No. 1496-P.H., 31ST OCTOBER 1922
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10. In one respect vaccination work in rural areas contrasts very favourably
with that done in municipalities, viz., in the number of operations performed by
the vaccinators. The facts given in column 8 of statement I on pages 8—16
of the Director's Report for each municipality and rural circle work out as
follows:—
Average number of persons vaccinated by a vaccinator.
Range.
North ... ... ... ...
Central ... ... ... ...
South ... ... ... ...
Total for the Presidency
Rural circles
2,150
2,342
2,685
2,398
Municipalities.
907
851
1,086
948
11. Thus the average rural vaccinator does well over twice, in the central range
nearly thrice as many operations as the average urban vaccinator, although the
former has to travel widely among a scattered population, while the latter need not
bestir himself beyond the radius of half a mile or so.
12. The key to this contrast is effective supervision. Rural vaccinations are
subject to the supervision and check of deputy inspectors of vaccination, and a
minimum outturn is insisted on. In most municipalities there is no such check.
Hence there is an enormous variation in the outturn of a vaccinator in one
municipality as compared with the outturn in another. In Tuticorin, for instance,
the number of cases performed in a year by a vaccinator is given as 3,131, in
Nellore 2,788, in Calicut 2,701, in Bellary 1,998, in Cuddalore 1,847, in
Trichinopoly 1,673, while in 32 municipalities the number does not exceed 700, less
than 2 per working day. It is noteworthy that in Tuticorin, Calicut and
Trichinopoly where the outturn was so good the vaccinations were supervised by
health officers of proved efficiency.
13. Although the cost of deputy inspectors of vaccination is debited to the
cost of vaccination in rural areas, while municipalities incur no such charges the
cost of each successful vaccination (including the cost of deputy inspectors) in
rural areas is slightly less than in municipalities " or only a fraction above."
Average cost of a successful case.
Range.
Northern ... ... ... ...
Central ... ... ... ...
Southern ... ... ... ...
Total for the Presidency ...
Rural circles.
A.
9
9
7
8
P.
1
0
10
7
Municipalities.
A.
8
12
6
9
P.
11
2
8
0
14. It naturally follows from this that in a municipality where vaccination
is well looked after the cost per case is much lower than in a municipality where
it is neglected. In Calicut, for instance, the cost per successful operation
is 5 annas 3 pies, in Vizianagram 3 annas 7 pies, in Bellary 3 annas 4
pies, while in Conjeeveram the cost is Rs. 1-1-5, in Tiruppur Rs. 1-2-3, in
Tirupati Rs. 1-14-9. It is clear that the rate-payers of some municipalities are
not getting good value for their money. It is advisable for each municipality to
fix a minimum outturn for its vaccination staff and to insist that the outturn is
attained.
15. One other point worth note is the proportion of successful operations on
children under one year of age to the number of " births available " (Statement
VI of the Director's report). The figures for the several municipalities are
arranged in order of merit in Annexure B. These figures show dangerous slack-
ness on the part of several municipalities, the percentage of infants unvaccinated
ranging from 22.6 in Negapatam to 87.6 in Coonoor and 94 in Chirala. Nowhere,
in fact, can it be said that vaccination has kept pace with the birth-rate,
even if infant mortality were reckoned as high as 226 per thousand births. The