title: Effectiveness of Muskaan Ek Abhiyan (the smile campaign) for strengthening routine immunization in bihar, India.
abstract: BACKGROUND
  In Bihar State, proportion of fully immunized children was only 19% ;in Coverage Evaluation Survey of 2005. In October 2007, a special campaign called Muskaan Ek Abhiyan (The Smile Campaign) was launched under National Rural Health Mission to give a fillip to the immunization program.
  
  
  OBJECTIVE
  To evaluate improvement in the performance and coverage of the Routine Immunization Program consequent to the launch of Muskaan Ek Abhiyan
  
  
  METHODS
  The main strategies of the Muskaan campaign were reviewing and strengthening immunization micro-plans, enhanced inter-sectoral coordination between the Departments of Health, and Women and Child Development, increased involvement of women groups in awareness generation, enhanced political commitment and budgetary support, strengthening of  monitoring and supervision mechanisms, and provision of performance based incentive to service providers.
  
  
  METHODS
  Immunization Coverage Evaluation Surveys conducted in various states of India during 2005 and 2009 were used for evaluation of the effect of Muskaan campaign by measuring the increase in immunization coverage in Bihar in comparison to other Empowered Action Group (EAG) states using the difference-in-difference method. Interviews of the key stakeholders were also done to substantiate the findings.
  
  
  RESULTS
  The proportion of fully immunized 12-23 month old children in Bihar has increased significantly from 19% ;in 2005 to 49% ;in 2009. The coverage of BCG also increased significantly from 52.8% to 82.3%, DPT-3 from 36.5 to 59.3%, OPV-3 from 27.1% ;to 61.6% ;and measles from 28.4 to 58.2%. In comparison to other states, the coverage of fully immunized children increased significantly from 16 to 26% ;in Bihar.
  
  
  CONCLUSIONS
  There was a marked improvement in immunization coverage after the launch of the Campaign in Bihar. Therefore, best practices of the Campaign may be replicated in other areas where full immunization coverage is low.
authors.affiliation: Departments of Health Management, School of Public Health, PGIMER, Chandigarh, India. sonugoel007@yahoo.co.in
authors.forename: Sonu
authors.initials: S
authors.lastname: Goel
authors.forename: Vishal
authors.initials: V
authors.lastname: Dogra
authors.forename: Satish Kumar
authors.initials: SK
authors.lastname: Gupta
authors.forename: P Vm
authors.initials: PV
authors.lastname: Lakshmi
authors.forename: Sherin
authors.initials: S
authors.lastname: Varkey
authors.forename: Narottam
authors.initials: N
authors.lastname: Pradhan
authors.forename: Gopal
authors.initials: G
authors.lastname: Krishna
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration*; D007194:India; D007223:Infant; D015397:Program Evaluation; D012189:Retrospective Studies