Alternate Vaccine Delivery reaches India’s most Climate Vulnerable District
Vaccines-for-All in Darrang, one of India’s most Climate Vulnerable Districts
Safely secured in blue-coloured boxes, and carefully balanced on a motorbike, life-saving vaccines reach the most hard-to-reach regions of Assam, India, thanks to the tireless efforts of people like Enamul Haque, who are part of the Alternate Vaccine Delivery (AVD) system.
Thanks to 26-year-old Haque, who hails from Panbari village in Assam’s Darrang district that is located around 82-km away from the capital city of the state, Guwahati, people living in the remote villages including Panbari, Galandi Habi, Kadamtala Bagicha, Barbori among others, can access life-saving vaccines, including the COVID-19 vaccine.
These villages are catered to by the Khrupetia Public Health Centre (PHC). Haque travels a distance of 35 km to ensure vaccines stored and delivered from the PHC reach the sub-centers of these villages, most of which lack a cold chain. Since 2013, Haque has been catering to these villages as an AVD person for a population of around 0.1 million.
“I get the requirements of vaccines over the phone from the Auxiliary Nursing Midwife (ANM) sisters. They carefully pack the vaccine carrier, and then I take it to the delivery point. My day starts quite early as I have to travel to remote areas, and it is usually evenings when I complete the day’s work.”
While the distance may sound inconsequential, in the case of Darrang, one of the most climate-vulnerable districts of Assam, the journey can be tedious. More than 85 per cent of the population lives in villages and char areas (sand bars) of the river Brahmaputra. Roads leading to these villages from Kharupetia, the nearest town, get muddy and silted during the monsoon season. Every year, multiple floods episodes affect thousands. During the flood season, Haque wades through water on foot or rides on country boats for long hours to reach these areas to ensure that no one is left out from receiving vaccination.
“Every monsoon and during floods, the vaccinations don’t not stop. I travel to chars like Garapari Chapari, Magurmari, Shyampur, etc., on a boat that is situated within a range of 5 km to 20 km with vaccines carefully packaged in boxes. I need to be extra careful so that the water does not reach the vaccines,”
Every Wednesday and Saturday, the health sub-centers of Darrang district get filled with the chatter of mothers and cries and giggles of children. Under the Intensified Mission Indradhanush (IMI), a flagship routine immunization campaign of the Union Ministry of Health and Family Welfare, children as young as a newborn and up to the age of five years are taken for vaccination. This year the IMI 5.0 (5th phase of Mission Indradhanush) was conducted across all districts in the country and included children up to 5 years of age to ensure immunization services reach the missed-out and dropped-out children and pregnant women.
“For us, Wednesdays and Saturdays are fun days. We get our children vaccinated and also get to meet other mothers and children. We can share if our children are facing any health issues, and the ANM sisters listen to all our queries carefully and suggest accordingly,” said Phulesha Begum, 23, after getting her 3-months-old daughter vaccinated in a sub-center located in the Kuwaripukhuri Mahatma Gandhi Model Hospital.
Darrang district is home to over 1 million, and five cold chain points suffice for the population, as per the national guidelines.
The villages under the Kharupetia PHC, to which Haque caters, are a mix of populations - most earn a living by working in paddy fields or as domestic workers in the town areas of the district. A major percentage of the population also seasonally migrate to Guwahati every year, to work mostly as construction workers. At times, due to the absence of a male member to accompany the mother and child to a health center and sometimes a lack of awareness arising out of low female literacy in the area, children get dropped off the vaccination cycle.
“During routine immunization on every Wednesday and Saturday, I speak to the beneficiaries about which vaccine is for what disease. I also make them aware of the reasons for completing the vaccines on time and always tell them to take their MCP (Mother and Child Protection) cards with them if they migrate to other places in Assam or within the country,” said Samjida Khatun, 41, who is an Auxiliary Nurse Midwives (ANM), the village-level female health workers. During these community visits, she also informs about the importance of taking the COVID-19 vaccine doses for high-priority groups. She has been working as an ANM for the past 13 years in Kuwaripukhuri sub-center. According to Khatun, the villagers are much more aware of the importance of taking vaccines than what it was a decade ago.
Sub-divisional medical officer of the Kharupetia Civil hospital, Dr. Abdul Jalil Ahmed, said quality human resources are a problem in the district. “Darrang has over 1 million people. In Kharupetia alone, the population is 0.58 million. Therefore, the services of AVD become so crucial. However, the need is more to cover other health centers as well to achieve universal immunization goals,” he said.
As per the National Family and Health Survey (NFHS-5), in Assam, 66.4 per cent of children aged between 12-23 months are fully vaccinated based on information from either the vaccination card or mother's recall. While the national percentage stands at 77 per cent, compared to 62 percent in the previous round of the survey.
The Darrang district is among high-burden districts in Assam when it comes to infant mortality and maternal mortality. “However, the situation has improved considerably, and we are working as a team to achieve the desired targets aligned with the Sustainable Development Goals,” said Dr. Jalil Ahmed.
