Community outreach is one of the mainstays of public health services delivery in the hard-to-reach hill districts of Manipur. The medical team at Primary Health Centre (PHC) Phungyar in Kamjong district visit remote villages once a week to provide primary health care and routine immunizations services to isolated communities living in this sparsely populated hill district bordering Myanmar.
Dr Prakash Bharadwaj, medical officer and district immunization officer, Kamjong district, writing a cough prescription for Ms Iwgyn’s (short for ‘I will glorify your name’) daughter at PHC Pungyar (Photo: Sanchita Sharma / © WHO India)
The Kamjong hill district is the home of the Tangkhul tribes, who live in small, self-contained communities. “There are 19 Health Sub Centres in Kamjong district. Most of the villages are sparsely populated and connectivity remains an issue, especially during the rainy season from April to November, when landslides occur and roads become unmotorable. Retaining human resources in isolated hill districts is a challenge, but infrastructure is improving,” said Dr Chambo Gonmei, State Immunization Officer, Manipur.
The four-beds PHC Phungyar is staffed with two medical officers and five ANMs, who serve 38 villages with support from 29 ASHAs (community health volunteers). “New roads have improved connectivity over the past year, I now spend less time to reach communities,” said ANM Ms Tonreiphy Jajo, PHC Phungyar.
Only 24 families live in Patbung village, which is a little over an hour’s drive from PHC Phungyar. The village ASHA, Ms Alungwon, is from the community and keeps track of immunization schedules of families in the village (Photo: Sanchita Sharma / © WHO India)
“Many of the communities we serve have to travel for a couple of hours by road each way to reach the PHC. There is no public transport, so we support by outreach initiatives. The ASHAs keep track of the heath and immunization schedules and organize site visits for the ANMs in different villages. The ANMs take equipment, vaccines and medicines on the scheduled day to villages to immunize children and screen the community for non-communicable and other health issues, and make referrals, as needed,” said Dr Prakash Bharadwaj, medical officer and district immunization officer, Kamjong district.
ASHA Ms Remember routinely visits every home in Kumran (Ngaprum) village, which has a population of 670. “We use the village community hall for health meetings for the community to identify the health services required with Ms Remember,,” said Mr Isaac Ningshen, headman, Kumran.
WHO surveillance medical officer reviews the mother and child protection (MCP) cards during a home visit to monitor the routine immunization status of children in Kumran village. He is accompanied by ANM Ms Tonreiphy Jajo and ASHA Ms Remember (extreme right). (Photo: Sanchita Sharma / © WHO India)
The WHO National Public Health Support Network is providing technical and monitoring support for routine immunization and vaccine-preventable diseases to the Government of Manipur with special focus on providing services to underserved and hard-to-reach areas. Under the Government of India’s Universal Immunization Programme, close to 2.67 crore children and 2.9 crore pregnant women are immunized free of cost against 12 vaccine-preventable disease annually.
At the national level, vaccines are provided against nine diseases – diphtheria, pertussis, tetanus, polio, measles, rubella, severe form of childhood tuberculosis, hepatitis B, and meningitis and pneumonia caused by hemophilus influenza type B. Vaccination against rotavirus diarrhoea and pneumococcal pneumonia are provided in some states and are currently in the process of being scaled up to cover the entiire country, while Japanese Encephalitis vaccine is provided to children in endemic districts.