routine immunization 28.05.2014.pdf

5/20/2018 Routine Immunization 28.05.2014.pdf

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Strengthening Routine Immunization through

Community Mobilisation: Parivartan Project in

Bihar

Background: Bihar is one of Indias largest and poorest

states with over 100 million people. Poor nutrition and

poor health, particularly for women and children, lead to

early deaths and generational cycles of lost potential. The

state has one of the countrys highest rates of maternal,

neonatal and infant mortality. Underlying factors that

contribute to these negative health outcomes primarily

include extreme poverty, gender and social inequality

among many others. Recent trends in routine immunization

outcomes in a high-burden state like Bihar is critical to

India achieving its goals and contributing to MillenniumDevelopment Goals (MDG) 4 and 5.

Despite recent gains and commitments from the Government of Bihar (GOB) and active leadership of key

stakeholders to improve routine immunization outcomes, deep-rooted problems limit the governments

ability to affect lasting change. Persistent barriers include poor quality and availability of frontline staffs,

limited access to services by neglected and marginalized populations, lack of accurate data, lack of

effective program management, weak training systems, of supervision in health facilities. To this end, the

Bill and Melinda Gates Foundation (BMGF) is currently funding the Ananya Initiative, in partnership with

the Government of Bihar (GOB), to accelerate improvements in a broad range of priority health outcomes:

reproductive, maternal, neonatal and child health, nutrition, key infectious diseases, and sanitation and

hygiene. Within Ananya, Project Concern International (PCI), in partnership with PATH and the

Foundation for Research in Health Systems (FRHS), is implementing a community mobilization and social

accountability grant, referred to as Parivartan, which provides a platform to empower communities to

engage in processes that catalyze support networks and enable shifts in behavior and social norms,

contributing to improved and sustainable health and sanitation outcomes in Bihar. Parivartans overall

objective is to increase the adoption of key maternal, new-born, child health, and sanitation (MNCHS)

behaviour among women of reproductive age in the Most Marginalized communities of scheduled castes,

scheduled tribes, and backward Muslims. Parivartans theory of change proposes to overcome the

barriers to driving health and sanitation outcomes among most marginalized communities in Bihar by

organizing women into Self Help Groups (SHGs), sensitizing them to be influencers on health & sanitation

and empowering them to lead their communities to improved family health behaviour, as well as greater

accountability and equity of services.

Parivartan Reach Out:Parivartan works in 55 blocks in

8 districts1of Bihar (see map) to address equity issuesrelated to caste, gender and other social variables which

influence health and sanitation outcomes. At the

grassroots, the project reaches approximately 275,000

women in the reproductive age group in the most

marginalized communities through 18,000+ SHGs created

by Parivartan, with each group typically having 12-15

1Patna, Begusarai, Samastipur, East Champaran, West Champaran, Gopalganj, Khagaria, and Saharsa


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women. In addition, Parivartan reaches out to approximately 150,000+ women belonging to 10,000+

Jeevika SHGs in two districts of Khagaria and Saharsa. Through these SHGs, Parivartan mobilizes

communities with a focus on: a) strengthening their ability to shape social norms and promote behavior

change and drive demand for services critical to MNCHS; and b) strengthening accountability and

monitoring mechanisms through community structures for MNCHS services and related schemes to

advance equity and service access. Each community group is supported by a Saheli, a village volunteer,

who initiates and facilitates the discussions on MNCHS, leading to behavior change.

arivartans

Focus on Routine Immunization (RI):

The vaccination of children against six serious

but preventable diseases (tuberculosis,

diphtheria, pertussis, tetanus, poliomyelitis, and

measles) has been a cornerstone of the child

health care system in India. The proportion of

children fully immunized has remained at 67.5%

in Bihar (AHS, 2011). According to Parivartan

Baseline Report (2014), 47% of children in the

targeted districts are fully immunized.

This is important to address, given Bihars low routine

immunization rates, as evidenced by the fact that nearly half ofthe children belonging to Parivartan groups are not fully

immunized. For addressing this issues Parivartan is making

efforts to increase awareness among marginalized on the

benefits of RI. This is being done through an integrated

approach, with messages on RI, specifically those on

immunization integrated with other MNCHS messages. The

Parivartan compendium consists of 13 modules, one of which

focuses entirely on the issues related to RI (See snapshot of the

module on the right).

The module on RI specifically focused and informed the

community members on:

About importance of routine immunization

Inform community about the vaccination date and

vaccination site (VHSND, PHC, Sub-Center and

Community Health Centre) and importance of the different doses

Sensitization and Awareness creation of group members on collective actions and also

Support ASHA and ANM in immunization process

65.665.4

67.5

Total Rural Urban

Children Fully Immunized ( ) - AHS 2011

48

39

43

53

47

41

54

0

47

0

20

40

60

Patna E Champaran W

Champaran

Saharsha Samastipur Begusarai Gopalganj Khagaria Overall

Immunization Baseline


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At the grassroots, Sahelis conduct group meetings,

during which modules are rolled out. In these meeting,

Sahelis engage in discussions using informational

materials such as flash cards, games, and stories fromthe modules. These discussions lead to increased

levels of participation which, over time, evolves from

the low end of passive listening to the high end of

collective action that ultimately results in adoption of

MNCHS behaviors at the individual level. Sahelis help

SHG women to understand that RI is not only a

personal issues, its more acommunity development

issue. They encourage debate and foster acceptance on

RI, which are described in detail in the module.

Further, emphasis is also placed on diffusion, through

the group members, to other eligible women within

their household, and in their neighboring areas. In

addition, Parivartan focuses on creating linkages with the front line workers (FLWs) such as ASHAs

and Anganwadi Workers (AWWs) through their participation in group meetings. Parivartan initiated

roll out of the RI module in the month of December-January 2014, and all 18,000 SHGs already

covered. Till date 2265 Sahelis had been trained for rolling out the module on RI. These trained

Sahelis have trained all the community groups across Parivartan Districts.

Different Doses

- OPV, VitaminA

BCG, DPT andOthers

Importance of RI

VaccinationSites and Dates

VHSND, PHC,

InformCommunity About

RISensitization

Awareness

Collective Actions


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For addressing the issues related with routine immunization, the Sahelis undertake a variety of

strategically related social mobilization activities in their assigned areas and also participate in

training sessions to improve their skills:

-

The Sahelis meet with womens groups to share information on routine immunization and enlist

their support in spreading the word. The Sahelis organize daytime gatherings of mothers to

encourage them to immunize their children. Even the Sahelis also visit homes to educate

caregivers of unimmunized children about OPV and engage them to fully immunize their

children. Sahelis first target families furthest from routine immunization points and where a

newborn resides and then secondarily any home behind schedule on routine immunization, and

finally households fully up-to-date on vaccination.

Through this process, the Sahelis basically help the community members to take collective actions.

Though, it will take some time to capture outcome and impact level indicators on RI issues from these

groups, but the outcome level indicators showed a huge change in the group level due to the roll out

of the RI module:

Sahelis Family Level Group Level

Influencing the Community

Groups

Influencing

Individuals

Learning Objectives

To informcommunity aboutbenefits of routineimmunization andMotivate the groupmembers

To facilitateexperiential sharingwithin and outsidegroups on RI

Session Overview

Importance of RI -Discussion onIssues realted to RI

Discussing thedifferent types ofVaccination

Stakeholders

Engaged

Women in the SHGs(Parivartan andJeevika SHGs)directly

Front line workers(linking to theSHGs)

Materials

Cards (variouscolors), flip chart,chart papers, boardmarker, boldmarker, cello tape,white board stand,clips

Presentationslides/flip chart


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Success Stories: We Musahars could never have got immunization services had we not got togetherSaheli, Dhanauji village, Block Pakridayal, East Champaran

Way forward: Parivartan has a plan of collecting RI outcome indicators such as number of fully

immunized children in Ananya districts. These indicators are captured through project MIS on

monthly basis, sample surveys on quarterly basis, and the evaluation studies (Midline and End line).

Further, for sustainability and scalability of processes, PCI has signed a Memorandum of Cooperation

(MOC) with Bihar Rural Livelihoods Promotion Society (BRLPS), for health and sanitation integrationwith BRLPS project Jeevika (Bihar Rural Livelihoods Project). Parivartan is focusing on the process

wherein all the Parivartan-promoted community groups will become incorporated into the Jeevika

framework with the retention of the ongoing Health and Sanitation Agenda. The transition process,initiated in the month of August 2013, would aim to cover all 18,000 community groups by

September 2014. Further, Parivartan has established a Health Technical Group (HTG) within Jeevikato provide technical assistance to Jeevika to advance the health, nutrition, water and sanitation

agenda within Jeevikas community-based institutions across the state of Bihar.

This village lacks access to good health facilities. There is no Anganwadi center in the village. TheANM used to conduct routine immunization in the house of a higher caste Rajput family on a

monthly basis and Musahars women were not encouraged to come forth to access her services.As a result, Musahars children and pregnant women were not vaccinated nor were they receiving

any other services from the ANM. When Parivartan started work in the village, care was taken to

appoint staff and Saheli that belonged to the Musahars community so that they could identify

with them and be viewed as one of them. One day, while discussing Routine Immunization it was

decided that some action must be taken to ensure regular immunization services. The Parivartan

staff met with block officials and due to this, ANM was directed by the Medical Officer to change

the venue for conducting immunization sessions in the village. After eight months hence, allpregnant women are receiving TT doses and IFA tablets at their doorstep and all Musahar

children are being vaccinated by the ANM regularly.

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57

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63

53

E Champaran

W Champaran

Saharsha

Samastipur

Begusarai

Gopalganj

Khagaria

Overall

Changes in RI

Outcome Indicator Baseline

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