Dr Ramesh Chander Guleria, district program officer (RCH) DDU Shimla, Himachal Pradesh, relates the experience of health workers trying to get families in slums to vaccinate their children.
Famous as a part of Dev Bhumi and one of the most frequented tourist destinations of India, Kullu district, is blessed with the bounties of nature. The district performs well on immunisation with 89 percent immunization coverage which is in line with the overall high immunisation coverage of the state.
In Kullu's slums settlements of Sarwari, Piridi and Bhuntar, most residents are migrants from Bihar, Rajasthan and Uttar Pradesh. In Sarwari, most daily labourers are from Bihar. In Piridi, the residents hail from Uttar Pradesh, and have been living and working in the city's garbage dump. The people in the Bhuntar slum hail from Rajasthan and are engaged in segregating garbage.
There are many reasons why immunisation is a challenge here, including illiteracy, ignorance, lack of awareness about the need for good health and the basic struggle to make a livelihood. All these have made these slums a challenge for the immunisation team of the district, according to information on the website of the Ministry of Health and Family Welfare.
People in these migrant communities believe that vaccines will make children weak, and hence they are opposed to immunising their children. To dissuade the Auxiliary Nurse Midwife workers (ANMs) and Accredited Social Health Activists (ASHAs) from entering the area, the slum dwellers often let loose dogs behind the health workers, snatch their wallets and mobile phones. However, the district team did not give up and continued with their efforts.
With the introduction of Mission Indradhanush and the thrust to immunise all unimmunized and partially immunized children through additional sessions in uncovered and under-covered areas, the district immunisation team's drive to convince the slum dwellers intensified
Taking a step further, the district's senior immunisation officials visited these slums to understand the problem in-depth and assess for themselves the barriers that were preventing these slums from accessing immunisation services.
In order to mobilise the community of these slums, the District Immunisation Officer (DIO), Medical officer, Health (MOH) and his team of doctors, ANMs and ASHAs held meetings with the leaders of the slums, met with parents and family members and explained to them the importance of immunisation. The team also held group discussions with the slum dwellers where they were asked to pose questions to the immunisation team.
Along with the official visits, the ASHAs visited each and every household and did one-to-one meetings with mothers and key family members, informing them about the special Mission Indradhanush (MI) sessions. Banners were put up in the common areas of the slums. The frequent visits by the senior officials and their efforts made a positive impression on these slum dwellers.
There was a good turnout of children during all the MI sessions held in these areas and the immunisation coverage has improved tremendously since then. Presently, with the continued and dedicated efforts of the DIO and his team, all the children of these slums are taking vaccines regularly. The situation has changed now that, if any child misses any vaccines due to any reason, the parents call the ASHAs to complete the vaccination.