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With regard to immunization, socio-demographic determinants play an important role in establishing the health seeking behaviours. The marginalized communities live in hamlets outside the main village with very little or no public amenities. Extreme poverty and illiteracy have been the main reason behind their rigid thought process and poor-health seeking behaviour. To increase the coverage and change the mindset of such communities, it is much need to generate awareness and address their hesitancy. Door-to-door counselling and community-wide education helped in strengthening community acceptance for vaccines.


The vulnerable population of Rupchakiya tola in Koilwar block is completely inhabited by the Musahar community. The residents mostly live in groups outside the village, aloof from conventional society. The community has its own way of living, and their thought process is predominant which does not get easily influenced by others.


The main reason of this social neglect is the issues faced in availing the benefits of government schemes. They are of the opinion that despite knowing their poor condition, the government does not pay attention to them and none of the officials help them in receiving support. Many-a-times, beneficiaries have been misguided or the concerned officials didn’t respond adequately to their queries for availing benefits of the governmental schemes. All these have created a negative impact on the routine immunization progamme. The Musahar community refrained from getting their children vaccinated, thus showing their disbelief and no confidence on the system. They believed that their children would become weak after taking the vaccine.

The health workers failed to convince the community to receive the due doses even after several attempts and hours of counselling. In fact, the people often got annoyed whenever the ASHA or ANM paid a visit.

Despite these challenges, a collective effort was made by the Primary Health Centre (PHC) Koilwar, led by the Block Health Manager (BHM) to bring a transformative change induced by shift in thinking process around immunization. With determination, the BHM started working along with the PCI team. First, the due list was prepared through house-to-house survey. After this, an action plan was made on how all the left-out children can be vaccinated. The ward members of the Musahar community cooperated, as they made an appeal to get the children immunized. Additionally, the BHM also coordinated with other officials such as BDO and CDPO to make a collaborative effort in breaking refusals.

A planned approach under the leadership of BHM was executed, by organizing a vaccination session on 15th July 2023 in the community covering 76 houses altogether. According to the due list prepared by the ASHA, the doses of 65 children in the community were pending. On the session site day, PCI team along with the ASHA made house-to-house visit in all 65 houses once more to inform the parents about the vaccination session. While most of them agreed to visit the site, a few refused to turn up. The field team of PCI addressed those refusals through one-to-one counselling.

Along with the immunization programme, some additional arrangements were provided at the session site including free health check-up and free medicine distribution. Apparently, the special provisions had a positive effect on the immunization drive. With the efforts of the BHM and other health workers, all 65 children and 2 pregnant women were vaccinated. This was first of its kind and now it is replicated in many of the Mushar community as a special RI drive in 218 pre-identified Mahadalit community of Bhojpur.


Author: Swati Savarn (Consultant)

Editor: Ronnie Clive Francis (Manager Comms KM)


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