How Uttar Pradesh’s health system is making sure babies born in private facilities get the vaccines they need on Day 1
Private facilities in India’s most populous state have historically been more likely to delay or even miss “birth-dose” vaccines than government hospitals. A new initiative is changing that.
- 22 October 2025
- 6 min read
- by Dr Manoj Kumar Shukul
In the Sambhal and Jhansi districts of Uttar Pradesh, a promising initiative that brings private healthcare facilities into closer collaboration with the public health system is being piloted. The aim? Ensuring that every newborn receives timely, free birth-dose vaccines and is digitally tracked through UWIN from day one.
UWIN is India’s national electronic immunisation registry ,designed to record and track every child’s vaccination status from the day of birth to the completion of the course recommended under the Universal Immunization Program (UIP) of the Government of India. It also supports the real-time registration of beneficiaries and enables tracking and automated reminders to support caregivers in ensuring the completion of the vaccination course. Gavi, the Vaccine Alliance supported the development and scale-up of UWIN as part of its health system strengthening support to India, with the United Nations Development Programme (UNDP) serving as the implementing partner.
The often-missed first step
The earliest vaccines a child receives – within hours of birth – are crucial. Under India’s UIP, every newborn should receive:
- BCG (to protect against severe tuberculosis),
- OPV-0 (Oral Polio Vaccine), and
- Hepatitis B birth dose (to prevent transmission from mother to child, recommended within 24 hours of birth).
Hepatitis B’s short 24-hour window makes adequate availability of vaccines at the point and day of delivery a must, be it at a government or a private health facility. However, at many private health facilities, birth-dose vaccination of the newborns is often missed or delayed – leading to vulnerabilities in newborn protection and gaps in immunisation coverage.
Why the private sector matters in urban India
Data from the most recent National Family Health Survey (NFHS-5, 2019–21) shows that private hospitals continue to play a major role in childbirth services in India’s cities. In rural areas, only about one in five institutional deliveries takes place in a private facility, but this proportion rises to over 40% in urban areas. That’s true of Uttar Pradesh too, where nearly 42% of the births that take place in urban health facilities occur in private hospitals.
This has the potential to result in out-of-pocket expenditures for families and disconnect them from public immunisation services, especially when private health facilities are not embedded within the well-established immunisation system of the government.
A collaborative solution in Jhansi and Sambhal
As per NFHS 5, private facility births account for 29.2% and 17.3% of all institutional deliveries – rural or urban – in Sambhal and Jhansi districts respectively. Recent administrative reports also highlight that hepatitis B coverage in the urban parts of both districts is the lowest among all the administrative blocks within them.
The Uttar Pradesh Routine Immunization (RI) division and partners have identified inconsistent birth-dose administration at private birth delivery centres as one of the major gaps. Supply interruptions, lack of knowledge and skill among staff, and incomplete reporting are some of the problems underlying that gap.
That’s something the Health Department of the Government of Uttar Pradesh, together with the William J. Clinton Foundation (WJCF), intends to change. A public-private initiative is currently being piloted in Sambhal and Jhansi districts, to bring the government’s vaccines into private delivery facilities.
As part of the project, qualified private health facility staff are trained and authorised to administer government-supplied birth-dose vaccines, within the prescribed time window of 24hours – and at no cost to eligible beneficiaries.
Here’s how it works:
- Training and onboarding: Private health facilities, with the provision of birth delivery services, are identified and their nominated staff oriented and trained on UIP’s birth-dose protocols, including vaccine handling, administration, and UWIN data entry.
- Government-supplied vaccines: The Government provides the birth-dose vaccines (BCG, OPV-0, Hepatitis B) free of cost, ensuring availability of these vaccines at private health facilities, which are the delivery centres as well.
- On-the-spot UWIN entry: Every newborn’s birth and vaccination details are recorded on UWIN, enabling end-to-end tracking of immunisation status. Registering a child on UWIN at the time of birth serves as the foundation for a seamless, end-to-end immunisation journey. It enables real-time tracking of each child’s vaccination status, generates automated reminders for upcoming doses, and allows health workers to quickly identify and follow up with those who may have missed a vaccine. This early digital footprint significantly reduces the likelihood of children becoming “zero-dose children” – those who receive no vaccines at all – and improves data-driven planning and resource allocation.
This approach not only enables timely vaccination, especially the critical hepatitis B dose within 24 hours, but also creates a digital record from birth, ensuring follow-up doses aren’t missed.
Digital linkages for long-term protection
By training private sector staff and integrating UWIN into their workflows, the initiative builds a continuum of care that:
- Improves birth-dose coverage in urban areas and strengthens vaccine equity, ensuring all children receive timely protection.
- Reduces the burden of out-of-pocket costs for essential vaccines.
- Enables real-time data visibility for public health officials, improving planning and follow-up.
- Bridges public-private silos and fosters a collaborative urban health system.
The initiative is currently being implemented across 17 private health facilities that provide birth delivery services, and has been directly benefiting 270 infants per month. Erstwhile these private health facilities were either not providing birth-dose services, or, if they were, were doing so at a cost to caregivers.
As one nurse from a participating facility in Jhansi shared: “Earlier, we had to ask families to go elsewhere for the vaccines; many didn’t follow up. Now, we can provide the life-saving vaccines to the baby right here, as soon as they’re born.”
Once this initiative gets extended to the remaining 50+ private health facilities in Sambhal and Jhansi, more than 1,000 newborns per month will start receiving their birth doses on a timely basis without any additional cost to the families.
“We are proud to support the government in demonstrating this inclusive model. It combines digital tracking, public vaccine supply, and private provider engagement to make immunisation equitable from the very first dose,” said Nitin Kothari, Associate Director, Urban Immunization, WJCF.
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Scalable, sustainable, equitable
With rising urbanisation and the significant role of private delivery care, initiatives like this have the potential to transform how India reaches its newborns. By supplying government vaccines, empowering private staff, and digitising immunisation records right at birth, Jhansi and Sambhal are setting a precedent that could guide other districts in closing urban immunization gaps.
Every child deserves a chance, and with approaches like this; none have to be left behind.
After years of working in immunisation, I’ve seen that the first dose a child receives often determines the course of their protection. When that first step happens on time, at any facility, it has the power to change everything that follows.
