Extended Programme on Immunisation (EPI)

Extended Programme on Immunisation (EPI) a programme of vaccination against six childhood diseases- diphtheria, pertussis (whooping cough), tetanus, tuberculosis, polio and measles. All of these diseases are preventable. The World Health Organisation has recently undertaken a programme for 'universal child immunisation' aimed at eradicating these diseases. In Bangladesh, as recently as 1985 only about 2% of children between the age of 12 and 23 months were immunised against these diseases. A programme was undertaken under the auspices of the WHO in the early 1980s which actually became fully operational in 1985. The programme called Expanded Programme on Immunisation achieved commendable success within just a few years with the result that by 1993 approximately 74% children were immunised and by 1998 the coverage reached nearly 85% for some of these vaccines.

Of the six EPI vaccines only the polio vaccine is oral while the others are injectible. The polio vaccine given during the EPI vaccination programme is the third of the three doses, the first two being given through a special programme of polio eradication which the government has undertaken since 1995. Two days are set every year as National Immunisation Days (NID), usually during the dry winter months to facilitate wide participation. Because of the EPI programme, Bangladesh today stands as an outstanding success story for universal childhood immunisation. It is estimated that about 1.15 million deaths have been averted during the period 1997-1999 largely due to EPI activities.

Between 1988 and 1992, the level of immunization for both urban infants and urban mothers increased from under 25 percent to over 80 percent. Under USAID/B's guidance, this project has been instrumental in bringing together the MOHFW and the Ministry of Local Government,
Rural Development, and Cooperatives (MLGRDC) to form the Interministerial Urban Primary Health Care (PHC) Coordinating Committee, with far-reaching consequences both for urban health systems and for effectively integrating health and family planning activities at the local level.

The urban EPI program covers the four major cities (Dhaka, Rajshahi, Khulna, and Chittagong) and 84 out of 133 municipalities with a combined population of 22 million, or 20 percent of the national population. Urban areas have little health infrastructure. The urban EPI program has successfully pulled together multiple disparate resources to set up fixed and outreach EPI centers. These have included GOB hospitals, municipal and private clinics, and NGO hospitals, clinics, and dispensaries. Critical to the program’s success has been the close collaboration between the MOHFW’s National EPI Program, the International Center for Diarrheal Disease Research, Bangladesh’s (ICDDR,B's) Urban FP/MCH Extension Project, the MLGRDC, municipal governments, UNICEF, and various NGOs. Under a cost sharing partnership between UNICEF and the USAID-funded BASICS Project, there are nine Bangladeshi urban operations officers located in four divisions. These staff persons are beginning to involve city and municipal administrations successfully in coordinating and managing the EPI program.

The EPI programme in Bangladesh has been found to be highly cost-effective. Cost calculations that have been made by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) suggest that the total cost for fully immunising a child with the EPI vaccines at present stands at $11.76 which is considerably lower than the developing country average of $15 per child. The current EPI cost represents approximately 0.06% of GDP. The per capita budget for health and family planning in Bangladesh today is about $3.5, far less than the EPI immunisation cost of $11.76 per child, but because of EPI activities the cost of each death prevented has been calculated to be about $136.

The Visible Successes are:

Decline in the infant mortality rate (IMR) from 118 in 1991 to 107 in 1997. The IMR declined about 25 percent between the early 1980s and the early 1990s, from about 117 to about 87 deaths per 1,000 births.

Decline in the under-five mortality rate from 180 in 1981 to 133 in 1991T.The under-five mortality rate, representing the number of children per thousand born who die before age 5, declined from about 180 in the early 1980s to about 133 in the early 1990s, a decline of about 26 percent.

Increase in urban immunization of women and children from 25 percent in 1988 to 85 percent in 1997. The 1994 National Coverage Evaluation Survey showed that in 1994, 82 percent of urban mothers had received two doses of Tetanus Toxoid (TT), compared to 80 percent nationwide. Urban immunization rates for children ages 12-23 months were as follows: 93 percent for Bacille Calmette-Guérin (BCG) (compared to 96 percent nationwide); 83 percent for Diphtheria, Pertussis, and Tetanus (DPT3) (compared to 88 percent nationwide);76 percent for measles (compared to 86 percent nationwide); and 75 percent for fully immunized (compared to 84 percent nationwide).