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S0965-8564(99)00061-0

**Chapter 12**

**Abstract**

**1. Introduction**

**175**

*Basant Kumar Panda*

Temporal Trend and Inequality in

Since 1978, India through its various health policies target to achieve the universal immunization, but profound progress is yet to be seen. This paper examine the trend in immunization coverage and differential access among the population subgroups. Data for the analysis was extracted from the two recent rounds of the National Family Health Survey (NFHS) conducted in 2005–2006 and 2015–2016. Descriptive statistics were used to understand the level of coverage, whereas the ratio method and concentration index was used to understand the inequality. The study identified immunization coverage had improved from 44 percent in 2005– 2006 to 62 percent in 2015–2016. However, considerable variation was observed among the regions and various wealth quintiles. In the Southern region, 63 percent of children from the poorest wealth quintile were fully immunized compared to 36 percent in North Eastern region. The coverage of full immunization among richest children was found to be 1.5 times higher than that of the poorest. The concentration index remains positive showing the pro-rich inequality. A positive result was found in the Northern and Northeastern region, where the poorest were showing an impeccable improvement over the period. Moreover, the study found the gap by place of residence and gender was close to convergence. The study suggests that the immunization programs have to be inclusive, with widespread reach, leaving no stones unturned. These steps can be beneficial in diminishing inequalities, acting as

an essential ingredient in achieving the sustainable development goals.

Socioeconomic inequalities in a child health is a major policy concern to achieve the Sustainable Development Goals (SDGs) framed by the United Nations in 2015 [1]. However, progress toward reducing these inequalities in child health indicators is not noteworthy among and between the countries [2]. Irrespective of the continued global effort to reduce the infant and child mortality rates, the targets of Millennium Development Goals (MDG) remained unattainable in many developing countries [3]. Nearly, 5.6 million of under-five death occurs worldwide [4], out of which quarter of death are due to vaccine-preventable diseases. Moreover, an estimated 19.9 million infants worldwide stay absent for routine immunization services. Around 60 percent of these children live in 10 countries, mainly from Africa and South Asia including India [5]. Though the Global Vaccine Action Plan (GVAP) has been endorsed by 194 countries in 2012, to ensure the equitable access to immuniza-

**Keywords:** inequality, immunization, India, NFHS, temporal

tion by the year 2020, profound progress is yet to be seen [6].

Immunization Coverage in India
