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U-WIN PORTAL

23rd July, 2024

U-WIN PORTAL

Source: IndianExpress

Disclaimer: Copyright infringement not intended.

Context

  • The U-WIN portal, the digital platform to record vaccinations, is poised for a nationwide launch by the end of August.
  • This portal, modelled after the Covid-19 vaccine management system Co-WIN, aims to create an electronic registry of routine immunisations for pregnant women and children under the Universal Immunisation Programme (UIP).

Details

  • U-WIN is part of India’s Universal Immunisation Programme (UIP), which falls under the Reproductive and Child Health (RCH) Program of the National Health Mission (NHM).
  • During the interim Budget for 2024-2025 in February, Finance Minister Nirmala Sitharaman emphasised the expeditious rollout of the newly designed U-WIN platform to manage immunisations and support Mission Indradhanush.

Key Features of U-WIN

  • Electronic Registry: Captures every vaccination event for pregnant women and children, ensuring accurate and complete records.
  • Digital Vaccination Certificates: Generates QR-based, digitally verifiable e-vaccination certificates accessible anytime by citizens.
  • Self-Registration and Scheduling: Citizens can self-register via the U-WIN web portal or mobile app, select vaccination centers, and schedule appointments.
  • Automated Alerts: Sends SMS alerts for registration confirmations, dose administration, and reminders for upcoming doses.
  • Frontline Worker Support: Enables frontline workers to digitally record vaccination events, facilitating accurate and easy record maintenance.
  • Ayushman Bharat Health Account (ABHA) IDs: Aids in creating ABHA IDs for comprehensive health record maintenance.
  • Reducing Zero-Dose and Left-Out Children: Uses a name-based tracking mechanism to ensure no child is left unvaccinated, particularly benefiting migratory populations.

How U-WIN Works

  • Registration: Children up to the age of six years and pregnant mothers are registered using government ID like Aadhaar and their mobile phone numbers.
  • Vaccination Records: Records of all 25 shots given to a child and two given to pregnant mothers are added. The platform generates a checkered vaccination certificate that color-codes all vaccines.
  • Vaccination Tracking: After each shot is administered and recorded on U-WIN, its date gets added to the card, showing the due date for the next set of vaccines.
  • Reminder System: SMS reminders are sent to parents before their children are due for the next dose.
  • Portability: The digital vaccine certificate can be downloaded by parents using their registered mobile numbers, allowing for vaccination anywhere in the country.
  • Health Worker Support: The platform can automatically generate a due-list of children in their respective areas, allowing health workers to track and ensure vaccination compliance.
  • Data Integration: U-WIN will eventually connect all digital records through ABHA (Ayushman Bharat Health Account) ID, integrating data from various government programs.

Pilot Project and Feedback

  • The U-WIN platform is currently in a pilot phase in 64 districts.
  • ASHA workers and other community health workers have been instrumental in its implementation, going door-to-door to collect data and register children and pregnant women on the portal.
  • Feedback indicates that while the portal is beneficial, challenges such as lack of vaccine storage facilities and patchy internet connectivity remain. Physical registers are maintained as a backup, and workers have requested to extend the data entry window from 24 hours to 48 hours.

Future Implications for Healthcare

  • Individual Tracking: Establishes a mechanism for individual tracking of immunizations, ensuring comprehensive coverage.
  • Enhanced Awareness and Accessibility: Improves awareness among beneficiaries about session locations and dates, particularly in urban areas, and addresses inequities in immunization coverage.
  • Comprehensive Information Source: Serves as the single source of information for immunization services, including pregnancy details, newborn registration, immunization status, and delivery outcomes in real-time.
  • Digitization of Records: Eliminates the need for manual record-keeping, streamlining session planning and updating vaccination statuses in real-time, thus reducing administrative burdens and improving efficiency.

Immunization in India

Universal Immunisation Programme (UIP)

  • The Universal Immunisation Programme (UIP) is one of the largest public health programs globally, launched in 1985.
  • It aims to provide free vaccines against 12 vaccine-preventable diseases to all children and pregnant women across India.

Target Groups:

  • Annually targets 2.9 crore pregnant women and 2.6 crore infants (0-1 years).
  • Provides more than 1.2 crore vaccination sessions annually.

Vaccines Administered:

  • Under UIP, 11 vaccines are administered to protect against 12 diseases, including:
    • Tuberculosis
    • Diphtheria
    • Pertussis (Whooping Cough)
    • Tetanus
    • Poliomyelitis
    • Measles
    • Hepatitis B
    • Haemophilus influenzae type b (Hib)
    • Rotavirus
    • Pneumococcal diseases
    • Japanese Encephalitis (in endemic districts)
    • Rubella

Immunization Coverage:

  • According to the National Family Health Survey (NFHS-5) 2019-21:
    • Full immunization coverage (FIC) for children aged 12-23 months has increased to 76.4% from 62% in NFHS-4 (2015-16).
    • States with high FIC: Punjab (89.7%), West Bengal (90.5%), Himachal Pradesh (89.9%).
    • States with lower FIC: Nagaland (57.6%), Arunachal Pradesh (59.7%), Uttar Pradesh (68.6%).

Challenges:

  • High dropout rates between DPT1 (Diphtheria, Pertussis, and Tetanus first dose) and DPT3.
  • Geographic and socio-economic disparities in immunization coverage.
  • Resistance to vaccination in certain communities due to myths and misinformation.

Zero-Dose Children:

  • Zero-dose children are those who have not received any vaccination.
  • According to the WHO and UNICEF, India had 1.6 million zero-dose children in 2023.
  • Significant in states with lower immunization coverage and higher instances of vaccine-preventable diseases like measles.

CAG Audit Report on the Reproductive and Child Health (RCH) Programme (2011-12 to 2015-16)

The Comptroller and Auditor General of India (CAG) released an audit report on July 21, 2017, scrutinizing the Reproductive and Child Health (RCH) programme under the National Rural Health Mission (NRHM). The NRHM, launched in April 2005, aims to provide accessible, affordable, and quality healthcare to the rural population. The RCH programme, a sub-component of NRHM, focuses on maternal and child health, immunization, and family planning.

Key Findings of the Audit Report:

1. Financial Management

Unspent Balances:

    • There were substantial unspent balances with State Health Societies every year.
    • In 27 states, unspent amounts increased from ₹7,375 crore in 2011-12 to ₹9,509 crore in 2015-16.

Delays in Fund Transfer: Delays were noted in the transfer of funds from state treasuries to State Health Societies, ranging from 50 to 271 days.

 Diversion of Funds: About ₹36 crore was diverted to other schemes.

Recommendations: Proper fund flow management was recommended, considering the absorptive capacity of State Health Societies.

2. Physical Infrastructure

Shortfall in Health Facilities:

    • A shortfall ranging between 24%-38% was observed in the availability of Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs) in 28 states/UTs.
    • The shortfall was over 50% in Bihar, Jharkhand, Sikkim, Uttarakhand, and West Bengal.

Issues with Existing Infrastructure:

    • Unhygienic environments.
    • Inaccessibility by public transport.
    • Non-availability of electricity and water supply.
    • Lack of separate wards for male and female beneficiaries.

Non-functional Completed Works: In 20 states, 1,285 works were completed but not made functional.

Recommendations: A review of civil works by the concerned authorities was recommended to ensure faster completion and commissioning of buildings.

3. Availability of Human Resources

 Shortage of Staff:

    • A shortage of doctors and paramedical staff was observed in almost all selected facilities.
    • In selected CHCs of 27 states, the average shortfall of specialists ranged between 77% and 87%.
    • Only 1,303 nurses were posted against the required 2,360.

Unutilized Medical Equipment: Medical equipment in some states was lying unutilized due to the non-availability of doctors and manpower to operate them.

Recommendations: The Ministry of Health and Family Welfare should ensure that sanctioned posts of healthcare professionals are filled up.

4. Availability of Medical Equipment and Medicines

 Lack of Basic Equipment: Selected health facilities across 29 states/UTs lacked basic equipment required for RCH services.

Non-availability of Essential Drugs:

    • Essential drugs were not available in 8 states.
    • In 14 states, medicines were issued to patients without prescribed quality checks.

5. Quality of Healthcare

National Quality Assurance Programme (NQAP):

    • The institutional framework for NQAP was either not in place or not effective.
    • Low number of internal and external assessments of health facilities.
    • Inadequate reporting and non-evaluation of key performance indicators.

6. Reproductive and Child Health Services and Outcomes

Janani Suraksha Yojana (JSY): Deficiencies were noted in the implementation of JSY, such as non-payment or delayed payment of incentive amounts to beneficiaries.

Millennium Development Goal (MDG) Targets:

    • The target for Infant Mortality Rate (IMR) was 27 (per 1,000 live births), but India’s IMR was 39. As per the Sample Registration System (SRS) Bulletin of Registrar General of India (RGI), the Infant Mortality Rate (IMR) has reduced from 37 per 1000 live births in 2015 to 30 per 1,000 live births in 2019 at National Level.
    • The target for Maternal Mortality Ratio (MMR) was 109 (per 100,000 live births), but India's MMR was 167. As per the Sample Registration System (SRS) Report of Registrar General of India (RGI), the Maternal Mortality Rate (MMR) has reduced from 8.1 in 2015-17 to 7.3 (PER 1000) in 2016-18 at National Level.

The CAG report underscores significant challenges in financial management, infrastructure, human resources, availability of medical equipment and medicines, quality of healthcare, and overall outcomes of the RCH programme. Addressing these issues is crucial for enhancing the effectiveness of the programme and achieving its objectives.

Interventions for improving Maternal Mortality Rate (MMR)

  • Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality by promoting institutional delivery among pregnant women.
  • Janani Shishu Suraksha Karyakram (JSSK) aims to eliminate out-of-pocket expenses for pregnant women and sick infants by entitling them to free delivery including caesarean section, free transport, diagnostics, medicines, other consumables, diet and bloodin public health institutions.
  • SurakshitMatratvaAshwasan (SUMAN) aims to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility to end all preventable maternal and newborn deaths.
  • Pradhan MantriSurakshitMatritvaAbhiyan (PMSMA) provides pregnant women fixed day, free of cost assured and quality Antenatal Careon the 9thday of every month.
  • LaQshya aims to improve the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum period.
  • Comprehensive Abortion Care services are strengthened through trainings of health care providers, supply of drugs, equipment, Information Education and Communication (IEC) etc.
  • Midwifery programmeis launched to create a cadre for Nurse Practitioners in Midwifery who are skilled in accordance to International Confederation of Midwives (ICM) competencies and capable of providing compassionate women-centred, reproductive, maternal and new-born health care services.
  • Delivery Points-Over 25,000 ‘Delivery Points’ across the country are strengthened in terms of infrastructure, equipment, and trained manpower for provision of comprehensive RMNCAH+N services.
  • Functionalization of First Referral Units (FRUs)by ensuring manpower, blood storage units, referral linkages etc.
  • Setting up of Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
  • Operationalization of Obstetric ICU/HDU at high case load tertiary care facilities across country to handle complicated pregnancies.
  • Capacity building is undertaken for MBBS doctors in Anesthesia (LSAS) and Obstetric Care including C-section (EmOC) skills to overcome the shortage of specialists in these disciplines, particularly in rural areas.
  • Maternal Death Surveillance Review (MDSR) is implemented both at facilities and at the community level. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care.
  • Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity for provision of maternal and child care including nutrition.
  • Regular IEC/BCC activities are conducted for early registration of ANC, regular ANC, institutional delivery, nutrition, and care during pregnancy etc.
  • MCP Card and Safe Motherhood Booklet are distributed to the pregnant women for educating them on diet, rest, danger signs of pregnancy, benefit schemes and institutional deliveries.

Interventions for improving Infant Mortality Rate (IMR)

  • Facility Based New-born Care:Sick New-born Care Units (SNCUs) are established at District Hospital and Medical College level, New-born Stabilization Units (NBSUs) are established at First Referral Units (FRUs)/ Community Health Centres (CHCs) for care of sick and small babies.
  • Community Based care of New-born and Young Children:Under Home Based New-born Care (HBNC) and Home-Based Care of Young Children (HBYC) program, home visits are performed by ASHAs to improve child rearing practices and to identify sick new-born and young children in the community.
  • Mothers’ Absolute Affection (MAA):Early initiation and exclusive breastfeeding for first six months and appropriate Infant and Young Child Feeding (IYCF) practices are promoted under Mothers’ Absolute Affection (MAA).
  • Social Awareness and Actions to Neutralize Pneumonia Successfully (SAANS) initiative implemented since 2019 for reduction of Childhood morbidity and mortality due to Pneumonia.
  • Universal Immunization Programme (UIP) is implemented to provide vaccination to children against life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B, Measles, Rubella, Pneumonia and Meningitis caused by Haemophilus Influenzae B. The Rotavirus vaccination has also been rolled out in the country for prevention of Rota-viral diarrhoea. Pneumococcal Conjugate Vaccine (PCV) has been introduced in all the States and UTs.
  • Rashtriya Bal Swasthya Karyakaram (RBSK): Children from 0 to 18 years of age are screened for 30 health conditions (i.e. Diseases, Deficiencies, Defects and Developmental delay) under Rashtriya Bal SwasthyaKaryakaram (RBSK) to improve child survival. District Early Intervention Centres (DEICs) at district health facility level are established for confirmation and management of children screened under RBSK.
  • Nutrition Rehabilitation Centres (NRCs)are set up at public health facilities to treat and manage the children with Severe Acute Malnutrition (SAM) admitted with medical complications.
  • Intensified Diarrhoea Control Fortnight / Defeat Diarrhoea (D2) initiative implemented for promoting ORS and Zinc use and for reducing diarrhoeal deaths.
  • Anaemia Mukt Bharat (AMB) strategy as a part of POSHANAbhiyan aims to strengthen the existing mechanisms and foster newer strategies to tackle anaemia which include testing & treatment of anaemia in school going adolescents & pregnant women, addressing non nutritional causes of anaemia and a comprehensive communication strategy.
  • Capacity Building: Several capacity building programs of health care providers are taken up for improving maternal and child survival and health outcomes

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Sources:

IndianExpress

PRACTICE QUESTION

Q: With reference to the U-WIN portal, consider the following statements:

  1. The U-WIN portal is an initiative by the Indian government to provide a unified platform for vaccination tracking.
  2. It aims to integrate vaccination records for both children and adults.
  3. The portal provides real-time data on vaccine availability and distribution across India.

Which of the statements given above is/are correct?

(a) 1 and 2 only

(b) 2 and 3 only

(c) 1 and 3 only

(d) 1, 2, and 3

Answer: (d)