Bela situated in the Khaira block of Jamui district is a small village. Inhabited mostly by Yadav, Tiwari, Kanu and Manjhi caste communities, the main occupation is working at the brick kiln, daily wage work nearby or migrating for work, whichever pays more. People in the community have just enough land to build their houses, and no other sources of secondary income. Extreme poverty, increased distance from Primary Health Center (PHC) and low literacy rates have been major barriers to the Bela residents getting vaccinated.
With a goal to further vaccine uptake and assess strategies for effective vaccination uptake, Bela was selected as one of the villages for Randomized Control Trial (RCT) under the RECOVER Bihar project. Ward Number 6 and partly 7 with a population of 1075 were selected due to its hard-to-reach characteristic, making it the most challenging to achieve 100% vaccination. A target of vaccinating 100 beneficiaries was set.
The PCI team began the line listing activities in this village for the RCT 12th February onwards with the help of the Block Coordinator (BC) and the two appointed Village Mobilization Coordinators (VMCs). The team went door-to-door updating the due list for 15-18, 18+ and 60+ categories.
Challenges faced during line listing and token distribution
When PCI started the line listing people were unable to recall the dates of their first vaccine or mention names of identification proofs. Even using CoWIN for dose tracking became difficult as many had registered with someone else’s phone number for the first dose, and most of them had migrated out for work. Due to low literacy levels, most residents were not even able to tell formal names of their family members as on the ID cards. Due to limited visibility into COVID and low risk susceptibility, it was becoming difficult to motivate the community to get vaccinated as they did not see the need or
importance of vaccination.
Strategies employed by the PCI team to gain trust and motivate the community
- A trusted village elderly was requested to volunteer for door-todoor mobilization to build trust with the community. Initially the elderly had doubts, but he was counseling to understand that – only those vaccinated are able to better fight this disease and have a higher chance of survival especially those who have comorbidities.
- Some of the lactating mothers were unaware about the new guidelines around vaccine safety for pregnant and lactating mothers. The PCI team informed about the new guidelines and counseled the women accordingly.
“If activities like these were planned before, we might have tackled hesitancy better and faster.”
- To help inform the community and make them understand the importance of vaccines, the PCI Block Coordinator and VMC
- To address issues around recalling dates and phone numbers, the verifiers used Aadhar number, ration number or voting card. For those who were not able to locate their ID proofs, PCI teams requested people to recall the month they got vaccinated. Based on the information given, the teams then cross checked it with line listing data at VMC level and the register that ANM maintains at PHC level.
- For those who still had not registered for counseling, the VMC and BC addressed their concerns using the mobilization leaflets, and also reached out to PHC to facilitate the process.
RCT vaccination camp site and coupon distribution The RCT campsite was organized on the 10th of March. For the RECOVER project, it’s not only about vaccination uptake but also ensuring a positive experience for the beneficiaries. Therefore, besides preparedness information given to the beneficiaries, the site also was designed to make the residents feel welcome. The community members were approached by the VMC who volunteered to make a rangoli at the session site to make it more interesting and appealing. Additionally, the colorful and educational drawings created by all 30 students were put on display. All of the student participants were felicitated with a notebook and pen by the PCI team.
At the site session, under RCT, a Rs. 200 coupon was handed out to those who got vaccinated. Besides incentivising, the community also felt compensated for missing a day’s wage. The initial target set was to get 100 beneficiaries vaccinated; out of which the team successfully
Rs. 200 coupons distributed to encourage vaccine uptake
got 81 beneficiaries vaccinated; from the 18+ age group, 21 received vaccine for 1st dose, and 50 got vaccinated for the second. Within the 15-18 age group, 4 received their 1st dose, and 6 were vaccinated for the second dose. There were around 4-5 elderly who were unable to come to the center. For such special groups, the verifier and the ANM also went to their houses and administered the vaccination.
The varied strategies adopted to make this site session successful speaks to the thought-driven and targeted approaches adopted by the RECOVER Bihar team. It also highlights how the field team is working in a completely integrated manner with all different sections of the system to ensure a holistic outcome, and support the government in achieving 100% vaccination coverage.