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Reaching the un-reached in Bihar
" Polio Virus Type 1, which is the most deadly strain of the polio virus, is said to be holed up in the Kosi and Kamala riverine areas. "

Priyanka Khanna

Khagaria, March 27: On a clear day, reaching Amausi village of Khagaria district requires three boat changes and a long trek by foot. When it rains, the hamlet all but disappears.

And villages like Amausi are in abundance in the Kosi river basin, which has now become the latest scene of the battle against the deadly polio virus in Bihar. Polio Virus Type 1, which is the most deadly strain of the polio virus, is said to be holed up in the Kosi and Kamala riverine areas.

Epidemiologists say that though most of Bihar has remained free from P1 virus over the last few years, 70 per cent of polio cases in the state in the last seven years have been detected in 72 blocks in the Kosi and Kamala basin. Called high risk, these blocks are at 12 times more risk of reporting P1 virus than any other part of state.

Tally sheet data from polio rounds suggests that over 500,000 children less than five years of age are residing in villages throughout the area, roughly corresponding to the population of an average sized Bihar district, though one with no roads. This represents tremendous challenges for achieving high coverage and improving the quality of immunization activities.

What makes this area inaccessible is the fact that as many as seven rivers converge in the Kosi sub-region comprising of Darbhanga, Muzaffarpur, Bhagalpur, Gaya, Samastipur, Kishaganj, Nalanda and Madhubani districts. The Kosi/Kamala riverine belt is practically submerged under flood waters for more than two to three months every year.  When the flood waters recede, access remains difficult as neither bridges nor roads exist.  Movement in the 3,000 sq km area is restricted to boat, motorcycle, or walking. 

To beat the virus out of the particular region, the multi-partner polio eradication team in Bihar is pulling out all stops before this year’s high transmission season sets in. A special operations group comprising of representatives from the state health department, UNICEF, WHO-NPSP and the Centre for Disease Control, has been set up by the State health secretary to intensify and focus efforts, increase field presence of staff, strengthen involvement of local communities, and rapidly improve operations and monitoring.
The group met this week and unveiled its war plan to reach each and every child living in such hard-to-reach or “access compromised areas”. A “grid approach” has been proposed to ensure full coverage in each polio immunization round.

The grid approach essentially means that nodal centres will be set up within the access compromised areas where representatives from the health department, UNICEF and NPSP will operate before and during each round. These officials will rope in personnel and resources from the closest sources and not be dependent on district headquarters. To identify location of such access compromised areas, the group relied on information from locals as well as satellite images. 

The community mobilizers will help bridge the gap between their communities and the programme thereby ensuring better quality operations and reach to families who need the most help in ensuring their children are protected from polio, and other vaccine-preventable diseases. Recruited locally, the CMCs will work closely with families, community leaders, influencers and vaccinators and help in reaching the largest number of eligible children in their areas

“We found that to reach some of these areas from the district headquarter, it took seven to eight hours. Under the new approach if a certain region is not accessible from within one district then it will be approached from others. Our guiding principle is to reach each child in every round,” said Bijaya Rajbhandari, State Representative, UNICEF Office for Bihar.

The other measures that were proposed in the meeting included placement of UNICEF’s Social Mobilisation Network supported Community Mobilisation Coordinators (CMCs).  The CMCs, 200 in all, will be deployed in 20 primary health centres or hospital areas of all the districts of Koshi sub-region — Darbhanga, Muzaffarpur, Bhagalpur, Gaya, Samastipur, Kishaganj, Nalanda and Madhubani.

UNICEF will also deploy block-level supervisors for this cadre of workers, to ensure that field-based activities are closely monitored and integrated into the overall programme effort. Patna district has already piloted the initiative and found that CMCs could contribute to the programme quality by creating an environment conducive to the polio programme.

It is hoped that with the group’s recommendations coming in, the cluster of blocks centered around the Kosi and Kamala riverine area which is said to be the location of the 2007 Type 1 polio outbreak will begin to turn the tide against the polio virus in Bihar.

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