It is not apathy, but lack of guidance, that has left the slum-dwellers unaware of immunisation’s importance. Mission Indradhanush is to create that awareness
Kalpana, a 32-year old daily wage worker, living in a slum on the outskirts of Delhi, woke up in the morning and took her child to an immunisation camp. This seemingly straightforward task was, however, a challenge for the single mother, who struggles every day to put food on the table for herself and her child. Every hour of work counts. Millions of others like her are scared of getting their children vaccinated, not due to apathy or a life choice, but because many like her fall amongst the unaccounted and nameless slum-dwellers who never get the privilege of choice.
life in an urban slum is as close to a marginalised society as it can get. living in some of the most abject conditions, subjected to stinging neglect, urban slum-dwellers are amongst the most deprived sections of the society. Urban slums today are home to millions of the most impoverished people, most of them ironically migrated to these areas in search of better economic opportunities.
Being unplanned settlements, living conditions are deplorable with lack of clean water, proper sanitation, lighting or any sort of basic amenities. To make matters worse, they are extremely cramped with high population density. All these make urban slum-dwellers amongst the most vulnerable sections of the society when it comes to exposure to deadly diseases.
Despite their close proximity to better medical care and health facilities within the urban set-up, health and safety concerns are paramount in these areas. They remain one of the most high-priority areas, in terms of the need for proper immunisation cover, but in reality they are the most under-served due to a complex set of challenges. One of the key reasons for this is that many of these dwellings remain unrecognised and unrecorded. Without proper records, there is no direct line of accountability and/or ownership to extend welfare activities and benefits to the slum-dwellers.
Another reason is the very nature of the social fabric in urban slums, with extremely low inter-personal contact and community support, making them less receptive to the benefits of immunisation. Mothers are mostly unaware of how necessary immunisation is to protect their children from deadly diseases.
Those who know about it are unable to avail the service without knowledge about the immunisation process, and in several cases, due to irregular availability of immunisation camps. Children remain undernourished and their young bodies are subjected to some of the harshest living environments. The threat of contracting fatal diseases and infections is palpable.
Above all, there is the problem of outreach. With no proper social structures in place, these communities require personal contact to build awareness and acceptability for immunisation. This is the task that has been taken up by Mission Indradhanush. Thousands of health workers have taken to the streets to mobilise this section towards full immunisation for their children. Health workers such as Auxiliary Nurse Midwife, Accredited Social Health Activist, Anganwadi Worker and Medical Officers with their teams engage with the elders and influencers of the community to educate and motivate families to attend the immunisation drives.
One of the challenges that the health workers face in these slums is to convince the parents that their child needs immunisation. Most parents are wary of the time they would need to spend in going down to an immunisation camp and the aftercare the child would require. But they remain ignorant of the price their child would pay for this negligence.
As such, health workers under Mission Indradhanush have taken the onus to reach to these communities, and first and foremost, sensitise them on the importance of immunisation for their children. Through dialogue and inter-personal contact, they are able to address the doubts and challenges in the parents' minds, thus successfully extending the immunisation coverage to the urban slums.
(The writer is a former Managing Director, Fellow of Indian Academy of Pediatrics; Coordinator of Development — International Pediatric Association, and President-elect, Asia Pacific Pediatric Association and Secretary, Child Health Foundation)