Helping Frontline Health Workers Make a Difference

UNICEF’s unique interventions in the Urban Routine Immunisation (RI) programmes of Chhatrapati Sambhajinagar and Nashik in Maharashtra have greatly enhanced the impact and effectiveness of health workers in the field.

UNICEF
Doctor giving vaccine to a child.
UNICEF/INDIA
05 April 2024

Over the past two years, field-level health workers under the National Urban Health Mission (NUHM) in Chhatrapati Sambhajinagar (formerly Aurangabad) and Nashik in Maharashtra have been displaying a new level of confidence and enthusiasm while planning and executing routine immunisation (RI) and other health care drives.

This transformation is due to a comprehensive set of resources and support from UNICEF, which has collaborated with local governments in both these cities to enhance the RI programme. These inputs have included training modules, equipment, and strategic guidance, all of which have significantly bolstered the capabilities of the health workers.

A woman getting her child vaccinated at a UNICEF camp.
UNICEF/INDIA Swarbaba Nagar, Satpur, Nashik: Priyanka Mallah (seated) and her husband Avinash get the first dose of Bacille Clamette-Guerin vaccine (commonly known as BCG) administered to their two-month-old twins Yogi and Jiva at a UNICEF-run camp in a low income locality. The Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHA) regularly conduct such outreach immunisation drives in major low-income residential localities where working populations reside.

The ANM and ASHA workers now have a new spring in their step. They are the primary frontline workers in several health and nutrition-related campaigns by the Urban Health Centres and the NUHM, providing crucial ‘last mile connectivity’ between government health officials and local communities.

औरंगाबाद रोड की झुग्गियों में यूनिसेफ ने साथ ने सफलता की राह दिखाई।
UNICEF/INDIA Aurangabad Road slum, Nashik: Nalini Chaskar, a Field Resource person (FRP) from UNICEF, joins an awareness drive in Aurangabad Road slum in Nashik about the significance of immunisation. She is accompanied by Manisha Kholase, an Auxiliary Nurse Midwife (ANM), and ASHA worker Manisha Sandansingh “The breakthrough in the Aurangabad Road slum was thanks to the help and guidance from UNICEF. Earlier people here would chase us away, they believed that children would fall ill due to the vaccines. But with support from the FRP, 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,” says Manisha Kholase

All health workers firmly stated that they are now better skilled, better equipped, and more effective. Additionally, practical support provided by Field Resource Persons (FRP) from UNICEF helped them tackle many of their significant challenges.

These encompassed certain lacunae in skill training, educational materials and infrastructure, and the absence of field support in convincing vaccine-refusal communities to shed their inhibitions and allow their children to be immunized.

 

A group of women during an awareness campaign with ANM and Asha worker.
UNICEF/INDIA Aurangapura Area, Chhatrapati Sambhajinagar: A group of women from the Mahila Aarogya Samiti (MAS), a women’s collective guided and led by the ANMs and ASHAs for organising community-based initiatives for healthcare services in low-income areas seen during a campaign.

UNICEF’s interventions began with intensive, large-scale training sessions conducted at the city level by experienced staffers. Subsequently, this has been backed up by constant mentoring and assistance in the field.

At another level, UNICEF has contributed collapsible tents that provide adequate shelter during outdoor campaigns, portable projectors, megaphones and IEC vans to carry out mass publicity drives, explanatory charts and booklets for door-to-door mobilisation and individual immunisation cards for every child. 

Dr. Sumedh Kudale giving information about vaccine maintenance during the visit to ANMs during UNICEF NMC.
UNICEF/INDIA Upnagar UPHC, Nashik: Dr. Sumedh Kudale, the Urban RI Coordinator at UNICEF NMC, in discussions with ANMs about various aspects of vaccine storage and transportation.

These have made it easier to carry out field-level interventions – mass awareness programmes, health and nutrition-related education initiatives, information about vaccines and schedules for groups and individuals, and actual mobilisation around immunisation drives.

The most prevalent intervention has been the new Routine Immunisation kit bags designed and donated by UNICEF.

These RI kit bags, which every ANM proudly displays, have specific placeholders for everything needed in the field and can also double as vaccine vial positioning stands when camps are conducted in the open.

They are also very comfortable to carry, hanging easily on their shoulder. This is especially important when camps are held at locations that cannot be easily accessed by road and where the material often has to be carried over long distances.

A group of ANM and Asha workers are walking along the railway track after returning from a routine camp. Thanks to the RI kit bags and portable vaccine containers provided by UNICEF, they are now able to easily reach even the most inaccessible areas, which has solved many of their problems.
UNICEF/INDIA Jai Bhawani Nagar, Chhatrapati Sambhajinagar: Sheetal Chowdhary (Right) and Ganga Munde (second from left), both ANMs, and ASHAs walking alongside the railway track after completing a routine immunisation camp. The RI kit bags donated by UNICEF and portable vaccine containers have made it easier for the teams to carry everything they need even to remote locations.

While routine immunisation has been the main focus, UNICEF has assisted the ANMs and ASHAs in streamlining other healthcare activities. One example is the monthly drive, the Urban Health and Nutrition Day (UHND), conducted with the local Anganwadi (nursery school) workers. 

UNICEF has given special training in conducting such sessions and helped them develop creative displays and presentations related to care during pregnancy and after childbirth, greatly enhancing their effectiveness.

The execution of routine immunization programmes, while a critical focus, is now expanding to encompass a broader range of healthcare services. This expansion mainly benefits young mothers and their children, instilling a sense of progress and optimism in our healthcare efforts.

An ANM administering the vaccine to nine-month-old Aamira while her mother Sabana holds her in her lap.
UNICEF/INDIA Silk Mill Colony, Chhatrapati Sambhajinagar: Prajakta Lanjewar, an ANM, is seen administering a rotavirus vaccine dose to nine-month-old Aamira while her mother, Shabana, holds her during a routine immunisation session at a hospital. “Earlier people from the local communities had many questions about immunisation and fears about injections. We would find it difficult to answer them. The UNICEF team gave us training on how to explain about the need for immunisation, and the information card they prepared, with its information and illustrations has been useful. The team comes with us on door-to-door campaigns especially in difficult areas. They planned a survey and we could identify households that were refusals. So, we could focus and convince them and now have drawn up plans to monitor the results also,” says Prajakta

While routine immunisation has been the main focus, the ANMs and ASHAs have also been assisted by UNICEF in streamlining some other healthcare activities too. One example is the monthly drive known as the Urban Health and Nutrition Day (UHND), conducted along with the local Anganwadi (nursery school) workers. UNICEF has given special training in how to conduct such sessions and also helped them develop creative displays and presentations related to care during pregnancy and after childbirth, greatly enhancing their effectiveness.

The new thrust in the execution of RI programmes is thus steadily being widened to cover other healthcare services, especially those for young mothers and their children.

Asha worker Afroz Mubin Khan (right) persuades his 3-month-old daughter Amyra to take the vaccine.
UNICEF/INDIA Swarbaba Nagar, Satpur, Nashik: The members of MAS - Disha Manoj Godase, Mangal Balchandra Gaikwad, Kavita, and ASHA workers - persuade Afrooz Mubeen Khan (R) to have her 3-month-old daughter Amaira vaccinated during a routine immunisation session. These dedicated women are focused on coordinating healthcare programs within communities from low income groups
Sheetal Choudhary giving guidelines to a women's group consisting of mothers and pregnant women on nutritious food.
UNICEF/INDIA Jai Bhawani Nagar, Chhatrapati Sambhajinagar: Sheetal Chowdhary, an ANM explains the need for a nutritious diet to a group of young mothers and to-be mothers residing in a densely-populated, lower income locality. ANMs and ASHAs now use creative presentations and displays to educate mothers of new borns or those who are expecting.