live in an urban or rural area, in a coastal plain or a hill area.

New skills, new hope

For immunization systems to be effective and resilient, health staff must have up-to-date training. Starting in just a few districts and then expanding to others, PATH and the government helped nearly 32,000 doctors, nurses, and other health staff upgrade their skills. Training participants learned how to better communicate with parents, administer vaccines safely, dispose of needles carefully, keep vaccines at the right temperature to maintain their quality, and better manage immunization services. These improvements also boosted parents’ and health care providers’ confidence in the system.

During training, health workers expressed concern that they had little access to experts who could help them solve their daily problems or improve the quality of their work. In response, the government and PATH contracted with faculty members from local medical colleges to regularly visit health centers. The faculty provide "supportive supervision"—advice, guidance, and constructive feedback—to health workers. By the end of 2006, they had made six supervisory visits to each of the 1,500 centers in the state.

Syringes that make injections safer

It would be tragic if injections meant to safeguard women and children’s health actually infected them with HIV or hepatitis. But in 2001, because of shortages of supplies of disposable syringes, health workers in Andhra Pradesh were still reusing syringes. When workers did discard them after use, many needles were left in open garbage dumps. They posed a danger to children who play near the dumps, and they could be picked out and resold.

The government and PATH negotiated with international and Indian manufacturers to bring autodisable syringes—which can’t be reused—to Andhra Pradesh at affordable prices. Now all vaccinations in the state are given with autodisable syringes. Health workers report a near disappearance of injection-related abscesses, and parents can trust that vaccinations will prevent disease, not cause it. In addition, a method of separating the used needle from the syringe barrel was introduced, so that even if syringes are disposed of unsafely, there will be no danger to the surrounding community. Building on this success, the national government of India has adopted a formal policy mandating the use of autodisable syringes and their safe disposal throughout the country.

A system women and children can count on

As a result of these activities, immunization services in Andhra Pradesh have improved dramatically. By the second visit made by supervising faculty, 80 percent of centers were keeping immunization cards for children, 80 percent were using community volunteers to help track children due for vaccinations, and 90 percent had constructed safety pits to dispose of used needles. All of the centers had improvement plans in place, were maintaining temperature charts on refrigerators to monitor vaccine quality, and were using autodisable syringes.

According to the 2006 survey results, improved services translated directly into increased numbers of women and children receiving the protection of vaccines. For children younger than 12 months, full immunization (children getting all doses of all the regular childhood vaccines) across the state increased significantly, from 72 percent to 80 percent. Areas with the lowest coverage increased the most, so that coverage is more uniform across the state. Similarly, immunization coverage used to be lower in urban areas than in rural ones, but the coverage is now more uniform. Finally, coverage with measles vaccine used to be unacceptably low; now more than nine out of ten children receive this vaccine—and on time, before their first birthday.

In addition, the government introduced hepatitis B vaccine as part of the project—a safeguard against chronic liver disease—and made it universally available, free of charge, to all infants in the state. Coverage for this vaccine increased from about five percent, provided by the private sector, to nearly 90 percent, mostly provided through the government health services.

Services for all time

Time-limited health projects have a habit of collapsing after the initial progress has been made and celebrated. In this case, the immunization improvements were tightly woven into the fabric of the state’s health system, to ensure their longevity. In fact, the Government of Andhra Pradesh and PATH agreed from the beginning that the government would take on the costs of the program incrementally, and by the fifth year of the project, all recurrent costs were paid by the government, and PATH’s contribution consisted only of technical assistance. This attention to sustainability means that, long after the project is done, millions of women and children in Andhra Pradesh—and more widely in India as the model program is adopted by other states—will continue to get a better shot at a longer, healthier life.

Photo: Richard Franco.