When India Works

Bikas Das/Associated Press

ALLAHABAD, India â€" Look in any direction at any time in this riddle of a state and you can’t help but find dysfunction.

Yet in the five days spanning Jan. 20 to 25, the Indian government administered polio vaccine to an estimated 172 million children â€" a number greater than the entire population of Russia â€" in an ongoing effort that has eliminated the disease here.

How can this be

From the unsafe water that’s delivered each day into hundreds of millions of homes and village hand-pumps, to a welfare system that allows half of India’s children to go hungry while politicians steal billions of dollars in food aid, it’s clear that poor people often survive here despite, and not thanks to, their citizenship in the world’s most populous democracy.

And yet. In 1988 India had as many as 200,000 new polio cases a year. In 2009, after two decades of vaccinations, it accounted for, at 741 infections, nearly half the world’s total. Last month, however, India marked two years without a single polio infection, a giant victory in a country that’s regularly trounced by its poorer neighbor Bangladesh in a number of health indicators.

India’s successful war on polio shows what can happen when its government sets clear policy goals backed with proper funding and real accountability.

The complexity of India’s polio project is “unprecedented in the world,” said Anuradha Gupta, a top official at the health ministry who oversees the nationwide effort. With 1.2 billion people speaking dozens of languages, multiple pockets of deep impoverishment and exploitation, and weak rural infrastructure, “it doesn’t get harder than the most difficult contexts in India,” said Rod Curtis, a spokesman for Unicef.

The drive last month was carried out by 2.3 million vaccinators deployed across the country, with special emphasis on 107 townships in Uttar Pradesh and Bihar, two northern states that stand out for their prolific birth rates, entrenched corruption and deep poverty. Teams go door-to-door in each town administering oral vaccine drops to small children and infants.

Their work is strictly monitored. In a rarity, local health officials and frontline workers have faced suspension for slacking on the job. Such disciplinary actions can be unusual in a system where many government posts are acquired thanks to patronage or bribes.

Here in Allahabad, in Uttar Pradesh, a massive tent city has been erected to accommodate the millions of people attending the Maha Kumbh Mela, a 55-day Hindu festival at the confluence of the Ganges, the Yamuna and the mythical Saraswati rivers. Teams are working 24-hours-a-day at roads and intersections to find children lacking the indelible ink-spot on their right pinky that denotes a recent vaccination.

Some parents are reluctant. “I tell them it’s mandatory,” Shaheena Parveen, a 19-year-old volunteer, told me as she waded into a stream of pilgrims to intercept a migrant peddler and her 4-month-old daughter. “I say it nicely, softly.”

After years of outreach, fewer than 1 percent of families turn down the vaccine. Teams last month vaccinated an estimated 100,000 children on movi! ng trains! .

In many towns, residents at first refuse to accept vaccination, using the drive to negotiate for basic municipal services they aren’t receiving, including working sewers and drains, officials told me.

This points to the limits of an otherwise impressive achievement. In the two years that India finally drove out polio, encephalitis killed more than 1,000 children in Uttar Pradesh. The principle source of those infections was the same as that for polio: rotten sanitation.

Is providing clean water and working sewers really more difficult than vaccinating hundreds of millions of children against a single devastating virus Why is one achievable and not (so far) the other

Here’s one possible clue. In the same period those children died of encephalitis, nearly a dozen state officials were charged with stealing an estimated $1.8 billion in health funds earmarked for rural areas â€" an amount five timesgreater than that spent by Indian taxpayers to eliminate polio in 2011 and 2012.

Dan Morrison is a journalist and the author of “The Black Nile.”