We are presenting this post for inputs from the viewers which will help us in critically reviewing the programme as an exercise for the post graduates. This may indierectly help in reaching the goals and objectives of GVAP by 2020.
Government of India (GOI) has launched Mission Indradhanush (MI) – a flagship programme of the country on good governance day: 25th Dec 2014 - as a new initiative for ambitiously improving vaccination coverage @5% per year to reach ≥90% by 2020 from 65% as per Rapid Survey of Children (RSOC) 2013-14. It is stated that in 5 years, coverage had increased @1% per year from 61% as per Coverage Evaluation Survey (CES) 2009 to 65.2% in 2013-14. We have the dubious distinction of being “highest in the world” as an estimated 8.9 million children do not receive all vaccines that are available under UIP - launched in 1985. This gap is further accentuated by iatrogenic widening as the children of elite population avail vaccination services from the private sector including Medical Colleges administering vaccines with no known potency and practicing whimsical schedule incompatible with National Immunization Schedule (NIS) – hampering Full Immunization Coverage (FIC), reporting through MCTS & HMIS with resultant accumulation of covert susceptible. This situation often becomes news when antibody for rubella during the routine ante-natal checkup in the developed countries was not found among those who received MMR by the private sector in India.
Management techniques play an important role in the effective implementation of a health programme. MI - launched as a special drive qualifies to be reviewed using VMOSA of business management; assigned to the Post graduates doing MD in community Medicine – who would be programme officers in future. MI is compared with the success story of planning units supported by the Department of Community Medicine – KVG Medical College which attained and sustained very high vaccination coverage both quantitatively and qualitatively much before the launch of MI (March 2013). As a guesstimate, a few thousands of planning units in the country may be already enjoying high coverage through dedication and commitment.
What is VMOSA?
It is the acronym for Vision, Mission, Objectives, Strategies and Action plan.
The Vision is simply a “dream” for realizing in the future. Philosophers, successful managers often iterated that everyone should know how to dream and the life will be successful for those who can / do dream: even day dream with open eyes.
Who has (have) to dream / visualize?
The smallest ‘Unit’ is one person who is dedicated, having in depth experience in the programme, has adequate knowledge starting from the grass-root service provider to national level, believes in learning by doing & working together empathetically, does pilot study, provides: supportive supervision / technical assistance / timely feed-back & forward / appreciates and rewards the good performers; develops successful template for replication. Vision statement by such person(s) will develop operable user friendly tool for fatigue free process, can be managed with available budget and dramatically realizes the dream hence it has long term sustainability. Such experienced person(s) may or may not have the authority or in the development organization.
On the contrary, vision statement from less experienced but authorized persons from higher formation with ivory tower approach, necessitating too much dependency on technical consultants whose support is not easily accessible and or available only for short duration being dependent on heavy budget, lack of operational clarity among the service providers at different level etc may not fetch the expected results timely and may revert back to ‘status-co’ as happened in the past and at present – the coverage is 62.6% as per NFHS4 (2015-16); 15.4% lower than 78% of CES 2009 inspite of operating Intensified Routine Immunization (IRI) 2012-13 and MI since April 2015.
VMOSA is for making a useful journey in the right direction for achieving the set objectives by these ‘Missioners’ (those who work in mission mode), preferably through the tested strategies and user-friendly practically workable sustainable comprehensive action plans with minimal fatigue and marginalized finance. The action plan should provide tool(s) for the team to self supervise and monitor the outcome as per the critical programme indicators provided in the guideline, helping in programme sustainability. If the outcome is dramatically / visibly / higher, needs to be shared concurrently with the community. Perceiving and appreciating the positive outcomes by the community through regular sharing will voluntarily promote utilization.
The process is expected to reorient, build the capacity, perpetuation through peer education for long term sustenance and better the quality of the programme compared to the ongoing.
Programmatically, Decade of Vaccines (2011–2020) made the decadal vision statement as a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. GVAP also expressed to realize this dream by delivering universal access to immunization. Between 1971 and 2016 the WHO region America has become disease free for 4 VPDs – smallpox in 1971, poliomyelitis in 1994, and rubella and congenital rubella syndrome in 2015 and now for Measles in 2016.
The Mission being action / outcome oriented, the statement describes why and what are to be done by the RI players to achieve the vision. The 'Missioners' work on a war-foot like the commandoes - stop not till they accomplish the "MISSION".
Core value as to how the partners, stakeholders, service providers at different levels and the beneficiaries believe needs to be considered and respected.
Goals as a general statement as to what needs to be accomplished and the specific
Objectives with specific milestones and specific timeline for achieving the goal are to be clearly defined. How much of what is to be accomplished with specific measurable results by when are to be drawn. The objectives of MI are to be achieved at community level. Though the ultimate ownership lies with the Govt, for timely reaching the national and international goals, collaborating and coordinating with all stake holders is mandatory. Pro-activeness by the latter is probably welcome.
Strategies are to be made to use the mission statement to achieve the vision statement, tested ones are preferable. Replicating the success stories will save time money and lives.
Finally the Action plan – the detailed blueprint in the form of specific micro-plan for: quantifying / reaching / service providing / recording / reporting / measuring the outcome / sharing / operational research etc can help in culminating the journey of realizing the dream – THE VISION.