Empowering communities helps enable access to lifesaving vaccines
Manhar village in Mehagaon block, Bhind district, Madhya Pradesh has an upbeat air about it. Mention the word “immunization” and people have lots to say—most of it positive. This is a somewhat unexpected reaction in a country where millions of children are still not receiving basic immunization for diseases like polio, measles, hepatitis, DPT, and tetanus toxoid. So, what is different about Manhar village?
The optimism in this community is a fairly recent development. Until some time ago, many people in the village didn’t get their children vaccinated. Children would fall sick often—sometimes with fatal consequences. What’s more, these diseases were prevalent not just in Manhar village, but also in countless rural and marginalized communities across the state. Despite the grim immunization situation in the village, the issue wasn’t prioritized by residents. That is, until the commencement of the Saving Children’s Lives Through Immunization (SCLTI) project being run by PATH India with funding from the Michael and Susan Dell Foundation. In 2009, SCLTI began working in Manhar village. “Today, practically everyone is aware of the importance of vaccination. Our children are noticeably healthier—things are looking up,” says Ms. Mithilesh, the village’s head accredited social health activist (ASHA).
Effecting sustainable change by involving residents in the process of immunization
In Manhar village, as in other villages and marginalized urban communities in Madhya Pradesh where the project works, the SCLTI staff and government health workers jointly conduct lively mothers’ meetings. ASHAs and Anganwadi workers (community-based health workers) use various activities to generate awareness among pregnant women, mothers of eligible children, and mothers-in-law. The meetings are also an ideal platform to clear any myths and misconceptions regarding immunization that may be present in the community. Ms. Reena, another ASHA in the village, explains, “Earlier, we used to face a lot of resistance—people were very reluctant about getting their children immunized. There were all sorts of misconceptions about vaccinations. Since the SCLTI staff started coming to the village and holding mothers’ meetings with us, people have become much more aware. Now, many mothers even approach us on their own!” Till date, a total of 1,465 meetings have been conducted in various districts of MP, in which 5,089 pregnant women and 23,756 mothers have been sensitized.
The awareness building is not just limited to women. The project also works to activate Village Health and Sanitation Committees (VHSCs). These community-based committees, which are comprised of local men and women, serve as a vital link between the government and communities. Before the SCLTI project, these groups were often dormant. With the support and training of the SCLTI team, they are now becoming active and play an invaluable role in ensuring their communities have access to quality health care services. Till date, 1,096 VHSC meetings have been conducted in MP—out of those, 1,081 committees have been activated. In fact, Manhar village’s VHSC recently received the government-approved money to spend on the health needs of the village for the very first time. Ms. Mithilesh, attributing this success to the efforts of the SCLTI staff, says, “They explained that this money is there for us to use, and helped us with the process of getting it.” What is the village planning to spend the money on? The committee is going to buy a few chairs and some other basic supplies to use during the mothers’ meetings and immunization sessions. The list also includes purchasing garbage bins for the village, cleaning the village drains, and arranging transport for the most impoverished women in the village to go to the closest facility for delivery.
A holistic approach to health
While the SCLTI coordinators focus on immunization during mothers’ meetings and VHSC meetings, they also work to improve overall health in the village. Amit Ranjan, the district’s SCLTI coordinator, elaborates, “The community trusts us because they know we have their overall health interests at heart. That is the only way to bring about real change. For instance, we encourage institutional deliveries and educate people about Janani Suraksha Yojana, a government scheme that provides incentives to women who opt for deliveries in the hospital rather than at home. Not only is this much safer for the mother and child, but it also ensures that the newborn baby receives the first two vaccinations in the hospital itself, getting him or her off to a good start.” At mothers’ meetings, after the immunization activities have concluded, a number of other health topics are discussed, including the importance of eating plenty of green vegetables during pregnancy and the benefits of breast-feeding.
This inclusive approach has certainly had an impact. Not only are people increasingly aware of the importance of immunization, the initiative has also helped transform the lives of health workers for the better. Says Ms. Reena, “When I first became an ASHA, my family wasn’t too happy about it. We are the daughters-in-law of this village, and it was not considered proper for us to be out and about, talking about these things. The community did not pay too much attention to what we said. But, with the knowledge and guidance given by the SCLTI coordinators, we have been able to better perform our duties. We now get a lot of respect from the villagers. Even my husband and mother-in-law encourage me in my work—they have realized how important it is. Today, when a pregnant woman goes into labour, whether it is day or night, one of the ASHAs calls the transport car and accompanies the woman to the nearby hospital—and no one raises an eyebrow!”
Real change, real lives
The community itself is placing immunization at the top of its list of priorities. Meet Ms. Ganga Devi, who has three children. Her two older children, who are six and eleven years old, have not been fully immunized. “We didn’t really know how important it was. There wasn’t that much information back then,” says Ms. Ganga. However, her three-month old son has received all the vaccinations due till now and Ms. Ganga is determined to take him for all the remaining rounds as well. She says that the various didis (sisters) in the village have explained the importance of vaccination through meetings and home visits. “When I was pregnant, they came to my house, took my weight, and took me back to the centre to give me shots. This time,” says Ms. Ganga Devi, “I am going to do things differently.”
Manhar’s health workers echo the optimism that imbues the village. Says Ms. Reena, “All of us work in tandem. Our village has five ASHAs and five Anganwadi workers—we are assigned to different zones. But we do not think in terms of zones. The entire village belongs to each of us, so if someone is absent due to an illness or an emergency, we take care of her duties. There is not one unattended spot here. We are working to make this a 100 percent vaccinated village. After all, we’re doing this for our children.”
In Naya Bazar, a settlement of marginalized people in the city of Gwalior, you will hear similar stories of community empowerment. Ms. Geeta, an Urban Health worker, says, “The change is there for everyone to see. People are now aware of the life-saving vaccines that they can access for their children. Many times, families in which both parents work find it impossible to bring their children to the center on the day of the immunization session. In these situations, we bring the children to the center, get them vaccinated, and then take them home.”
These are just a few instances of how the SCLTI project is helping create agents of change from within the community. In turn, these health workers are investing their time and effort into making sure every child receives necessary vaccines. The result? People in project areas are increasingly recognizing immunization as the foundation of good health in their communities and are placing the issue at the top of their list of priorities.