Building a vaccine ecosystem in an isolated community
SITUATIONAL INSIGHTS
Hard-to-reach areas serve as a niche for sustaining the transmission of Vaccine Preventable Diseases (VPD) as the proportion of unvaccinated and partially vaccinated children is high. The inequities in accessing hard-to-reach areas have very serious implications for the prevention and control of VPD. While reaching difficult geographical terrains was a challenge, it was even harder to facilitate the process for conducting a smooth vaccination process. As part of the intervention, efforts were made to focus on remote pockets and reach the last mile by defying topographical and logistic constraints, covering long distances to health centre and commuting via inadequate transportation network. Through collaborative approach, trust building and addressing parent barriers to immunization these unprecedented barriers to access were met.
Lavni is a hard-to-reach tribal community that resides in the difficult geographical terrain of Sirdalla block, Nawada. Located at the foothills ‘Chanaka Pahadi’ and surrounded by dense forest cover, the community has a population of 178 inhabitants. The nearest population is far – flung, and the Primary Health Centre (PHC) is at nearly 28 kms. Chopping wood for sale in the local market is the main occupation here.
In July 2023, the area was identified amongst the lowest immunisation coverage pockets of the district. 45-year-old, Indu Kumari, Auxiliary Nurse Midwife (ANM), refrained from reaching the session site alone due to safety issues. Crossing the forest to reach the Lavni community was difficult for her. Therefore, she came along the vaccine courier staff to the session site. Often, Indu reached the site late and left early as there was hardly any beneficiary at the session site. This may be ascertained to the fact that there was no ASHA to prepare the due list and mobilise beneficiaries.
With the population being in a hard to access area, timely immunisation became an issue. The community was ignorant and did the least to get their pregnant women or children vaccinated. Parents lacked knowledge and awareness on immunisation, feared it and resisted changes. This led to a major part of the community not being immunised. Most of the children had missed their birth doses, as parents were unaware, partly since they did not come across the ANM or opt for institutional deliveries. Eventually, this saw a rise in the proportion of zero dose and partially vaccinated children.
Post mapping the key challenges, a strategy plan was chalked out. A paid mobiliser was positioned due to the absence of ASHA, to mobilise and counsel the beneficiaries. Refusals were tactfully managed by the block coordinator and the mobiliser together with a community influencer, Manoj Prasad, a private medical practitioner of the area. The community revered and trusted him. Manoj accompanied the mobiliser counselling door-to-door emphasising in the local dialect on the importance of immunisation for vaccine-preventable illness.
After the preparation of due list, it was seen that the doses of 3 pregnant women and 9 children below 5 years were due. In the first week of August, on the session day, the mobiliser supported in mobilising the community. With the collaboration of PCI team, the ANM, the mobiliser and the influencer, 100% beneficiaries were vaccinated. While vaccinating the beneficiaries, the ANM also shed light over the four key messages to parents and family members accompanying the child. Vaccination/MCP card with the child’s details was also updated.
Authors: Swati Savarn (Consultant) and Nagendra Prasad (Block Coordinator, Nawada)
Editor: Ronnie Clive Francis (Manager – Communications KM)