ASHA worker Ms Rabia Khatun lives and works in Pitoni urban settlement in Bhutnath in Guwahati, Assam. Pitoni, the local word for wetlands, is home to mostly migrant families who live in homes built on stilts over sludgy marshland prone to frequent flooding during the monsoons from May to October.
“Vaccine hesitancy is high here. All vaccines are provided free to everyone, but some families still don’t want to get a healthy baby vaccinated. They believe in kismat and say they would deal with the illness when it happens,” said Ms Rabia. The Government of India’s Universal Immunization Programme provides free vaccines to all children nationally against 11 diseases, and sub-nationally against Japanese encephalitis in endemic areas.
Ms Soofiya Khatun getting her “zero doser” daughter Sultana Parveen immunized by auxiliary nurse midwives (ANMs) Ms Suman Sharma and Ms Minjuara Begum at the outreach immunization site in Pitoni in Guwahati, Assam (Photo: Sanchita Sharma / © WHO India)
One such unprotected child is Sultana Parveen, who is an eight-months-old ‘left-out’ baby girl who has never been vaccinated against any disease. “If she gets fever following vaccination, she will keep crying. My husband gets angry if the baby cries at night, he is tired and wants to sleep,” says her mother Ms Soofiya Khatun. Not one to give up, Ms Rabia met the family several times to convince them about the benefits of immunization. “I visited Soofiya at home eight times, she finally agreed to bring Sultana for immunization today,” says Ms Rabia.
ASHA worker Ms Rabia Khatun visits Ms Akleema Khatun’s home to follows up on baby Parvati Kumari’s vaccination status. Parvati is seven-months old and has received all due vaccinations (Photo: Sanchita Sharma / © WHO India)
The outreach immunization site in Pitoni is organized once a month in the porch of Mr Saiful Rahman, a good Samaritan who has offered his home to the health department for immunization activities. “Vaccines protect, all children should be protected. I have the space, this is the least I can do for my neighbours,” says Mr Rahman.
It is one of hundreds of immunization sites set up once a month in high-risk and underserved areas in Guwahati. Kamrup Metropolitan Health Department has strengthened urban immunization by using geographic information system (GIS) to re-define the catchment areas of health facilities, improve microplanning and stakeholder coordination to identify and vaccinate ‘drop out’ or ‘missed’ children in areas with low immunization rates.
Dr Bhupendra Kumar Das, District Immunization Officer, Kamrup Metropolitan, identifies ‘grey zones’ on the old Guwahati map where the health facilities catchment areas were not clearly defined. His department now uses updated GIS maps to rationalize health coverage to provide public health services to people close to where they live. (Photo: Sanchita Sharma / © WHO India)
“We used the updated digital maps of Guwahati Municipal Corporation wards, which were redistributed and increased from 31 to 60 in 2022. We identified 154 missed areas that had no allocated mobilizers, following which ward-wise health facility mapping was done and new maps with clear area demarcation were prepared for health mobilizers under each auxiliary nurse midwifes (ANM). The ANM catchment area demarcation was completed for all 232 ANMs by February 2023,” said Dr Bhupendra Kumar Das, District Immunization Officer, Kamrup Metropolitan district, of which Guwahati is a part.
Other interventions to strengthen urban immunization in Guwahati included microplanning involving advocacy, training and handholding support to medical officers, nursing and midwifery/staff nurses, health workforce, cold-chain handlers, urban field volunteers, and programme and data handers; and validation of high-risk areas, and urban-periurban and interstate boundaries for setting up routine immunization session sites. Accountability and governance strengthening included setting up of an urban immunization task force and regular programme and data reviews.
WHO National Public Health Support Network team with ASHA worker Ms Rabia Khatun at the outreach immunization site in Pitoni (Photo: Sanchita Sharma / © WHO India)
WHO National Public Health Support Network (NPSN) provides technical and field support to the Government of India and state governments for acute flaccid paralysis surveillance for polio, fever and rash surveillance for measles, and achieving full routine immunization, including urban immunization strengthening and Special Immunization Drives. WHO NPSN team in Assam also supported in the GIS mapping of health facilities and RI session sites in Kamrup Metropolitan district.