Editorials

Improving immunisation coverage in rural India

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2553 (Published 17 May 2010) Cite this as: BMJ 2010;340:c2553
  1. Jishnu Das, senior economist
  1. 1World Bank Main Complex, 1818 H St NW, Washington DC, USA
  1. jdas1{at}worldbank.org

    Incentives help, but not nearly enough

    Despite decades of rhetoric about improving health and two decades of economic growth, vaccination rates in India remain low. As in Ethiopia, Burkina Faso, and Afghanistan, measles vaccination rates in India are around 70%, and only 44% of children aged 1-2 years are fully immunised.1 Low vaccination rates have been alternately blamed on insufficient public funds, poor implementation of vaccination programmes, and a general apathy towards the health of the poor. Yet, we have remarkably little evidence to help us separate problems with implementation of vaccination programmes from design flaws that restrict take-up.

    Banerjee and colleagues’ linked cluster randomised trial (doi:10.1136/bmj.c2220) brings together time tested methods from public health (randomised trials) with the latest thinking in economics on incentives and human behaviour to examine fundamental problems of design in the delivery of vaccinations.2

    The authors compared two interventions in a region where vaccination rates are low. In the first intervention, vaccination camps were held in villages on a monthly basis. The second intervention also established camps, but the researchers provided households a small food incentive (lentils worth $1; £0.66; €0.78) for every vaccination and …

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