(The author is a researcher at the Indian Institute of Public Health, Shillong)
Childhood immunization is one of the most cost effective interventions instrumental in reducing the burden of infectious diseases. The World Health Organisation (WHO) estimates that vaccines prevented at least 10 million deaths between 2010-2015. With the efforts put forth by governments and development partners, considerable progress has been made in improving immunization coverage amongst children. In 2015, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services, an increase from 73% in 2000.
The Government of India rolled out the Universal Immunization Programme (UIP) in 1985. It is one of the largest programmes of its kind in the world in terms of number of beneficiaries covered, quantity of vaccines used and the areas covered. Initially, UIP started with four vaccines against six preventable diseases and this was progressively expanded. The current programme offers free immunization against tuberculosis, polio, diphtheria, whooping cough (pertussis), tetanus, measles and Hepatitis B, across the country. In addition mumps, rubella, rotavirus, pneumococcal vaccines and Japanese Encephalitis have been launched in some states. Even though UIP has helped make significant advances in increasing the immunization coverage in the country, the desired level of coverage is yet to be achieved. In the last few years, the increase in immunisation coverage had been at only 1% per year. Like in rest of the country, the UIP is also being implemented in Assam. Even after concerted efforts by the government and development partners, a lot remains to be done. The National Family Health Survey (NFHS-4) reports Assam's full immunization coverage in 12-23 month old children to be 47.1% which is below the national average of 62%.
A host of factors may be responsible for the low percentage of fully immunized children in Assam as reported in the NFHS-4. These may include, but not limited to, caregivers not being aware of the benefits of immunization, sick child, immunization session time not being convenient, session site located far away, fear of adverse effects, non-availability of vaccines, rumours related to immunization. A lot of these issues can be addressed if the community realises the importance of immunization and itself seek it (demandside factor). If vaccine-seeking behaviour can be promoted resulting in the community itself demanding immunization services, the immunization coverage can be improved. Innovative interventions that engagecommunities meaningfully can contribute to improving immunizationuptake.
One such novel community engagement intervention, SALT (Stimulate, Appreciate, Learn, and Transfer),is being implemented in 3 districts of Assam- Kamrup, Bongaigaon and Udalguri. The project is funded by the International Initiative for Impact Evaluation (3ie) and is being implemented by Constellation and its local partners. The Indian Institute of Public Health in Shillong, a regional public health institute is evaluating the impact of the project. The project involves a baseline survey, a community level intervention and an end line survey. The baseline survey was completed in 2016 and the community level intervention is ending shortly. An endline survey will be conducted to assess the effectiveness of the intervention.
The SALT intervention is based on the premise that communities think and act for themselves, and that communities have the capacity to change themselves. Every community has the capacity to respond to life's challenges, to build a common vision, to act, and to adapt. Communities have the capacity to respond to an issue that they own. The intervention seeks to nurture that capacity. SALT employs facilitated conversations to elicit community strengths, increase self-awareness and stimulate self-confidence and action. As a part of the approach, the Facilitators had discussions on individual household's dreams, hopes and concerns and that of the community as a whole. The communities also self-assessed themselves as to what level they are in to achieve their dreams. This has been followed by making an action plan by the communities themselves and taking doable actions.
Over the years, massive health programmes have been implemented across the country. Appropriate community engagement approaches, which can empower the communities and make them a stakeholder in developing solutions to overcome barriers to health, can go a long way in positively influencing these programmes.