By giving communities correct and comprehensive information, SCLTI creates demand for routine immunization

When Mr. Mahinder, an SCLTI field coordinator, first visits Ms. Mangesh (a resident of the tribal village of Raipur Khasir in Madhya Pradesh), he discovers that her three-year-old son has never been vaccinated. Her other son, who is a few months old, has received two vaccinations but none after that since Ms. Mangesh has misplaced her son’s immunization record card. Mr. Mahinder explains that  the auxiliary nurse midwife (ANM) can make another card for the baby. At first, Ms. Mangesh looks disbelieving, but as the field coordinator repeats his statement and emphasizes the importance of vaccinating her baby, she begins to nod. Eventually, she says, “All right, I will go and talk to Didi [“sister” in Hindi, a term by which most villagers refer to the ANM]. She is a good woman, but I wasn’t sure if I could go back to her without the card.”

Household visits such as this one are an integral part of the SCLTI project. Field coordinators go from house to house and talk to families. The goal is to assess the knowledge and perception of community members and increase awareness about immunization while reinforcing ANM visits. The opportunity is also used for identifying unvaccinated children. To date, the PATH staff have visited 29,323 households.

Then and now: a world of difference

Mr. Ram Adivasi, one of the leaders of Raipur Kasir village, can recall a time not so long ago when diseases that could be eliminated through routine vaccination were rampant in his village. He says, “Children used to fall sick often but still, most people wouldn’t bring their children to be vaccinated. They didn’t understand the concept of immunization—in fact, many thought it would harm their children.” Mr. Ram’s daughter pipes in, “We were terrified of needles!” However, Mr. Ram feels that things have improved in the past couple of years. “The household visits have helped a lot. Now,” he says, “many women in the village, including my daughter, go running with their kids when the ANM holds a session. They ask voluntarily whether it’s time for their babies to be vaccinated since many of them cannot read the immunization record cards that are given to them. As a result, fewer children in the village are falling prey to diseases.”

The results have further inspired government workers to make more frequent house visits. Says Mrs. Sarita, a mother of two, “I had my older child vaccinated in a private hospital—I didn’t know enough about government services to avail them back then. But I have been taking my recently born baby for the locally held immunization sessions. We have learned more about how it will make our children’s lives better…And the Anganwadi comes to call us regularly for the vaccinations now.”

The health workers face numerous challenges along the way. Some of the villages in the project area are almost untouched by modern-day healthcare due to difficult terrain, so to embed the importance of immunization in the community is an uphill task. Sure Start field coordinators along with ANMs, accredited social health activists (ASHAs), and other linchpins of the government health system need to be patient and persistent—qualities that are indispensable when working with communities. There are also widespread and deep-rooted preconceived notions about vaccination. SCLTI staff and government health workers are battling these prejudices together. Ms. Shubhangi, who has been an ANM in the Gwalior rural district for 22 years, elaborates, “Babies often develop a fever the day after being vaccinated, and this leads to many misconceptions. Now, we tell the parents in advance that the child will probably develop a slight fever the next day, so that they don’t panic. We emphasize that the fever after the vaccine will last for a day or two, but the immunity is for a lifetime—so it’s worth it!”

Creating a ripple effect to spread the message

The SCLTI project has also started the innovative Parent Recognition Scheme, which was piloted in four poor-performing blocks of Madhya Pradesh. Parents who successfully completed the immunization of their children on time were presented with a “Healthy Baby Certificate,” recognizing them as good and responsible parents. The certificates were presented at Parent Recognition Meetings organized by SCLTI, in which the parents were honored by local health government and members of the village government.

This creative scheme has gone a long way in raising awareness about the importance of immunization. Meet Mr. and Mrs. Pramod who live in a marginalized settlement in Gwalior city. They have a baby daughter and were recently presented with a “Healthy Baby Certificate” by the health minister of Madhya Pradesh. The certificate has a photograph of the family and the health minister at the function. Mrs. Pramod has kept the certificate carefully rolled up with its red ribbon intact, and Mr. Pramod plans to have it laminated and put up in his tiny, one-room home. Says Mrs. Pramod, “We have got a lot of respect and honor as a result of the certificate. Many people in our neighborhood now know about how important vaccines are thanks to this event. Mahinder Sir and ASHA didi told us about vaccines and convinced us to get our baby vaccinated. Now, we are doing the same with people around us.” Mr. Pramod adds, “There were doctors present as well—many parents got information from them. We hope there are more such functions.”

To date, 95 Parent Recognition Meetings have been conducted in which 3,119 parents were honored and a total of 2,17,927 people were targeted for awareness on routine immunization. The ripple effect of awareness-building measures such as this has greatly benefited the community. Ms. Geeta, who is an urban social health activist (USHA) in Gwalior city, explains, “A few years ago, there were still many families who didn’t get their children vaccinated—because they simply didn’t know how important it was! Today, according to my estimates, almost everyone in the community is aware. We still have to work very hard to make sure all the vaccinations take place on time but at least people have a basic understanding of immunization. My own family’s perceptions have also changed—my in-laws are far more accepting of my work and my husband encourages me a lot. The improvement is there for everyone to see.”

“We’re doing this for our children”

However, it is Khairo Bai, the head ASHA of Raipur Khurd village who has the last word on the progress brought about by greater awareness. When asked whether these changes will last, the old lady smiles broadly and says, “Why won’t they last? I myself am an emblem of lasting change. There was a time when girls couldn’t get out of the house or study…Now, it’s different—girls get the same food, same education, same everything! The mahila panch [woman village head] and I take important decisions together. We even decide how to spend the Rs.10,000 allocated to the village by the government! The change in the attitude toward immunization is the same kind—people are gradually becoming more aware and the routine immunization is becoming embedded in the village. There was a time when we had no idea at all about vaccines. We used to try and use wild herbs…But look at us now—this is a nearly 100% vaccinated village. And of course it’s going to last. After all, we’re doing this for our children.”