Reaching Out to the Unreached
UNICEF partners with Maharashtra government to deliver routine immunization to the most vulnerable children of nomadic communities
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UNICEF is collaborating with the Maharashtra Government to ensure that the routine immunisation programme reaches the most vulnerable children belonging to marginalised, nomadic communities in urban Maharashtra
Frontline health workers supported by UNICEF have persistently campaigned for the last two years in Chhatrapati Sambhajinagar (formerly Aurangabad) and Nashik (Maharashtra) to bring children of the most marginalised nomadic communities who live on the outskirts of the city under the government’s routine immunisation programmes.
Two striking examples are the Kasliwal slum in Chhatrapati Sambhajinagar, where members of the Wadar community reside, and the Aurangabad Road slum in Nashik, inhabited by the Sayyed community.
Both communities do not own land and therefore have no fixed roots. They lead a semi-settled existence, camping on whatever land they can squat on somewhere in the outskirts of the city. They are forced to take up whatever ‘employment’ comes their way – working as casual labour, roadside hawkers or in other occupations with no job security. Often, the men travel to neighbouring cities and districts for weeks at a time when temporary opportunities arise. Burdened by lack of steady income opportunities, these communities are forced to live in temporary ramshackle structures with little or no access to clean water and sanitation. The children, therefore, were vulnerable to many vaccine-preventable diseases.
Despite persistent efforts by health workers in the past, both communities had remained out of the government health care network. Overcoming their hesitation and fear (fuelled by lack of education, age-old traditional myths and a suspicion about modern medicine) proved to be a major challenge.
Things began to change when UNICEF entered the picture. With mentoring and constant field support, the UNICEF teams encouraged the ANMs and ASHAs to persist. Repeated efforts in patiently reaching out to a few families finally began to yield fruit. Gradually, the team was able to build a level of trust and bonds with the community. Over time, a few of the more vocal and less aggressive mothers were convinced to allow their children to take their first dose.
Jyoti Chavan, an ANM with an experience of 14 years, and Varsha Ambore, an ASHA Tai, who has worked in the field for seven years explain. “When we first came to the Kasliwal slum, the people would oppose us. But with the help of UNICEF, we decided to try again and again and now we have won their confidence. Some of the women even join us to campaign door to door.”
Manisha Kholase and Sunita Ahire, who together are responsible for mobilisation in the Aurangabad Road slum in Nashik remember, “Earlier people here would chase us away, they believed that children would fall ill due to the vaccines. But with support from the UNICEF’s Field Resource Persons (FRPs), we came back again and again and kept trying to talk to them. Finally, one woman agreed as she had seen vaccination camps in another slum where she lived earlier, and she viewed some of the UNICEF videos on our mobile phones. Now she is like part of our family and comes with us to convince others.”
While the first breakthroughs took many months, awareness campaigns became easier when the health workers were accompanied by a few members from within the community.
The beneficiaries of the vaccine programme echo these sentiments as well. Says Sangeeta Pappu Vyas, the mother of six-year-old Bhavna, who resides in the Kasliwal slum, “Earlier we had lots of doubts about these medicines. But now I am so happy to see that our children are being protected against different illnesses. When other mothers ask, I always encourage them to get their children vaccinated too. These teams from the health centre (dawakhana) are so helpful. In addition to the vaccination, they also give us a lot of guidance about general health and care for the children too.”
Since those early difficult days, the response has grown stronger and stronger. Nowadays, every new-born child in these communities is identified by the health workers and UNICEF FRP and the parents are encouraged to participate in the regular camps to ensure their children develop their immunity against diseases.
Regular contact, door to door pre-camp awareness drives and post-immunisation monitoring visits to check on any reactions have helped the health workers to bond closely with the community.
Identifying and vaccinating the zero-dose cases has been no easy task – it is estimated that to locate one non-vaccinated child about one thousand persons have to be screened! But the search is worth the benefits - primarily, healthier children within the community who will lead healthier lives. Simultaneously, other new windows have opened for these communities too. They are now beginning to understand the benefits of becoming part of an organised system of public health care. Recently, a young mother-to-be Chandrakali Jaising was enrolled under the government’s Pradhan Mantri Matru Vandana Yojana (PMMVY). She underwent regular check-ups at the maternity home during the entire duration of her pregnancy, and was even taken to the Health Centre at the time of delivery. She had to open a bank account and received some monetary benefits under the scheme as well.
It is a small, but significant step. Though Chandrakali’s new-born baby had to be sheltered outside the home because of per traditional beliefs and practices of the community, the little one has now stepped firmly into the formal health care system of the country!
