The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low-and middle-income countries, while strengthening the capabilities of governments and the private sector in those countries to create and sustain high-quality health systems that can succeed without our assistance. For more information, please visit http//www.clintonhealthaccess.org
The William J Clinton Foundation (WJCF, India), an affiliate of CHAI, has been working in India in close partnership with and under the guidance of the Ministry of Health and Family Welfare (MoHFW) at both the Central and States’ levels on an array of high priority initiatives aimed at improving health outcomes for people living with HIV/AIDS, TB, Hep C, Cancer and Immunization; providing effective care and treatment for children suffering from malnutrition, diarrhoea, pneumonia, and malaria; and helping increase access to quality family planning services within the RMNCH+A framework. WJCF focuses on improving market dynamics for medicines and diagnostics, lowering prices for treatment, accelerating access to life-saving technologies, and helping build capacity required for high-quality care and treatment programs.
Additionally, WJCF is also supporting large-scale programs to arrest childhood and maternal mortality due to malnutrition, anemia, diarrhea and pneumonia, and helping increase access to quality family planning services in the State under the guidance of the Department of Public Health & Family Welfare of the State of Madhya Pradesh.
WJCF operates an immunization program in India to support the MoHFW’s Universal Immunization Programme (UIP) at the national level and in the focus states of Madhya Pradesh(MP), Uttar Pradesh(UP) and Bihar. With the aiming of helping attain the goal of 90% Full Immunization Coverage (FIC) in a sustainable and equitable manner, WJCF supports national and state governments on routine immunization (RI) aspects such as data quality and decision making, capacity building, and systems improvements for immunization service delivery.
Immunization Demand Overview
Immunization services in India have primarily been offered to under 5 children but with advent of COVID-19 vaccine, these services have been extended to adult vaccination as well. FIC amongst infants has seen a continuous rise in India from 61% in 2011 to 87% in 2020. Increasing access to Immunization services for a great majority of beneficiaries country wide has played a pivotal role in building these coverage gains. India has committed to achieving the Sustainable Development Goal of reducing IMR to 25 by 2030 through various health and nutrition interventions. Since 2014, Government of India has prioritised immunization coverage improvement and new vaccine introductions to further decrease IMR and U5MR. India’s Universal Immunization Programme (UIP) caters to 26 million infants and ~30 million pregnant women through ~9 million immunizations sessions spread across the country. Ministry of Health and Family Welfare (MoHFW) has strengthened UIP and intensified immunization in India by putting a sharp focus on national catch up campaigns, rollout of new vaccines for diarrhea, pneumonia and rubella, supply chain improvements and improved monitoring of Adverse Events Following Immunization. Along with improving access to services, Government of India (GoI) and states, have also deployed well-structured messages with effective mediums of communication at distinct levels: the citizens, the community, and the family. Some evidence suggests that constant media exposure has helped increase coverage by up to 35% in routine vaccination of DPT and Rota vaccine within subgroups. Researchers have also noted that positive media sentiments has led to an increase in polio vaccination.
However, coverage is affected by supply as well as demand drivers. Concurrent Monitoring data suggests that drop out (partially immunized) and left out (completely unimmunized) rates are majorly affected by awareness and information on vaccines (34%), AEFI apprehension (28%), operational challenges (8%), refusals (9%), travel of the child (14%) and others causes (7%). In the state of Uttar Pradesh, information gap and apprehension for AEFI were found to be the two main reasons (22% and 23% respectively) for children not being fully immunized (which includes unvaccinated or dropped out children). Awareness and information gap was also found to be the key reason the states of Madhya Pradesh and Bihar at 57% and 39% respectively. Further, significant issues of equity in coverage exist across dimensions of gender, birth order, religion, caste, wealth index, place of residence and associated socio-demographics. These root causes and negative outcomes are further exacerbated by allied socio-economic factors in many districts and blocks of the country which are well below the national FIC percentage and this geographic variability in outcomes further necessitates a contextualized approach. In sum, programme monitoring and research suggest that demand side challenges are now the primary drivers of poor FIC in the country.
Experience shows that root causes of and effective solutions for demand are usually localized and not only take cognizance of this local context but are also situated in it for operations. Further, there is increasing reliance on models of individual and household level health seeking behaviour rather than on broad brush ones which do not usually yield situation-specific actions by community front line workers and influencers. In an inspiring turn of events, the national and state governments have taken up the cause of enhanced demand generation on priority. This effort has begun to be augmented by development partners who are exploring solutions for impacting demand through micro-level initiatives.
We seek a highly motivated and entrepreneurial individual with outstanding credentials for a key role as a Immunization Demand Lead. The Immunization Demand Lead will support CHAI in drawing a portfolio-wide action plan for countering the demand challenges in different CHAI focus states. The Demand Lead will craft strategies rooted in evidence and built on the fundamental premise of measurable impact on aspects of demand. The ideal candidate would have a highly successful track record in public health demand side interventions and rich experience in immunization and worked across allied fields and on innovative ideas which have been scaled by governments for increasing demand in public health programs. The ideal candidate would have helped pivot the thinking of government decision makers from traditional ‘push’ based approaches to ‘pull’ driven effective demand strategies where not only are the individuals convinced of the need for vaccination but act as active proponents of vaccination in their peer groups.
 WHO concurrent monitoring data
 Comprehensive Multi Year Plan 2018 – 2022, Immunization Division, MoHFW, GoI
 Mass media exposure increases demand for vaccinations, study by Ben-Gurion University and Soroka University Hospital
 Concurrent Monitoring Data as of 27th January 2021.
 MoHFW Uttar Pradesh, Routine Immunization monitoring report – May 2014: House to house monitoring of immunization coverage 2014.
 Annual Immunization Dashboard, ITSU, MoHFW, May 2020 edition