Building trust to reach zero-dose children in India
Shalu Vishal Kale and her family live under an overpass in the bustling community of Bandra, in Mumbai. She sells flowers at traffic stops, earning about $5 USD a day. Shyam Vishal Kale , 2, is seen with Lovely, his cousin. These children, along with their families, came to Mumbai to earn a living. Shyam Vishal Kale , 2, with Lovely, his cousin, who live on the streets under a flyover in the busy Kherwadi area, in Bandra with their families. Shalu has three children, aged between 2 months old and 4 years old. Until recently, they were all zero-dose children, meaning they hadn’t received any routine vaccinations that would protect them from preventable diseases like measles and polio. For Shalu, taking her children to a vaccination center to get the vaccines they needed would mean losing her daily earnings, which her family relies on. But thanks to the launch of an immunization programme in India, known as Intensified Mission Indradhanush (IMI), her children are now fully protected. As part of the initiative, health workers travel to reach families like Shalu’s. The programme is making sure that children in India get the important vaccines they missed during the COVID-19 pandemic. Currently about 25 per cent of children under 2 and pregnant mothers missed out on routine vaccinations The IMI initiative, launched in 2018, is part of India’s Universal Immunization Programme (UIP), which is one of the world’s largest public health efforts. IMI’s objective is to reach all children under the age of 2 and pregnant women who have missed out on routine vaccinations. The aim is to achieve 90 per cent vaccination coverage cross the country, with the current rate currently at about 75 per cent. Blocks Public Health Nurse Ratna Kharade (right) is seen administering DPT (first dose), OPV, MMR & Vitamin A to two-year-old zero-dose child Shyam Vishal Kale UNICEF/U.S. CDC/UN0734547/Anita Khemka Public Health Nurse Ratna Kharade (right) is seen administering DPT (first dose), OPV, MMR & Vitamin A to 2-year-old zero-dose child Shyam Vishal Kale. Awareness posters and paintings are seen at the Shivaji Nagar Health Centre in Mumbai. The artworks are intended to drive home the importance of routine immunization of children in order to help prevent the spread of diseases and protect infants and toddlers against dangerous complications. UNICEF/U.S. CDC/UN0734572/Anita Khemka Awareness posters and paintings are seen at the Shivaji Nagar Health Centre in Mumbai. The artworks are intended to drive home the importance of routine immunization. 25-year-old Nargis Shaikh holds her 10-month-old daughter, Azka, as they wait for Azka to receive a dose of the Measles-Rubella vaccine at the Shivaji Nagar Primary Health Centre in M East ward, Mumbai. UNICEF/U.S. CDC/UN0734579/Anita Khemka 25-year-old Nargis Shaikh holds her 10-month-old daughter, Azka, as they wait to receive a dose of the Measles-Rubella vaccine at the Shivaji Nagar Primary Health Centre in Mumbai. Display caption Show Original Caption Display caption Show Original Caption UNICEF is a key partner in this effort and is working directly with the government of Maharashtra, which is the state that Mumbai is the capital of. UNICEF spearheads social mobilization efforts, social and behaviour change projects, and oversees cold chain logistics. “We still have one child out of four who is not getting every vaccine. This one child resides in communities which are the urban poor, migrant communities or marginalized communities. They’re in scattered geographical areas that are hard to reach and where access to immunization is difficult.” Rajeshwari Chandrasekar, Chief of UNICEF’s field office in Maharashtra As Chandrasekar notes, there are several factors that contribute to the significant number of zero-dose children in India. These children are predominantly from low-income families, where caregivers are faced with financial and time constraints. They often can’t afford to lose their daily wages or travel to health facilities. Mehjabeen, 20 months, a zero-dose child who lives with her family along the pipeline at Indira Nagar slum in Bandra (E), Mumbai, is seen near their home. Mehjabeen, a zero-dose child who lives with her family along the pipeline at Indira Nagar slum in Bandra, Mumbai, is seen near their home. Furthermore, misinformation is a contributing factor, with some caregivers fearful that their child might experience a bad reaction. “Sometimes fever or swelling post vaccination makes the community wary of getting their child vaccinated. However, few families are aware of the benefits of immunization and get their children vaccinated.” Umesh Jadhav, immunization field monitor UNICEF has been working directly with the Brihanmumbai Municipal Corporation, which is the governing civic body of Mumbai, to promote trust and spread awareness. A team of experts, including doctors, social health activists, midwives and community health volunteers have been traveling to the homes of families. It’s there that they can directly address any questions and reassure caregivers that have any concerns. A Mahila Aarogya Samiti (MAS) meeting is seen at Ambika Nagar, Aurangabad. UNICEF/U.S. CDC/UN0735383/Anita Khemka A Mahila Aarogya Samiti meeting is seen at Ambika Nagar, Aurangabad. The group is a local women’s collective who organize community level efforts for health services in slum pockets. Auxiliary Nurse Midwife (ANM) Vrushali Agiwale (centre) and Accredited Social Health Activist (ASHA) Deepali Kumbhe (right) are seen in Siddharth Nagar, Ghatkopar (W), Mumbai, counselling the grandmother of 18-month-old Noorjehan, who is a zero-dose child. UNICEF/U.S. CDC/UN0734670/Anita Khemka Auxiliary Nurse Midwife, Vrushali Agiwale, and Accredited Social Health Activist, Deepali Kumbhe, are seen in Mumbai, counselling the grandmother of 18-month-old Noorjehan, who is a zero-dose child. Display caption Show Original Caption Display caption Show Original Caption It’s crucial that more families like Shalu’s are reached, as the urban slum communities they live in are among those with the highest rate of zero-dose children. Significant progress has been made, but the COVID-19 pandemic disrupted those advances. Before the pandemic, the number of zero-dose children in India stood at around 1.3 million. In 2021, the figure alarmingly went up to 2.7 million. Outbreaks of preventable diseases like measles have been seen in cities like Mumbai. If a child is not vaccinated against measles and contracts the disease, they’re at a much greater risk of experiencing complications that can potentially be fatal. Some families also migrated during the pandemic and that’s proven to be a contributing factor to the fall in immunization rates. This campaign, supported by UNICEF, is committed to reaching those families, with mobile health teams deployed to bus terminals and railway stations. Father Abdul Haq holds his zero-dose daughter, Sugra, who is one year and one day old, in the Baiganwadi slums in Govandi, Mumbai. Father Abdul Haq holds his zero-dose daughter, Sugra, in the Baiganwadi slums in Govandi, Mumbai. Among the children they’re trying to reach is Sugra who is 13 months old. Her father, Abdul is a bag maker and hails from Basti, in the state of Uttar Pradesh, which is about 1,000 miles away. The family has delayed getting Sugra vaccinated because they keep travelling back to their native village. Abdul adds that Sugra has been unwell, and that’s an additional reason she remains unvaccinated. Kartik, a zero-dose child, is seen with his mother, Sheela Vilas Shinde, at the Kasliwal Slum in Aurangabad. Kartik, a zero-dose child, is seen with his mother, Sheela Vilas Shinde, at the Kasliwal Slum in Aurangabad. Another community that’s previously been difficult to reach is a nomadic tribe in the city of Aurangabad, east of Mumbai. The tribe has historically kept their children unvaccinated, believing that a thread that’s blessed by the local religious leader and tied around arms will protect them from ailments. Furthermore, misinformation that vaccines lead to sterility and impotence has spread. The absence of vaccines, combined with often poor sanitation and low nutrition levels, place children here at high risk of preventable diseases. In an effort to reach tribal communities, UNICEF is partnering with civil society partners to mobilize community leaders and influencers. Religious leaders are also involved in the process. They’ll engage with the community, advocating for good sanitation, nutrition and health, which includes getting vaccines. Their efforts have begun to have a significant impact in both urban and rural areas. Auxiliary Nurse Midwife (ANM) Jyoti Chavan is seen at the Urban Health and Nutrition Day (UNHD) at Kasliwal Slum in Aurangabad with the specially designed UNICEF routine immunization bag. UNICEF/U.S. CDC/UN0735363/Anita Khemka Auxiliary Nurse Midwife Jyoti Chavan is seen at the Urban Health and Nutrition Day at Kasliwal Slum in Aurangabad, with the UNICEF routine immunization bag. Auxiliary Nurse Midwife (ANM) Rekha Dhondkar prepares to administer a dose of Measles-Rubella vaccine to 12-month-old Arman Shaikh, and to give her a dose of Vitamin A, during a door-to-door outreach session in Mesarwadi, Aurangabad. UNICEF/U.S. CDC/UN0735397/Anita Khemka Auxiliary Nurse Midwife Rekha Dhondkar prepares to administer a dose of Measles-Rubella vaccine to 12-month-old Arman Shaikh during a door-to-door outreach session in Mesarwadi, Aurangabad. Display caption Show Original Caption Display caption Show Original Caption For Rajeshwari Chandrasekar, UNICEF’s field chief in the region, it’s clear that the Intensified Mission Indradhanush initiative is having a positive impact. “Immunization is a shared responsibility that involves communities, service providers and policy makers alike. Health workers are working relentlessly to narrow the gap in immunization coverage in urban slums and vulnerable communities by going door-to-door. They’re ensuring that children get an opportunity to go to school and grow up healthy.” Rajeshwari Chandrasekar, UNICEF’s field chief
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