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The RECOVER Bihar team distributing Rs. 200 coupons to encourage vaccination uptake

In the lap of Chakai hill ranges and situated in the interiors of Chakai Block in Jamui District, lies a small village called Karijhal. One can experience the raw geography of Bihar while journeying through a red soiled, rocky terrain, and scanty vegetation to reach this remote village. With a population 623, it consists of three tolas – Karijhal, Chandosol and Jamnitar which are home to several Hindu Scheduled Tribes such as Murmur, and Marandi, and a small proportion of Christians. Karijhal has been prone to Naxal invasion, and therefore unsafe to move around after sunset. 

In the lap of Chakai hill ranges and situated in the interiors of Chakai Block in Jamui District, lies a small village called Karijhal. One can experience the raw geography of Bihar while journeying through a red soiled, rocky terrain, and scanty vegetation to reach this remote village. With a population 623, it consists of three tolas – Karijhal, Chandosol and Jamnitar which are home to several Hindu Scheduled Tribes such as Murmur, and Marandi, and a small proportion of Christians. Karijhal has been prone to Naxal invasion, and therefore unsafe to move around after sunset. 

“Men work in the forest or are involved in road construction work. To get vaccinated, we have to go to the other side. Either we lose a day’s pay or if we choose to go after the day ends, the vaccine is over.”

Beneficiary (F) from Karijhal village

The PCI team began their intervention in Karijhal in the month of February. One of the biggest challenges identified here was accessibility. The main hamlet is divided by a stream of river. Crossing the rocky terrain is only possible on a bike or by foot. The nearest PHC housed in Chakai block is located 10 kms from the hamlet, and the nearest market is about 4 kms. Therefore, access to healthcare among other things has been a huge barrier to increase vaccination coverage.

In fact, the field team learnt that those willing to get vaccinated had to walk 4 kms to Bamdah village to get the first dose. To add to this frustrating experience, the Bamdah site hosted neighboring villages  The RECOVER Bihar team distributing Rs. 200 coupons to encourage vaccination uptake RECOVER Diaries / 08
15th March 2022 which led to difficulty in crowd management; and due to the limited supply in the few initial months, the residents of Karijhal returned
disappointed to their village.

Yet another challenge that emerged was the gap in targeted counseling and mobilization. The ASHA of this village also shoulders responsibilities for 2-3 other
villages, due to which her visits are limited to only once a month or so. Majority of the mobilization efforts had been done by the Auxiliary Nurse Midwife (ANM) and the Anganwadi Worker (AWW).

With a mission to make every village under the program, including Karijhal, a 100% vaccinated village, the PCI RECOVER team intervened. The Village Mobilization Coordinator (VMC) has been diligently spearheading mobilization in this village using tools created by Vihara Innovation Network. The VMC
conducted line listing in the month of February, and also undertook door-to-door mobilization along with the Block Coordinator (BC), a  day before the vaccination session held on the 7th of March. One day prior to the vaccination camp, the VMC distributed Mobilization tokens – a physical reminder with information on time, date and venue for vaccination. It also houses preparedness protocols so that the beneficiaries undergo minimal post-vaccine side-effects and have a positive vaccination experience.

To further the uptake of COVID vaccine, Karijhal was shortlisted as one of the intervention sites with a Randomized Control Trial (RCT), being conducted by Yale University in collaboration with PCI. RCT cross randomizes village and household level interventions in order to assess strategies for effective vaccination uptake, and interaction with mask and vaccine promotion has been implemented.

MOIC, Dr. B.K. Roy, PHC, Chakai talks to beneficiaries around preparedness & vaccine safety

The RCT in Karijhal was inaugurated by the Medical Officer In Charge (MOIC), PHC Chakai, on 7th March 2022. From arranging for an Alternate Vaccination Delivery (AVD) vehicle to transporting vaccine, verifier and the staff nurse (ANM) to the organization of the camp was done by the PCI team. All those being vaccinated received a coupon of Rs. 150 that could be redeemed at the local kirana store. During this session, the VMC reiterated the role of the kirana shopkeeper who was also present, and elaborated the process to be undertaken by him. PCI clarified that the coupons can be used to purchase anything available in the store, except cigarettes, alcohol, and such. An additional coupon of Rs. 50 for every beneficiary vaccinated was also given to the ASHA for her continued support.

The VMC’s family has been the backbone of the community mobilization in this village, since his wife, who’s the AWW, himself and his sister-in-law, who’s an aspiring ASHA are already supporting the community in various capacities. Applauding their efforts, during the MOIC, Dr. B.K. Roy, PHC, Chakai talks to beneficiaries around preparedness & vaccine safety “Men work in the forest or are involved in road construction work. To get vaccinated, we have to go to the other side. Either we lose a day’s pay or if we choose to go after the day ends, the vaccine is over.” Beneficiary (F) from Karijhal village inauguration, the MOIC informally charged his sister-in-law with the responsibilities of an interim ASHA, handed over some medication, and gave necessary guidance, with a promise to finalize the official paperwork soon. 

“When our team used to come and convince the people to get vaccinated, even 15 people agreeing would be a great achievement. But it’s only because of the PCI team, that we were able to vaccinate 46 village residents in this hard-to-reach area.”

Staff Nurse

Village residents arriving at
the site with their mobilization
tokens and receiving coupons
post vaccine

Finally, the footfall in this session was beyond the mere 17-18 target that the team had set based on past experience of ANM, and were able to vaccinate a total of 46 people, out of which 19 received their first dose and 27 their second dose. 52 odd people still remain unvaccinated, but the coverage achieved during this session in this extremely remote village is noteworthy. 

This village is an epitome of what a hard-to reach village looks like. Despite the several challenges this community grapples with on an everyday basis, the sheer diligence of the residents to get vaccinated, coupled with the efforts of PCI, this village is on the road to success. PCI has been instrumental in not only mobilizing people but also in last-mile delivery of vaccine, by organizing camps in the village itself which has made it convenient for the residents to get vaccinated within a few meters radius of their homes instead of walking miles to another village. This is, indeed, an example of what a great collaboration between the local community, an implementation organization like PCI, and the government looks like.

We appreciate the commendable efforts of Roshan K.Singh & Niwash K. Roy (Verifier), Shashi Hembram (Village Mobilization Coordinator), Rina Kisku (ASHA), Rajkumar (Staff Nurse), Manoj Kumar (Block Coordinator), and Makeshwar Rawat (District Coordinator) in bringing this village a step closer to being 100% vaccinated.