A PROJECT ON SOCIAL MARKETING

CHAPTER 1. WHAT IS SOCIAL MARKETING
The health communications field has been rapidly changing over the past two decades. It has evolved from a one-dimensional reliance on public service announcements to a more sophisticated approach which draws from successful techniques used by commercial marketers, termed "social marketing." Rather than dictating the way that information is to be conveyed from the top-down, public health professionals are learning to listen to the needs and desires of the target audience themselves, and building the program from there. This focus on the "consumer" involves in-depth research and constant re-evaluation of every aspect of the program. In fact, research and evaluation together form the very cornerstone of the social marketing process.

Social marketing was "born" as a discipline in the 1970s, when Philip Kotler and Gerald Zaltman realized that the same marketing principles that were being used to sell products to consumers could be used to "sell" ideas, attitudes and behaviors. Kotler and Andreasen define social marketing as "differing from other areas of marketing only with respect to the objectives of the marketer and his or her organization. Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society." This technique has been used extensively in international health programs, especially for contraceptives and oral rehydration therapy (ORT), and is being used with more frequency in the United States for such diverse topics as drug abuse, heart disease and organ donation.
Like commercial marketing, the primary focus is on the consumer--on learning what people want and need rather than trying to persuade them to buy what we happen to be producing. Marketing talks to the consumer, not about the product. The planning process takes this consumer focus into account by addressing the elements of the "marketing mix." This refers to decisions about 1) the conception of a Product, 2) Price, 3) distribution (Place), and 4) Promotion. These are often called the "Four Ps" of marketing. Social marketing also adds a few more "P's." At the end is an example of the marketing mix.
Product
The social marketing "product" is not necessarily a physical offering. A continuum of products exists, ranging from tangible, physical products (e.g., condoms), to services (e.g., medical exams), practices (e.g., breastfeeding, ORT or eating a heart-healthy diet) and finally, more intangible ideas (e.g., environmental protection). In order to have a viable product, people must first perceive that they have a genuine problem, and that the product offering is a good solution for that problem. The role of research here is to discover the consumers' perceptions of the problem and the product, and to determine how important they feel it is to take action against the problem.
Price
"Price" refers to what the consumer must do in order to obtain the social marketing product. This cost may be monetary, or it may instead require the consumer to give up intangibles, such as time or effort, or to risk embarrassment and disapproval. If the costs outweigh the benefits for an individual, the perceived value of the offering will be low and it will be unlikely to be adopted. However, if the benefits are perceived as greater than their costs, chances of trial and adoption of the product is much greater.
In setting the price, particularly for a physical product, such as contraceptives, there are many issues to consider. If the product is priced too low, or provided free of charge, the consumer may perceive it as being low in quality. On the other hand, if the price is too high, some will not be able to afford it. Social marketers must balance these considerations, and often end up charging at least a nominal fee to increase perceptions of quality and to confer a sense of "dignity" to the transaction. These perceptions of costs and benefits can be determined through research, and used in positioning the product.
Place
"Place" describes the way that the product reaches the consumer. For a tangible product, this refers to the distribution system--including the warehouse, trucks, sales force, retail outlets where it is sold, or places where it is given out for free. For an intangible product, place is less clear-cut, but refers to decisions about the channels through which consumers are reached with information or training. This may include doctors' offices, shopping malls, mass media vehicles or in-home demonstrations. Another element of place is deciding how to ensure accessibility of the offering and quality of the service delivery. By determining the activities and habits of the target audience, as well as their experience and satisfaction with the existing delivery system, researchers can pinpoint the most ideal means of distribution for the offering.
Promotion
Finally, the last "P" is promotion. Because of its visibility, this element is often mistakenly thought of as comprising the whole of social marketing. However, as can be seen by the previous discussion, it is only one piece. Promotion consists of the integrated use of advertising, public relations, promotions, media advocacy, personal selling and entertainment vehicles. The focus is on creating and sustaining demand for the product. Public service announcements or paid ads are one way, but there are other methods such as coupons, media events, editorials, "Tupperware"-style parties or in-store displays. Research is crucial to determine the most effective and efficient vehicles to reach the target audience and increase demand. The primary research findings themselves can also be used to gain publicity for the program at media events and in news stories
SEVEN STEPS TO SOCIAL CHANGE


A set of Seven Doors

Elements of the model
This model allows us to identify which elements are already being fulfilled, and so concentrate resources on the gaps.
The seven elements are -
knowledge
desire
skills
optimism
facilitation
stimulation
reinforcement
1. Knowledge/awareness
An obvious first step is that people must -
know there is a problem;
know there is a practical, viable solution or alternative. This is important. People are practical - they will always demand clear, simple, feasible road maps before they start a journey to a strange place.
identify the personal costs of inaction and the benefits of action in concrete terms people can relate to (ie. they 'own' the problem).
An awareness campaign aims to harness people's judgement.
2. Desire - imagining yourself in a different future
Change involves imagination. People need to be able to visualise a different, desirable, future for themselves.
This is different to being able to recognise rational benefits.
Desire is an emotion, not a kind of knowledge. Advertising agencies understand this well - they stimulate raw emotions like lust, fear, envy and greed in order to create desire. However, desire can also be created by evoking a future life which is more satisfying, healthy, attractive and safe.
To design a campaign that harnesses your audience's imaginations, you'll have to start by liberating your own (I'm the first to admit that in an era where everything has a strategic plan, this can be difficult!)
3. Skills - knowing what to do
Being able to easily visualise the steps required to reach the goal. This is not about emotion - it is purely rational (it is what we have rationality for).
People learn skills best by seeing someone else do them. The best way to do this is to break the actions down into simple steps and use illustrations to make visualisation easy. It's amazing how many social marketing campaigns forget this element.
4. Optimism (or confidence)
The belief that success is probable or inevitable. Strong political or community leadership is probably an important ingredient of optimism.
I can't over-emphasise optimism. EPA research showed about 14% of the population are disabled from environmental action by their sense of isolation and powerlessness. If government and business are not leading by example, who can blame people for sensing their individual efforts may be futile?
5. Facilitation - having outside support
People are busy with limited resources and few choices. They may need accessible services, infrastructure and support networks that overcome practical obstacles to carrying out the action.
If personal behaviour change is blocked by real-world obstacles (and it usually is) then all the communications on earth will be ineffective. The role of an 'education' strategy might therefore need to be expanded to involve the establishment of new services and infrastructure. This is why recycling has been successful - we now have simple, quick, low-cost collection services which make recycling easy.
6. Stimulation - having a kick-start
We are creatures of routine. Even with all the knowledge, desire, good will and services in the world, there is still the inertia of habit to overcome. Consciousness is the tool human beings use to overcome habit, but we are unconscious most of the time. How can social marketers create moments which reach into our lives and compel us into wakefulness?
When I think of the moments which have compelled me to act, they are of two kinds - either threatening (direct and personal, like an airport being proposed in the next suburb; or a threat to my world-view like a terrible famine in Sudan); or inspirational. The inspirational has always happened in a collective context - a kind of inspirational mass conversion which is based on our human social instincts (like the mass meeting where we make a personal commitment or give an extra large donation).
So the stimulation could be an imminent threat (like a cost increase), a special offer or competition (based on self-interest), or, better still, some communally shared event which galvanises action (e.g. a telethon, a public meeting, a festival).
7. Feedback and reinforcement
A host of voices, situations and institutions daily compel us to act in undesirable, unhealthy and anti-social ways. These forces don't disappear just because we've run a campaign. Effective social marketing is about continuous recruitment and reinforcement of messages - with regular communications which report back to people on the success of their efforts and the next steps which are expected of them.
Many NGOs (CAA, Amnesty, Greenpeace etc) have learnt this lesson and devote considerable resources to continuously feeding success stories and updates to their contributors, as well as new calls for support and action. We need to learn the same lesson and devote resources to celebrating people's successes (a Waste-Not Week might be a useful focus).

A 7-step research methodology
To be useful, a 7 step approach needs to feed into a research methodology. We need to figure out where the obstacles are (ie. which gates are closed) with a given audience. Here is an example of the kind of research questions you could ask, assuming that home composting was the goal of the proposed campaign.
Knowledge
STATEMENT: The best way to have great garden is to compost kitchen scraps and lawn clippings.
Strongly agree/Agree/Neither/Disagree/Strongly disagree
Skills
STATEMENT: I know how to make a clean, odour-free home compost.
Strongly agree/Agree/Neither/Disagree/Strongly disagree
Desire
STATEMENT: A home compost is part of a healthy, natural lifestyle.
Strongly agree/Agree/Neither/Disagree/Strongly disagree
Services
STATEMENT: I know where to find compost bins and advice on how to use them.
Strongly agree/Agree/Neither/Disagree/Strongly disagree
Optimism
STATEMENT: I don't bother to compost because it won't make any difference.
Strongly agree/Agree/Neither/Disagree/Strongly disagree
Stimulation
STATEMENT: I don't compost because I'm too busy OR just not interested.
Strongly agree/Agree/Neither/Disagree/Strongly disagree
[There's no need to test for Reinforcement - it's a given!]










































CHAPTER-2
PROJECT PROFILE









Title of the Study
Social Marketing a Study on Social advertisements and Social Campaign in India.

Objectives of the Study
“Social Marketing seeks to influence Social behaviors not to benefit the marketer,but to benefit the target audience and the general Society.”

Significance of the Study
Every Study is conducted to fulfill Certain Objectives in turn fulfill Some purpose and are of Significance for one or more than one party.

Scope of the Study
Most organizations that develop social marketing programs operate through funds provided by sources such as foundations, governmental grants or donations.

Limitations of the Project
Social marketing programs can do well in motivating individual behaviour change, but that is difficult to certain unless the environment they are a supports that change for the long run.




























CHAPTER-3
FINDING









What is Atithi Devo Bhavah?

A pioneer initiative by Ministry of Tourism, Government of India that will help tap into the full potential of tourism in India. Ministry of Tourism, Government of India has introduced “Atithi Devo Bhavah Program”- A nation wide campaign that aims at sensitising key stakeholders towards tourists, through a process of training and orientation. The endeavour is to boost tourism in India, which in turn would act as a catalyst for India’s economic growth. To launch a national level initiative that works at many levels to address all the above issues.
Atithi Devo Bhava aims at creating awareness about the effects of tourism and sensitizing people about preservation of our rich heritage & culture, cleanliness and warm hospitality. It also re-instills a sense of responsibility towards tourists and re-enforces the confidence of foreign tourist towards India as a preferred holiday destination.
The entire concept is designed to complement the ‘Incredible India’ Campaign.

Why Atithi Devo Bhavah?
Last year we had 3.3 million visitors, but when you consider that Singapore gets 7 million a year. Thailand 9.6 million a year. Malaysia 11.5 million.
There is no reason why we can’t aim to increase our numbers by 100%. And that too would be just a beginning. However to do this we need to change our attitude towards those who visit us. Often tourists are Mistreated, Cheated and rudely dealt with.
It’s simple logic, if someone in a house is rude to you, as a guest, you don’t encourage your friends and relations to go there.
This is perhaps the reason why in spite of an incredible wealth of Tourist spots, Cultural Attractions, Natural Wonders and Destinations for the soul, India still isn’t amongst the top 15 tourist destinations Of the world. The time has definitely come to get together to change this.To change our attitude.
We’ve lost touch with the hospitality we were famous for. Now it’s a time that we make an effort to make it a part of us again.
Inspiration behind Atithi Devo Bhavah ?

Respect has always been an integral part of the Indian soul. From time immemorial we have always respected - Our teachers, our elders, our parents And our guestsPerhaps this is why a great Indian Emperor once observed'In Hindustan our manner is very respectful and our hearts are always open'In many ways, at that time India was the ultimate destination for the enlightened travelers. Now, thousands of years later, we can bring that golden age back again.This inspired us to go back to those years, when Indian hospitality set the standard for the world And we found the keystone of what we want to do Or guest is blessed. Our visitor is God.
That how we arrive at our mission called
'Atithi Devo Bhavah'

The seven point Atithi Devo Bhavah Program Atithi Devo Bhavah is a 7 point program of hospitality and training Samvedan Sheelta or Sesitisation-

Here we will sensitise the various sections of the tourism industry about how each of them to contribute for the growth of the tourism industry and how they will benefit from it.Prashikshan or Training and Induction –
This involves explaining to them the needs and expectation of the tourist, how they should respond and behave in order to satisfy them needs and meet those expectations.Prerna or Motivation –
This is motivation to participate in this program through various measures e.g. awards for the best worker in the segment. Because when you are enthused you can do wonders.Pramani Karan or Certification –
Certification to ensure standards shall be done at an appropriate stage in the training programPratipushti or Feedback –
Feedback shall be obtained from tourists about the Service they have received and the experience they had, in order to improve the training program on a continuous basisSamanya Bodh or General Awareness –
The mass media communication campaign will be undertaken to create general awareness among the public about the necessity and the benefits of the Atithi Devo Bhavah programme.Swamitwa or Ownership-
The Atithi Devo Bhavah programme is a movement we will urge all segments of the Indian society to adopt, and look upon as their own.

The Charter of Atithi Devo Bhavah Training Program
Hygiene & Cleanliness :
Hygiene & Cleanliness shall cover the areas of product for e.g. vehicles like taxies, hotel rooms, restaurants, shops, etc., personal hygiene & cleanliness of the person providing the service and cleanliness of the monuments / places of tourist interest.
Conduct and Behavior:
The person concerned for e.g. the taxi driver / hotel employee shall behave in courteous and polite manner towards tourists.
Integrity and Honesty :
The person providing service to the foreign tourists should display honesty and integrity.Safety and Security:
The safety and security of the tourists shall be ensured.

Components of the Atithi Devo Bhavah Program

TrainingIn this we are going to train key stakeholders (of the tourism industry) in terms of changing their attitude and behaviour towards foreign tourists. The programme shall cover 4 areas:Hygiene - This include personal hygiene of the person and also that of the product / service.Conduct and behaviour - Politeness and basic courtesies in interacting with the foreign tourists.Integrity - This implies that the person does not cheat the tourists and charges him a fair price for the service.
Safety and security - Person look after safety and security of the foreign tourists.Key stakeholders being covered in the training include taxi drivers, baggage handlers at airport, tourist guides, hotel staff, employees of tour operators, immigration and customs officials etc.
Since these segments have diverse backgrounds, education and levels of sophistication, the training is divided into 2 categories:
Level 1 : Covers taxi drives, tourist guides and baggage handlers and porters.Level 2 : The tour operators, shop owners / staff, hotel staff, immigration and customs officials.This training program is initiated at the following places - Delhi, Mumbai, Hyderabad, Jaipur, Agra, Aurangabad, and Goa. In the next financial year this programme will be rolled out to other important cities in India.
These people will be given certificates which shall be valid for about 6 months after which they have to come and get themselves re-trained. Till 31st March 2005, we plan to train about 26,000 people. From April 2005 to March 2006 these 26,000 people will be retrained and another substantially large number of people will be trained. Once a threshold level in terms of number of people trained is achieved (likely by October 2005), we shall introduce Atithi Devo Bhavah as a symbol of quality. Foreign tourists will be told to look out for the Atithi Devo Bhavah badge / sticker which will mean that the service is of certain minimum quality. PR Road Shows
Besides training we are also undertaking PR Road shows with the tourism trade in order to get their active participation and ownership of the Atithi Devo Bhavah programme. Right now the contact programmes are being conducted in 7 cities mentioned earlier. After April 2005 contact programmes will be conducted in other cities in conjugation with the roll out of the training programme.
Mass Media Communication
We shall also be carrying out mass media communication in newspapers, TV, cinema and outdoors to create general awareness about the Atithi Devo Bhavah programme and to communicate to key stakeholders as to how it is in their own interest that foreign tourists be treated well and should go back happily from our country.

Role of the India Tourism Offices
The India Tourism offices of Delhi, Jaipur, Agra, Mumbai, Aurangabad, Goa and Hydrabad have a crucial role to play in the campaign. They act as nodal agencies to facilitate and coordinate the essential part of the program ie. Training. The nodal offices as we term it will have the following roles:
a) Provide their cooperation and support to make the training programs run in an effective mannerb) Registering the stakeholders who are contacting them for the purpose of training and deciphering the information to us, so thatthey can be contacted and made a part of the training programc) Re-registration of the stakeholders who underwent a training program after six months, the stakeholders will approach them for the purpose of re-training and re-certification

From the Minister
ATITHI DEVO BHAVAH
'Atithi Devo Bhavah' is a Social Awareness Campaign aimed at providing the inbound tourist a sense of being welcomed to the country. The campaign targets the general public as a whole, while focusing mainly on the stakeholders of the tourism industry. The main components of the campaign are training and orientation to taxi drivers, guides, immigration officers, tourist police and other personnel directly interacting with the tourists, while simultaneously creating a brand equity for the trained persons.
"Atithi Devo Bhavah" involves Sensitisation, Screening, Induction, Training & Orientation, Certification and Feedback of key stakeholders of the Tourism industry in India.
As Smt. Renuka Chowdhury, the Minister of State for Tourism (Independent charge) says 'Atithi Devo Bhavah' is a nationwide campaign aimed at sensitising people about India's rich cultural heritage, its preservation, cleanliness, hospitality and bringing out an attitudinal shift among the masses towards tourists. It is a symbolic representation of India's age old hospitality and with this campaign, we are trying to re-install in the stakeholders a sense of pride and responsibility towards tourists, while positioning India as a popular tourist destination worldwide."
The Ministry of Tourism is thus looking at both the macro and micro perspective by promoting destinations on the one hand and bringing about a sea change in the mindset and behaviour of people, on the other.



























India: Working and street adolescents begin campaign on social issues

'Jagruti', a group of working and street children and youth from Bhima Sangha and Namma Sabha in India have started the campaign to raise awareness about social issues among their members and members of their community.
They are using different mediums like drama, songs, role plays, 'kawali', drawings, story telling, dialogues, group discussions, 'Yakshagana' to create awareness in community about alcoholism, child marriage, female foeticide, HIV-AIDS and motivate people to fight against these social issues.
Their performances focus on how these social issues impact on children and women in various ways. They are also developing a tool kit of strategies and materials to address the above issues among their peers as well as members of women's groups in Bhima Sangha and Namma Sabha. The adolescents have prepared an action plan to stage their performances during various cultural programmes that will be organised on the occasion of the Ganesha and other festivals.
Jagruti has been supported in this project by Macarthur Fund for Leadership development.



















Maharashtra to review midday meal scheme
Concerns that over three-fourths of school-going children in Maharashtra who receive a cooked lunch in school daily have not benefited from it have prompted the state’s education minister to order an impact evaluation study of the midday meal scheme

Maharashtra’s school midday meal scheme will be reviewed following reports that 75% of schoolchildren who are covered by the programme have not yet recorded age-proportionate development.
The ‘impact evaluation study’ will also investigate complaints about the quality of food being served and concerns that large numbers of eligible children are not covered by the scheme.
Eight million children from classes 1-5 in 67,000 state-run schools in Maharashtra are supposed to be provided with a free, nutritious lunch on all school days, under a scheme that aims to boost school enrolment figures, decrease the number of school dropouts, ensure attendance at school, and reduce child malnutrition.
The review of the scheme, which will attempt to curb lapses in implementation as well as optimise coverage, will assess its effectiveness on all of the above counts, says State Education Secretary Anand Kulkarni. The study will be formalised by a committee set up under the state’s Gunvatya Vikas Karyakram. “Moreover, I will form a squad which will look into the quality of food that’s provided by the schools,” Kulkarni adds.
In November 2006, a midday meal committee formed to look into the issue sent 700 field officers to monitor and report on the functioning of the scheme in districts schools. Not one of them reported any problems.
“But we realised things weren’t okay when we started visiting the schools personally,” says J M Abhyankar, a Karyakram officer. For instance, the daily allowance never reached schools on time, forcing them to buy pulses from the local grocer. Since prices in the open market varied, the quality of food served suffered.
States like Andhra Pradesh and Rajasthan have better records in implementing the midday meal scheme, perhaps due to the active involvement of CSOs. For instance, the Nandi Foundation in Hyderabad prepares meals in a modern kitchen and delivers them to schools in sealed, insulated containers just before the lunch recess.
And Rajasthan, which serves up one of the best menus in the country under its midday meal programme, now provides a 600-calorie meal to its students, as against a minimum prescribed daily intake of 500 calories.
The review will include a district-wise assessment of the food preferences of children after which the committee plans to recommend district-specific diets, for example rice and wheat for some schools, and only rice in others.
The increased focus on the menu of the school meal scheme is in keeping with the trend in other states where the scheme has been in place for some years now. Having put in place the basic infrastructure for the scheme and streamlined its delivery, the effort is now on providing more nutrition, variety and catering to varied tastes.
The review committee is expected to submit its report by the end of March.

India's diversity not visible in public spaces
Experts from an interview with Abusaleh Shariff, in which the chief economist at the National Council of Applied Economic Research and Sachar Committee member expands on the much-debated findings of the committee’s report, "Social, Economic and Educational Status of the Muslim Community"

Civil society-political party duet at ISF
Politicians and NGOs shed a taboo at the recent India Social Forum, entering into an uneasy synergy. NGOs would like a political party to push their agenda without being identified with it. And politicians would like to use NGOs to enter areas they have failed to, but they also believe that advocacy sans political ideology won’t work

Gujarat’s campaign for ‘unanimous’ panchayat polls opposed
A government circular pushing for wider acceptance of the samras scheme, under which a village sarpanch (head) is ‘elected’ by consensus, has been criticised by rights activists as being undemocratic and corrupt
An attempt by the Gujarat government to offer financial incentives to villages that select their sarpanch (panchayat head) by consensus and not through the usual voting procedure has raised a storm of protest from civil society activists who say offering voters incentives, disincentives and issuing veiled threats to promote the practice violates the democratic process and hijacks the panchayati raj endeavour. More sinister, perhaps, is the accusation by some that the move is a ploy by the predominantly pro-Hindu government to get its right wing supporters into panchayat office.
With elections to 18,000 village panchayats due on December 10, the government whip has stressed the need for more samras (unanimity) villages. It has also hiked the samras incentive from Rs 60,000 to Rs 1 lakh as bait to lure villages into adopting the scheme. Villages that adopt a samras candidate for the second time will get an additional amount of Rs 50,000.
There are some reports that a nexus of district and block-level officials, in connivance with influential local residents, is forcing villagers to settle for consensus in electing a sarpanch. A Panchmahals district panchayat circular says villages that do not opt for samras will remain backward, while those opting for the scheme will be looked after. “This is a violation of democratic norms. The incentives, disincentives and veiled threats are robbing the villagers of their voting rights,” says Laljibhai Desai of the Buniyaadi Adhikaar Andolan, Gujarat (BAAG).
The government says the samras campaign, which offers incentives to villages that arrive at their choice of headman through popular mandate -- doing away with the need for formal elections and thus saving on poll expenditure -- ensures that villages have more money to spend on development. They say it also helps maintain peace in the village around election time by eliminating the possibility of poll-related violence and clashes between supporters of rival candidates. No survey has been conducted to compare the development indices of villages that have opted for this scheme and those that haven’t.
Over 3,900 villages ‘voluntarily’ opted for the scheme when it was first introduced during the last panchayat elections in December 2001.
However, a network of women's non-government organisations is planning an agitation against samras system on the ground that women and Dalits are being denied their democratic rights. "Men of upper caste groups wielding political and social clout usually decide on the 'consensus' candidate," says Sitaben Rabari of Veir village in Kutch.
"The poor and illiterate villagers are often forced to accept the recommendations of the mamlatdars (taluk revenue officers) and withdraw from contest," alleged Kantaben of the Mouchha village in Prantij taluka of Sabarkantha district.When someone from her community wanted to contest, he was asked "to pay Rs 1 lakh (the samras grant promised by the government)."
Persis Ginwala, one of the convenors of the Panchayat Elections Vigilance Committee formed by over 70 CSOs, alleged that even after the model code of conduct for elections came into force on November 15, village and taluka revenue officers were visiting villages to discourage people from contesting and openly suggesting the names of candidates with Hindu fundamentalist leanings as the unanimous choice.
In a number of cases, the reluctant villagers had been threatened with penal actions, besides being denied the special government grants if they chose to hold regular elections, Ginwalla, who is also vice-president of the Mahila Swarajya Abhiyan, alleged. She pointed out that government officers were going round the villages threatening people with penal action if they refused to fall in line.
Several women representatives of the Abhiyan coming from various villages alleged that on the first day of filling nominations on November 22, government officials functioning as the returning officers had refused to accept the nomination forms.
Representatives of the Panchayat Elections Vigilance Committee have called on the State Election Commission responsible for conducting free and fair elections to the village panchayats. But it expressed its inability to interfere in the matter as the samras scheme was a state government scheme over which the Election Commission had no jurisdiction. Now, the committee says it is exploring various ways, including seeking legal remedy, to prevent the government from "denying the basic democratic rights to the people."

Devolution of funds biggest challenge to panchayats
In most Indian states, says a review of panchayats in the country, general-purpose unconditional transfer of funds to panchayats is not significant. Kerala leads the way, with nearly 40% devolution of its plan outlay to panchayats for planning and implementation

The two biggest challenges before India’s panchayati raj (local self-government) system are ensuring the impartiality and credibility of panchayat elections and increasing funds to meet their functional mandate, says ‘The State of Panchayats -- A mid-term review and appraisal’, that was released by Indian Prime Minister Manmohan Singh on November 20. It will soon be tabled in parliament.
According to the 1,600-page review, brought out by the Union Panchayati Raj Ministry, incomplete devolution of funds is perhaps the greatest challenge to the effective functioning of panchayats in the country. One of the most important lessons learnt from past experience is that, instead of gradually building up capacity and laboriously undertaking academic exercises in training panchayat members, it is better to entrust serious and substantial powers to panchayats immediately and rely on hands-on experience in administrative work to train panchayat members in their duties.
The ministry is in the process of evolving a gram swaraj scheme to reinforce such an approach to devolution by making available funds for building capacity and undertaking formal training exercises, the report says.
In most Indian states, the review points out, general-purpose unconditional transfer of funds to panchayats is not very significant. Where they do exist, they are not given on the basis of a well-designed formula, taking into account the panchayat’s expenditure requirements. The review says Kerala has shown the way, with nearly 40% devolution of its plan outlay to panchayats for planning and implementation. In Karnataka, financial devolution is of the order of Rs 7,500 crore per year. Two other states that are likely to emerge at the top in 2006-07 are Sikkim and Punjab.
For financial accountability, public account committees specifically for panchayats, complemented by a Fiscal Responsibility Act, are necessary, the report says.
A major challenge to be tackled head-on is the issue of “parallel bodies,” which, according to Panchayati Raj Minister Mani Shankar Aiyar would help policymakers further the cause of panchayati raj institutions (PRIs) and devolution of power to the people. They must be brought through legal provisions into an organic, symbiotic relationship with PRIs and report to the gram sabhas.
Pointing out that public participation in panchayat elections was substantial, very often higher than in parliamentary or assembly elections, the report says that these elections are supervised by state election commissions, and that there are deviations in procedure and practice at the state level.
The review suggests that all responsibilities in the election process, including drawing up the electoral rolls, de-limitation of constituencies, reservation and rotation of candidates, and conduct of elections, be put squarely on the state election commission. Common electoral rolls and the use of electronic voting machines would significantly promote the conduct of free and fair elections to panchayats, it adds.
Recommending a review of funding through centrally sponsored schemes, along with additional central assistance for state plans, the review seeks a simplification of the funding mechanism to panchayats.
Describing participation in gram sabhas as a challenge, the report says that giving them a prominent legal position is of no consequence if they remain neglected. “There is scepticism about the Utopian concept of people getting together to solve their problems. The feeling prevails, that in the face of elite groups, marginalised segments and local politics this does not work on the ground. What can be done is to evolve modalities where those who want to participate are facilitated.”
The report says that the acid test for successful fiscal reform for panchayats lies in the extent to which they raise revenue. The willingness of people to pay taxes is a barometer of the panchayat’s capacity to deliver and the quantum of trust it enjoys among the people. Local taxation is the best check that people can exercise over their elected representatives.
The report also calls for the need to recognise the constitutional sanctity given to the state finance commission. With greater fiscal devolution, fund availability at the panchayat level could go up considerably.





















CHAPTER-4
EVALUATION
















Child survival and safe motherhood program in RajasthanJain SK1, Chawla Uma1, Gupta Neeru2, Gupta RS1, Venkatesh S1, Lal Shiv11 National Institute of Communicable Diseases,Indian Council of Medical Research, India2 Division of Reproductive Health and Nutrition,Indian Council of Medical Research, India
Correspondence Address:Gupta Neeru F-8/17, Krishna Nagar, Delhi-110051 India
Abstract

Objective : This study was planned to evaluate the MCH services, particularly immunization in rural areas of the poor-performing state of Rajasthan. Methods : A community-based, cross-sectional survey using the WHO 30 cluster technique was carried out as a field exercise by participants of 9th Field Epidemiology Training Programme (FETP) course by National Institute of Communicable Diseases (NICD) in rural areas of Alwar district of Rajasthan. Results : Less than one third (28.9%) of children, aged 12-23 months, were fully immunized with BCG, 3 DPT, 3 OPV and Measles vaccines; around a quarter (26.5%) had not received even a single vaccine (non immunized), and little less than half (44.5%) were found partially immunized. Around half of the eligible children were vaccinated for BCG (55.9%) and Measles (43.6%). Though nearly two-third (66.8%) were covered with first dose of DPT and OPV, but about one third of these children dropped out of third dose of DPT and OPV for various reasons. National Family Health Survey (NFHS) data also had revealed that BCG coverage was 64.3%; measles was 36.2%; and coverage by DPT 1, 2, 3 and Polio 1,2 and 3 were 64.4%, 57.0%, 46.6% and 77.5%, 71.1% and 54.4% respectively in rural areas. The main reasons for drop-out or non-immunization was "lack of information about the immunization programme" (41.3%). Though nearly all (more than 96%) of the children were immunized through Government established centers, but immunization cards/documents were made available only to 27.6% of children. Conclusion : The problem of low coverage and high drop-out rate of immunization could be overcome by creating awareness of the program and relevance of 2nd and 3rd doses of DPT and polio vaccines. Increasing community participation through intensive and extensive health education campaign should also be undertaken. Since most of the deliveries were done at home under the supervision of untrained midwives, training programme as well as involving them in IEC activities should be contemplated.

Communicable diseases kill more than 14 million people every year, mainly in the developing world.[1] Despite the availability of safe and effective vaccines against these diseases in the last 3 to 4 decades, diseases like measles and tetanus continue to be a major cause of mortality and morbidity, especially among young children in most of the developing countries like India. Universal Measles immunization coverage is one of the activities targeted in order to reduce child mortality by two-thirds by all the 191 United Nations Member States as one of the eight UN Millennium Development Goals (MDG).[2] As of now, Measles, Pertussis and Tetanus are the leading causes of DALYs (Disability adjusted life years) among Childhood diseases,[3] and hence constitute the main global burden of diseases among childhood illnesses.As per WHO estimates, in 1998, approximately 30 million cases and 8,88,000 deaths occurred worldwide due to measles, of which 85% occurred in South East Asia and Africa regions.[4] Diphtheria also has the potential to cause outbreaks especially in those countries with very low reported levels of vaccination coverage.[5]Following the success in eradication of small pox through vaccination, India initiated immunization programme in 1978 under the banner of Expanded Programme of Immunization (EPI), with the objective to reduce morbidity and mortality due to five child killer diseases which are vaccine preventable diseases (VPDs). Those are: Diphtheria, Pertussis, Tetanus, Polio and Tuberculosis. Additional inputs were provided under Universal Immunization Programme (UIP) by strengthening the cold chain facilities and streamlining logistics for vaccine, other essential supplies and measles vaccination. The aim of UIP is ( i ) to give the full course of DPT, OPV, BCG and Measles vaccines before the first birthday to all children and ( ii ) to give 2 doses of tetanus toxoid to all pregnant women throughout the country. These services were organized as a part of primary health care through the existing health infrastructure. During 1992, this programme was integrated with National Child Survival and Safe Motherhood (CSSM) programme. Following the International Conference for Population and Development (ICPD) held at Cairo, a paradigm shift was brought about and "Reproductive and Child Health Programme" was launched in October, 1997. Immunization continues to be an important component of the RCH programme. In the past decade and half, all the districts in the country have been covered under the Universal Immunization Programme. However, providing immunization, by itself, does not guarantee a reduction in disease morbidity and mortality. The full course of vaccines must be given at the right age and the vaccines must be potent. Vaccination activity should not be an end in itself but lead to development of immunity against diseases.The accurate measurement of vaccination coverage and maternal care, antenatally and during delivery, are essential steps in determining the successful implementation of the maternal and child health programme. This can be performed with the help of a coverage evaluation survey, in field. Keeping this in view, a community-based, cross-sectional survey, using the WHO 30 cluster technique[6], was carried out as a field exercise by participants of 9th FETP course. The study was aimed to estimate the immunization coverage of DPT, OPV, BCG and Measles amongst children of 12 - 23 months and to know the reasons of immunization failure. It also aimed to estimate the immunization coverage of Tetanus toxoid and the status of antenatal care and delivery practices of mothers of infants, and then to cross check the results with routine reporting system.
Materials and MethodsA Survey was conducted in Rural area of Alwar District, Rajasthan, among children, 12-23 months of age, and mothers of children (0-11 months of age) from 25 - 30 September, 2004. Sampling Technique used was Standard WHO-30 cluster sampling; Population Proportionate to Size (PPS)[6] and Sample Size were 210 mothers and 210 children.Total rural population of Alwar district is 25,57,653. The sampling interval determined was 85,255. The first random number selected was 73. 210 mothers, and 210 children were selected from these 30 clusters (7 per cluster for each i.e., 7 mother of children in age group 0 -11 months and children of 12 - 23 months of age). A standard WHO pre-designed schedule available for evaluation of immunization coverage was reviewed and adapted. The schedule was pre-tested in the classroom by role-play method. 14 Participants of 9th Regional FETP assisted by staff of Field Practice Unit (FPU), NICD branch, Alwar, constituted the survey team and it was supervised by the faculty of Epidemiology Division NICD Delhi and Field Practicing Unit, NICD, Alwar.Briefing for the survey team was done from 20th to 24th of September 2004. The briefing session consisted of schedule's review and Role-Play in the classroom. Question by question instructions and guidelines were given to the surveyors.Data Collection in the Field Survey was carried out in 30 clusters of rural area of Alwar district by four teams (each team comprised of 3 or 4 trainees of the 9th Regional Field Epidemiology Training course and one paramedical staff from Field Practice Unit, NICD Alwar). Information as per pre-tested schedule was collected by interviewing either mother or caretaker of children below two years.House-to-house visits were made in each of these clusters until seven mothers of children under one year of age and seven children in 12 -23 months age groups were found. The selection of the first house was done randomly and subsequent houses were selected by going to the next nearest house. Immunization status of children (12-23 months), source of immunization and reasons for failure to initiate or complete immunization schedule were ascertained. Wherever possible, the dates of immunization were determined by immunization cards or registers. For those who had no such documents, the months and year of immunization were recorded only if convincing "verbal history" was given. Whether immunization was done at the right age was determined from dates of immunization and birth dates. First DPT before one and a half months and Measles immunization less than 9 months were considered invalid immunizations. Question on immunization status (Tetanus-toxoid), antenatal care received, place of delivery and person who conducted the delivery were asked from seven mothers of infants (0 -11 months) in each cluster.For immunization status, definitions from Service evaluation coverage, CSSM 1992[6], were followed. The right age for vaccination was considered as: for Measles, soon after 9 months (9 months completed); BCG-any time after birth; Polio/DPT-first dose, any time after 6 weeks of birth. Subsequent doses spaced at least one month or 28 days apart.A fully-immunized child is the child who was vaccinated for BCG, 3 doses of OPV, 3 doses of DPT and 1 dose of measles in the eligible population (12-23 months of age). First DPT before one and a half months and Measles immunization less than 9 months were considered invalid immunizations, and such vaccina­tions were excluded from the computation of fully immunized children even if all doses for six VPDs were given. Partially immunized child was the one who had not received complete immunization schedule or received one or more than one of these immunizations at wrong age. A person vaccinated at the wrong age was considered not vaccinated. A second or third DPT or Polio vaccination which was given less than one month after the preceding vaccination was considered invalid. It was checked that the vaccinations were completed before 12 months of age. Measles vaccine given before 9 months age (270 days) was considered not valid. Non-immunized were those who did not receive even a single dose of any vaccine or have been administered at a wrong age. In case of a partially immunized or a non immunized child, the responsible person in household was asked to give the most important reason why the immunizations were incomplete. The information collected was transferred to 'Master Sheets' and analysis was done manually.
ResultsThe rural of Alwar district has been covered in the present survey covering a population of about 25.58 lakhs (information of present survey is given in Methods). Of of 211 eligible children, 134 (63.5%) were males and 77 (36.5%) were females. Less than one-third (61/211, 28.9%) of children aged 12-23 months were fully immunized with BCG, 3 DPT, 3 OPV and Measles vaccines; around a quarter (56/211, 26.5%) had not received even a single vaccine (non immunized) and tittle less than half (94/211, 44.5%) were found partially immunized [Table - 1]. Around half of the eligible children were vaccinated for BCG (55.95) and Measles (43.6%). Though nearly two-third (66.8%) were covered with first dose of DPT and OPV, but about one-third of children dropped out of the third dose of DPT and OPV for various reasons [Table - 1]. The main reasons for drop-out or non-immunization was "lack of information about the immunization programme" (41.3%). Other obstacles like absence of vaccinator (15.2%) and a busy schedule of the mother at home (10.8%) were other major responses to vaccine non-compliance [Table - 2].Three-fourth (74%) of mothers of the infants (0-11 months) were found fully-immunized with tetanus toxoid. Nearly all (96-100%) of them had received it from Government established centers. Less than one-fourth (23.8%) of mothers had contacted health personnel/health center for at least three times for receiving antenatal care, and 37.6% received over 100 tablets of Iron and Folic acid (IFA) during their entire period of gestation [Table - 3]. Around three-fifth (127) deliveries took place at "Home". 'Untrained midwives conducted 60% of total deliveries at homes.
Discussion
This study shows that the vaccination coverage has remained more or less the same as compared to the previous studies carried out in the same state/district[7],[8] [Table - 4]. A recent evaluation of routine immunization coverage in some districts of West Bengal and Assam carried out during the period from November 2003 and April 2003 showed variable picture. Immunization coverage was good in Pashim Medinipur (82.5%), followed by Kolkata (71.6%), Malda (65.3%), and 24 Praganas South (61.9%) districts of West Bengal. Murshidabad district of West Bengal had only 41.3% coverage, while poorest coverage was observed in Goalpara district (27.2%) of Assam.[9] According to NFHS-2, the proportion of children fully-vaccinated in 12 months of age was 35%; 52% being urban and 29.3% being rural children. In Rajasthan, the vaccination coverage was found to be 17%, which is much less compared to National average[10].One-third (45/134; 33.6%) of males and one-fifth (16/77; 20.8%) of females were found to be fully-immunized. Complete immunization (fully immunization status) was better among male children (33.6%) than that of females (20.8%). However, statistically this difference was not found significant for overall immunization status (fully, partial or non-immunization status) (x[2]=4.89; p>0.05). Hence, only seemingly, immunization status of males was better than that of females.Vaccination coverage was found to be much lower than the goal of universal immunization [Table - 1]. NFHS data also revealed that BCG coverage was 64.3% and measles 36.2%; coverages by DPT 1, 2, 3 and Polio 1,2 and 3 were 64.4%, 57.0%, 46.6% and 77.5%, 71.1% and 54.4% respectively in rural areas[10]. The reasons for non-immunization or drop-out [Table - 2] were similar as have been noted in prior studies[7],[8],[9]. Though nearly all (more than 96%) of children were immunized through Government established centers, but immunization cards/documents were available only to 27.6% of children [Table - 1]. According to NFHS-2 also, the public sector is the primary provider of childhood vaccinations in India. NFHS-2 also reports that immunization cards were shown by 40% urban and 30% rural children in India and only 15% children in Rajasthan[10].Nearly three quarters of mothers were fully immunized for tetanus but only quarter of them received three antenatal check-up, and 60% deliveries were conducted by untrained dais. This is a matter of concern and calls for intensive training of the midwives in these areas for effective management of labor and infant vaccination later on.Comparison of Evaluated Coverage with Recorded Coverage BCG was reported to be 103.43%; for 3 doses of DPT the recorded coverage was 106.69%; for 3 polio doses, it was 106.69%; for measles, 103.43%l and complete immunization (BCG+3 doses of DPT+3 doses of Polio +Measles) was 103.43 % as per records (2002) in Alwar district. But the evaluated coverage in the present field coverage evaluation survey (25th -30th September, 2004) was 55.9% for BCG, 38.4% for 3 doses of DPT, 38.9% for 3 polio doses, 43.6% for measles and 28.9% for full immunization [Table - 1]. So, the observed difference between recorded and evaluated coverage as per present survey was 74.53%. Acknowledgement This study was funded by World Health Organization and was a part of training of WHO Fellowship called "Field Epidemiology Training Programme". This course was being conducted by NICD.) ( Survey Team: D.S.L. Karma, Nepal; Narain Thapa, Nepal; Tarun Paudel, Nepal; Kunal Chatterjee, Armed Forces, India; Somenath Karmakar, India; Sona Pradhan, Bhutan; Subhasis Debbarma, Tripura; Kamal Riyang, Tripura; K.P. Debnath, Tripura; K.T. Lepcha, Sikkim; Maya Sarkar, West Bengal; Tun min, Myanmar; H.G.S. Navratne, Srilanka)




NEW TACK MAY STAMP OUT POLIO FOR GOOD
Northern India remains one of the last strongholds of polio, despite ongoing vaccination campaigns designed to stamp it out for good. Now researchers think they understand what has gone wrong – and how to fix it.
Polio has exploded in India in recent weeks, leading to renewed criticism of the World Health Organization’s much-postponed goal of eradicating polio. There have been 522 cases in India this year – compared with 47 by the same time last year – and most of them have occurred in the north Indian states of Uttar Pradesh (UP) and Bihar.
Polio is entrenched in the poor, crowded slums of Ghaziabad and other districts in the Indian state of Uttar Pradesh, one of the areas where vaccination efforts are focused (Image: Science)
Statistical analysis shows that is probably because these areas are more crowded with less sanitation than elsewhere in India, says Nicholas Grassly at Imperial College in London, UK. That suits polio, a gut virus that spreads in faeces, but this is not enough to explain such a massive hike in polio cases.
Alarmingly, children in these states are each getting on average 15 doses of oral polio vaccine, compared with 10 for the rest of India, and three in the richer nations of the west. Yet even these heavily-vaccinated children are being paralysed by polio.
Reduced chances
To investigate, Grassly and colleagues studied data from 96,000 children treated for polio-like paralysis since 1997 across India. They discovered that oral poliovirus vaccine is significantly less effective in UP and Bihar. In UP, each vaccination cut a child’s chances of getting polio by a mere 9%, compared with 21% elsewhere in India, and 65% in the developed world.
Oral polio vaccine contains three strains of live, weakened virus, which elicit an immune response in the gut. Studies have shown that diarrhoea and other competing gut viruses – which are particularly common in UP and Bihar – can prevent the "trivalent" vaccine viruses from producing a strong immune response.
But it now seems that the three strains of polio in the vaccine also compete with each other. Last year children in Bihar started getting a “monovalent” vaccine containing only the Type 1 strain of polio – the main one circulating there. Preliminary observations suggest it is three times more effective than ordinary vaccine. Cases have now started to decline in Bihar.
New schedules
The new vaccine will now be used regularly in UP, alongside routine vaccination with the trivalent vaccine. Another single vaccine, for Type 3 polio, will be given in the few pockets where that strain persists.
Type 1 polio should remain the priority because it is more infectious and more likely to cause paralysis than the Type 3 strain, says Bruce Aylward, coordinator for the WHO’s Global Polio Eradication Initiative. The last case of Type 2 polio anywhere in the world was seen in 1999.
“We are planning a big push to get Type 1 polio knocked out in India during the first half of 2007,” says Aylward. “We can go back and hit Type 3 later – and within 24 months we hope to eradicate it completely.”
He says this is an ideal time to hit Northern India because the major transmission season has just ended and they currently have enough monovalent vaccine to cover the key areas.
The eradication programme has already cut polio cases from 350,000 in 1988 to about 2000 in 2005. Countries which had eliminated the disease, but were re-infected by outbreaks spreading from Nigeria in 2003, have now been mostly mopped up. The toughest areas, say WHO officials, are the countries polio has never left: Nigeria, Afghanistan, Pakistan and India.
Sterility and cancer
This week Saudi Arabia announced that all people arriving in the country from India would be given a booster dose of trivalent oral vaccine, in order to reduce the chances of new outbreaks, particularly during the Haj pilgrimage period, which begins at the end of November. This follows the introduction of similar restrictions at the start of November on arrivals from Nigeria.
It is hoped such measures will encourage uptake of vaccine among Muslims in north-Indian states, who will also be encouraged to get vaccinated before they arrive.
Vaccination teams have recently fought opposition from Muslims in UP, who are being targeted by pamphlets alleging that polio vaccine causes sterility – or, in a new twist, cancer. Similar rumours caused the 2003 outbreaks in Nigeria, and seem to be partially responsible for the upsurge in India this year – in UP, Muslims make up 17% of the population, but 70% of polio cases.
“Pamphleteering isn’t the only cause, but it certainly doesn’t help,” says Grassly. “Most of the new cases are occurring in Muslim areas, but these also tend to be the poorest communities and therefore the children are the most susceptible to infection.”

Polio taking its toll
Polio has become a health headache in the country in the last decades and despite prolonged government efforts has not been exterminated, causing in many cases life-long disability and death.
Alarmed by the polio situation in the country, United Nations has recently written to Prime Minister Manmohan Singh and World Health Organisation has shot off a letter to Health Minister Dr Anbumani Ramadoss, expressing concern over the persistence of poliovirus in Uttar Pradesh and the risk it poses to other countries. Both the agencies have taken note of the current outbreak in UP which has this year reported 255 cases, according to official sources. India as a whole has already reported 283 cases this year, the maximum since 2002 when the number of polio cases had risen to a high of 1,600 due to an outbreak in UP and Bihar.
The two agencies have said the poliovirus from UP poses a danger not only to neighbouring states but also to other countries like Bangladesh, Nepal, Angola and Namibia, which had largely succeeded in controlling the disease. Bangladesh, which was polio free for five years, has reported 13 cases, all attributed to exportation from UP, Bihar, till September 06 has reported 17 cases, Haryana 5, while one case each has been reported from Uttaranchal, Jharkhand, Madhya Pradesh, Maharashtra, West Bengal and Chandigarh. Though the National Capital has not reported any polio case this year so far, detection of cases in neighbouring Ghaziabad is being seen as a risk.
Authorities in Delhi attribute the failure in UP to a lack of political and administrative will in the state. About Rs 20 crores is allocated to the state for every round of polio vaccination. The state government has attributed its failure to control polio to lack of quality vaccine. Union government officials maintain that it was the same vaccine which had controlled polio in other parts of the country. Muzzaffarpur, Saharanpur, Moradabad, Badayun, Rampur and Bijnaur are some of the badly affected areas of UP Government officials have said. Though the state had been warned last year that children were not getting covered during immunization rounds, action was delayed against the erring officials which led to damage to polio eradication efforts.
Almost two weeks after the UN pulled up India for the spread of polio virus Health Minister Ramadoss admitted that nearly 7 to 15% of children in Western UP- the epicentre of this year's outbreak had been left out of the polio vaccination drive. Ramadoss, who held an emergency meeting with states on September 20 that have reported a spurt in polio cases, announced there would be three rounds of polio vaccination across the country, starting this November. The reason: children were left out in the 2005 vaccination exercise and the virus began manifesting itself from May last year. There have even been 23 deaths.
Following the outbreak WHO has redefined the high risk zones. It includes Maharashtra, Haryana, Uttaranchal and Chandigarh. The first phase of the immunization drive will concentrate on these new high risk zones where 37 million children under the age of five would be vaccinated.
The high risk zones have been identified not because there are a high number of cases now but also because of high migrant population, Jay Wenger head of National Polio Surveillance Programme has said, explaining the causes. For example, the virus has been found in sewage water samples collected from slums in Dharavi, Wadala and Shivaji Nagar in Mumbai. It has the same genetic sequence as the UP strain.
Another problem that the government has to deal with is that UP is large Muslim minority are reluctant to get their children immunized because of rumours that polio drops are a part of a Western conspiracy to make their children sterile. Nearly 70% of the cases are from minority communities. Doctors in urban areas have pointed out health officials ignored evidence in the 1980s that three doses of the oral polio vaccine (OPV) would not prevent polio paralysis in a large number of children. The three dose schedule lasted until the mid 1990s when the government launched pulse polio campaigns to give all children under 5 years extra doses of OPV on designated dates during the year. Five doses would also have revealed multi-dose failure with OPV and stimulated rethinking about eradication strategies, a former expert Dr Jacob John has said.
Dr John believed policy makers displayed an unscientific bias towards OPV over the inactivated injectible polio vaccine that had been shown through studies as superior in many ways.
An agency report circulated in mid September has said falling immunization rates has emerged as a worrying factor in many states as only 47 per cent of the children in the age group of 12 to 35 months in 43 districts surveyed received full immunization coverage. While districts such as Tumkur in Karnataka topped the list with 93.4% coverage, the districts of Gaya in Bihar and Lalitpur in UP dragged down the achievement with a dire 5% coverage followed by Dholpur (Rajasthan) and Sitapur (UP) with 6.7% and 6.8% respectively. Within Karnataka itself, Raichur could immunize only 23% of its children indicating disparities within districts too. These findings are borne out of a Government of India-UNICEF survey covering 2,580 villages on sample basis from 43 districts of 14 states, which are focal districts of the Government of India-UNICEF country programme of Cooperation Cycle of 2003-2007.
According to Dr NC Saxena, member National Advisory Council, it points to falling immunization rates in many states as corroborated by a midterm review undertaken by Planning Commission, despite an impressive overall growth rate charted by the economy. Rather than improving on health allocation, state governments are reducing allocation for the health sector, Dr Saxena is reported to have pointed out. While there has been considerable improvement in the areas of water availability and education, on the fronts of sanitation and child protection much more needs to be done.
At this point of time, it is necessary to be pro-active and positive about immunization of children of both sexes for a brighter tomorrow for the coming generations, and not to take a complacent stand in the matter. Health, education or awareness must go hand in hand - the responsibility lies with the government state or Central to involve NGOs, field personnel and even the clergy for positive results.


INDIA SECOND ONLY TO NIGERIA IN POLIO CASES

With fresh cases of polio reported in 16 states last year,India saw an un-precedented increase of 909% in the number of polio cases.A government report on Intensified Pulse Polio Immunisation Programme reveals that with 666 cases last year, India earned the second spot internationally in the highest incidence of polio- just after Nigeria.

Of the 17 countries that are still reporting fresh cases of polio,Nigeria had the highest number at 1,090.While India was second, the rest of the Indian sub-continent fared better.There was no increase in Nepal and Pakistan showed only a slight rise from 28 cases in 2005 and 39 in 2006.Afghanistan,however showed an increase from 9 to 31 cases. Even Somalia fared better than India.

According to the report that has complied statistics from 27 states and union territories in India, eight states that had not reported a single case in 2005 saw fresh cases in 2006.These include Assam,Chandigarh, Himachal Pradesh, Jammu and Kashmir, Maharashtra,Rajasthan and West Bengal.UP replaced Bihar as the state reporting maximum number of polio cases.

The biggest problem in the immunisation programme being undertaken is that of absenteeism. According to the report,the government officials involved in the programme either report late for the programmes at Pulse Polio centres do not report at all. In Delhi,the absenteeism has increased steadily over successive drives.

The report has identified problem areas in the immunisation programme.It has found that door-to-door surveys,the backbone of the programme,are not conducted properly.Sometimes, the upper floors of a colony are not covered at all and marking outside the doors is not proper.Banners are also not displayed properly.The government staff has reported problems in covering cooperative societies as they are not allowed inside the premises.

Seeing the increase in number of cases in Delhi from one to six over one year,the government has decided to further intensify the programme.Polio drops will now be administered at 50 Metro stations also.






CHAPTER 5
REPORTING





























SUMMARY

Some people think social marketing is a dating service; others, a mass media campaign of public service announcements; others, any programme that establishes a product-distribution network. But it is more. Social marketing defies quick definition because its programmes are not easily stereotyped.

Social marketing is the application of marketing principles to the design and management of social programmes. It is a systematic approach to solving problems, in this case public health nutrition problems related to the adoption of health-promoting behaviours such as the enhanced use of services, the trial and continued use of a product, and the improvement of household or community practices. Because it is an approach and not a solution, there is no template for others to copy.
CONCLUSION
In conclusion, my central message is that an education strategy that actually works, as opposed to one that looks good on paper, is likely to involve a lot more than just communication techniques.
If the social marketing mission is to be successful, then as marketers we may need to step outside the conventional boundaries of 'awareness communication'. we may have to help people visualise new futures. We may need to work with engineers to build services and infrastructure. We may need to work with politicians and managers to provide leadership. You may need to create a sense of event. And we will have to think in the long term and ensure that resources are available to repeat and reinforce our messages.
There were low levels of immunization coverage for both mother and children (age 12-23 months). Only one third of eligible children and three-fourth of mothers were completely immunized for their immunization schedule. Lack of awareness of the immunization programme was the main reason behind this. Regular and focused IEC activities regarding need for immunization is required so as to elevate community belief on the need for vaccination. The problem of high drop-out rate of immunization could also be overcome by creating awareness of the programme and relevance of 2nd and 3rd doses of DPT and polio vaccines. Increasing community participation through intensive and extensive health education campaign may also be required. Since most of the deliveries were done at home and conducted by untrained midwives, a training programme as well as involving them in IEC activities should be contemplated.
BIBLIOGRAPHY

www.social-marketing.com
www.social-marketing.org
www.psi.org