6 April 2022

An innovative initiative in the North-East region of India is ensuring that women waste pickers are not deprived of COVID-19 vaccine. Since May 2021, over 250 women waste pickers have been sensitised in the state of Meghalaya and many of them have been vaccinated.

Finding the ones in need
Meghalaya has a population of 3.4 million across 11 districts and has the privilege of being one of the richest biodiversity areas in the world. Its major tribes are Khasi, Pnar and Garo. In order to ensure that vulnerable groups here receive their vaccination, it was crucial to reach out to them with accurate information on the COVID-19 vaccine. But first, the high prevalence of myths and misinformation needed to be addressed. To add to it, access to vaccination services was a challenge for some because of difficult terrain and lack of transportation facilities to health centres. For daily wage earners, it meant losing the day’s wages.
Meanwhile, it was observed that waste pickers in the state had been left out of pandemic response. They had not received facilities like free ration, or awareness on COVID Appropriate Behaviour and access to the COVID-19 vaccine. Given that waste pickers are at high risk as they are handling waste materials, it was felt that this should be a high priority group.
Dr. Madhulika Jonathan, Chief of Field Office UNICEF Assam and North-East in India, emphasized that waste pickers are society’s silent heroes. “They contribute to the local economy, to public health and safety and environmental sustainability. They are exposed to waste in the most unorganised manner every single day. Recent studies have shown that the COVID-19 virus can survive upto days on contaminated material. By giving them priority for information on COVID Appropriate Behaviour and COVID-19 vaccination, we are helping in reducing the risk of them being exposed to the virus and altering their chances of being hospitalised with complications. Looking out for them is looking out for the rest of society.”

Clearing doubts from the minds
UNICEF proposed a sensitization training with a women’s Self-Help Group (SHG) of waste pickers in Mawiongrim village, East Khasi Hills district, to the Health department in May 2021. The plan was consulted with the State Immunization Officer of Directorate of Health Services and officials. The village head was also approached. A member of the SHG of waste pickers mobilised the group of 15 women waste pickers and a training was conducted by the health department. Health officials gave information on COVID-19 in the local language Khasi and the participants’ doubts and queries were addressed. This training was done in an online format with the women using their smartphones.
Bibisha Kharnaior, President of the women’s Self Help Group of waste pickers, said she was initially apprehensive about the COVID-19 vaccine but the training helped clarify her doubts. “I was one of the first among us to get vaccinated. I make it a point to motivate other women waste pickers to also take the vaccine,” she says. A waste picker for over 35 years she says the community is often stigmatised and left out when it comes to accessing health services.
Three more training programmes were conducted for waste pickers by the Directorate of Health Services. The state immunization officer and consultants from UNICEF facilitated the face-to-face trainings. Members of the women’s SHG also gave their testimonies and motivated the community to access vaccination services. Over 250 women have been sensitised in four villages.

A vaccinated and CAB aware community
Dr. P Manners of the Health Department said that reaching waste pickers with COVID-19 vaccination services was crucial as they are a moving population. “Reaching the most vulnerable sections who have very little access to health services at their doorstep has been an excellent initiative,” she said, praising the waste pickers community for coming forward to get vaccinated. The village headman of Mawiongrim village said he was grateful a sensitization training was conducted for the waste pickers community. “This community is among the hardest hit in the pandemic. We have been trying to reach out to them,” he said. Wansuk Kharnaior, a waste picker at Marten dumping ground, Shillong, attended the first sensitization training. She has since got herself vaccinated and encourages her co-workers to get vaccinated as well.

Given that Arunachal Pradesh has diverse ethnic groups and tribes, what were some of the challenges in ensuring uptake of COVID-19 vaccination?

Arunachal Pradesh is the largest North-Eastern state covering an area of 83,743 square kilometers with a population of 1.3 million (Census 2011) and population density of 17 per sq. km. Over 98% of the geographical area is land, of which 80% is forest. Arunachal Pradesh borders the states of Assam and Nagaland to the south and shares international borders with Bhutan in the west, Myanmar in the east and China in the north. Despite challenges due to scattered population, hilly terrain, harsh monsoons and unstable internet connectivity in some places, the State has achieved 83% coverage of the first dose of COVID-19 vaccination. It has also recorded the second highest increase in full immunization (+26.7%) of children under 5 according to NFHS 5.
 The state introduced at-the-doorstep COVID-19 vaccination facility in June 2021 before the Har Ghar Dastak campaign launched by Government of India in November 2021. Under the cluster approach to achieve 100 per cent COVID-19 vaccination in villages, a detailed vaccination plan is prepared for every village. Each house is visited by the vaccination team and eligible beneficiaries are vaccinated.

What are some of the social and behaviour change strategies/community engagement strategies that have been most effective for COVID-19 response?

The state has diverse ethnic groups consisting of 28 major tribes and 100 sub-tribes. There are more than 50 distinct languages and dialects and the topography is diverse. Hence, the social and behavior change strategies are decentralized. Based on the need, communication materials such as hoardings, kiosks and posters in local dialects were used in public spaces. Mass media was used strategically: radio jingles and talks, panel discussions on state broadcaster Doordarshan, and public service advertisements and press releases in newspapers were some of the mediums used. Messages were also shared through social media. Healthcare workers and frontline workers used community meetings, home visits, focused group discussions and interpersonal communications to mobilize people.

Household visit regarding RI by ASHA and UNICEF team at Chug village in Dirang block of West Kameng district ©UNICEF/India/2022/Sanjay

Line listing of refusals was organised and different stakeholders came together to address the issue. Healthcare workers, representatives of the administration, development partners approached the communities with low vaccination rates and explained to them about it. They answered vaccine related questions and fixed vaccination appointments for them.
Social media was used effectively to amplify factsheets, online resources, key messages and answers to frequently asked questions. People were encouraged to share their positive vaccination experience on social media with a selfie.
Convergence with different government departments and stakeholders was crucial to increase uptake of COVID-19 vaccination. These include Department of Women and Child Development, Department of Education, State Institute of Rural Development and Panchayati Raj, Nehru Yuva Kendra Sangathan, among others. Indigenous and faith-based leaders, student unions, NGOs and CBOs were also engaged.
 
What are some of the efforts being made towards improving Routine Immunization coverage?

The state has improved in Routine Immunization coverage by 26.7%; from 38.2% (NHFS 4) to 64.9% (NHFS 5) through constant efforts on community mobilisation. Consistent efforts are ongoing to achieve full immunization coverage. For strengthening routine immunization, left-out and drop-out children are identified. Capacity building of medical officers and staff is done for micro plan preparation and management of AEFI (adverse event following immunization). Apart from regular fixed sessions, outreach sessions, Routine Immunization campaigns and intensified Mission Indradhanush are conducted from time to time. The tribal immunization strategy approved by Govt. of India is implemented in the state with technical support of UNICEF. Community influencers and leaders and faith-based organizations, NGOs, CBOs, SHGs are involved to generate demand for routine immunization and Village Health Nutrition Day (VHND) sessions.

Awareness on COVID 19 Vaccination by Medical Officer of Daporijo block, Upper Subansiri district  ©UNICEF/India/2022/YariDulam

How is UNICEF supporting pandemic response and uptake of COVID-19 vaccination and Routine Immunization?

The State Health department is getting consistent technical and logistics support from UNICEF. It has helped in coordinating with government departments such as Education and Women and Child Development, as well as Panchayati Raj Institutions. UNICEF has helped build capacities of community-based organizations and faith-based organizations to promote demand generation for routine immunization. In low performing districts, UNICEF-supported partners are helping increase coverage of RI and COVID-19 vaccination.  
UNICEF helped collaborate with local radio stations; talk shows were organized for increasing demand for immunization services and communication materials were developed. With the support of UNICEF, Govt of India approved tribal immunization strategy was implemented. Community influencers, local leaders, women and youth groups, religious leaders, were engaged for increasing awareness and acceptance for immunization within the community. UNICEF has also provided 2 RTPCR test machines, 150 oxygen concentrators, 5 oxygen generation plants, 20 Large ILRs (Ice Lined Refrigerators) and 60 vaccine carriers, 6 High flow nasal cannula for pediatric care and 23,000 PPE kits.

From studying in a village school to spearheading social and behaviour change initiatives, Suresh Parmar has had a fascinating career trajectory in the humanitarian field. Suresh completed his schooling in Ahmedabad, Gujarat and went on to do a Masters in Social Work from MS University, Baroda. He has also studied managerial effectiveness in community health from IIM Kolkata. In his 18 years of experience, he has seen it all from the West to East, literally.  

Prior to joining UNICEF, Suresh worked in various states across India on a range of issues such as HIV/AIDS, CSR and education. Much of this work has been around vulnerable populations such as injecting drug users, migrant communities, women in sex work and homosexuals. “The work on HIV/AIDS is not limited to the virus but encompasses so much more – it’s rights-based, and involves rights of marginal groups,” Suresh says. He adds that a lot of the HIV/AIDS initiatives were community-led, for example, use of peer leaders to reach marginal communities. All of this brought great learning opportunities.
Suresh joined the UNICEF office for Gujarat in Gandhinagar in 2015 in the Child Protection section. Starting on an IKEA funded project for prevention of child labour and promotion of girls’ education, he moved on to the area of social and behaviour change where addressing social norms was a major focus area. “Rural 'caste' panchayats are very influential and getting their support is crucial for addressing practices such as child marriage” he says.

In 2019, Suresh moved to the UNICEF Office for Assam and the North-East as Communication for Development Officer and very soon rose to the position of Specialist. “People in the North-East are very warm,” he notes, adding that there is a lot of cultural diversity. Strengthening the North-East SBCC Alliance has been one of his key focus areas. Strengthening partnerships with universities, civil society groups and faith-based organisations for SBC and RCCE programming in the North-East region has also been close to his heart. In the tea gardens of Assam, he helped scale up using folklore for adolescent empowerment and community engagement. The initiative has now been adopted by the State Education Department and reaches 4,000+ schools across 33 districts.

Suresh lives in Guwahati with his wife and two school-going daughters. His parents live in Ahmedabad. Spending time with family is his most prized leisure activity. He is also fond of cricket and enjoys listening to old Hindi film songs.

New materials added to the UNICEF IEC eWareshouse include a Report on 'Healthy Parents Healthy Child Initiative' for promoting health of women in preconception period, Nashik, Maharashtra, December 2021. A documentary film and TV PSAs on the subject have also been added.