ODISHA, India (WOMENSENEWS)--As the autorickshaws begin lining up inside the compound at 7 a.m., Vijaylakmi Sahu knows she has just 30 minutes to finish her work.
Over the next half hour, Sahu works with clockwork precision. She ensures that the temperatures of the vaccines for pregnant women and children are checked before they are packed under her supervision in cold boxes. After that, three to five autorickshaws, known as the Immunization Express, head off to the villages where mothers, children and pregnant women await them.
Suha is the block program manager of the "alternate vaccine delivery system" at the Chandanpur community health center here in this eastern state.
The program has been helping pregnant women receive their antenatal and postnatal shots and children receive a full range of immunization services. By removing the responsibility for handling and transporting the medications off health workers, the program frees health workers to focus on the task of keeping the immunization sessions running on time. With the help of the autorickshaws as the delivery method, the health workers, almost all of whom are women, can spend more time counseling pregnant women, mothers and children. The autorickshaw drivers, all of whom are male, also take care of returning the vaccine waste and used syringes to the community health center.
All the way along this supply chain, women such as Sahu are critical to the rickshaw brigade that has been helping to lower infant and maternal deaths in the state.
In Sahu's case, the key function is ensuring the smooth running of the cold chain for the free vaccines.
"The cold chain is pivotal for safe immunization needed to protect pregnant women and children from preventable deaths," said Dr. Indira Rath, deputy director of immunization in the Odisha government's health and family welfare department, in an interview held at the Chandanpur health center. "Vaccines need to be stored and transported at a certain temperature to ensure their potency and efficacy. The women entrusted with the vaccines understand their importance in saving lives and have played a crucial role in reducing maternal and infant mortality."
Falling Death Rates
Between 2007 and 2012 the state maternal mortality ratio fell to 235 deaths per 100,000 live births from 258. For infant mortality the key figures in that same ratio fell to 57 from 71.
Every year 8,306,690 infants and 987,823 pregnant mothers receive immunization in the state, according to a UNICEF assessment report on Odisha's alternate vaccine delivery system. Since 2008 there have been no reports of any new cases of polio as a consequence of sustained immunization of pregnant women, health officials say.
Once the vaccines reach their first delivery point, an accredited social health worker and auxiliary nurse midwife – both of whom are usually women -- take over. It is up to these frontline health workers to make sure none of the pregnant women or children due for vaccinations misses their dose.
In a state where 50 percent of the population is difficult to reach, and 48 percent of people live below the poverty line, the services provided by the women make the difference between life and death.
Workers focused on lowering the death tolls often contend with what Dr. Rath calls the ignorance and superstition of customary attitudes towards health care. "They prefer to practice traditional customs to treat disease instead of visiting health facilities," said the physician.
Kunilata Patra, who lives in Jamarasuain village, was convinced home remedies would ward off illnesses. Having married early, Patra was unable to complete her education. Since she did not go for prenatal immunization, she was convinced there was no need to immunize her daughters either.
Only after she received training to become a social health activist did she understand how she had let superstitions endanger the lives of three of her daughters, as well as her own life. This led her to immunize her fourth and youngest daughter, the only one in the family to be vaccinated.
Since then she has been a relentless crusader, using her own example to raise awareness of the importance of immunization and motivating pregnant women and mothers to bring their children in for vaccination.
Innovative Tracking Bag
Part of the immunization program is an innovative mother-and-child tracking bag that helps workers monitor immunization cycles and try to prevent anyone from getting left behind. The bag has 12 pouches, one for each month of the year.
The pouches hold health cards placed by health workers, auxiliary nurse wives and anganwadi (child center) workers responsible for taking care of newborn babies and children up to the age of 6. Each card keeps a record of the immunizations for each pregnant woman, mother or child in the system. As the card holder receives the required immunization, the card is moved to the next pouch depending upon the dates of the next session. This system makes it easy to track the drop outs, who currently make up 12 percent of those who need postnatal care and 20 percent who need immunization.
In Alikia village, Jayanti Pradhan, the local accredited social health activist, knew the cultural importance of getting the family's acceptance for immunization. So when she found Tikina Paine was ready to bring her daughters for immunization if her father-in-law agreed, Pradhan turned to Paine's mother-in-law for support.
"It took some time to convince her but finally she understood why immunization was important for the mother and child," said Pradhan, who has twice won "best motivator" prizes from the health department. "Now whenever it is immunization time, Paine's mother-in-law sends her husband out of the house on some pretext and asks her daughter-in-law to quickly slip out to the health center."
Including Male Family Members
While this may have been the best solution in that particular case, workers are increasingly focused on pulling male family members into the process as allies. For many workers, motivating husbands to take the day off to bring their pregnant wives into the clinic and spend time during counseling to understand the importance of timely prenatal immunization is one of their biggest achievements.
For the past 10 years, Sumati Das has worked as an auxiliary nurse midwife at the health center in Jamarasuain village. A decade ago men's participation seemed impossible, to the huge detriment of their families' health.
"The lack of male participation resulted in poor utilization of prenatal and postnatal services by pregnant women," said Das in an interview as she filled in the immunization register at the village health center. "Men did not give much importance to the health problems of women. But now many husbands take time off from their work to bring their pregnant wives to the health center."
Aniya Mohanty's husband told Das that he had closed his shop for four hours so he could bring his pregnant wife for her injections.
Dhirendra Behara, a marketing executive, set an alarm on his mobile phone because he didn't want his wife and newborn to miss their immunizations. He even informed his boss that he would be delayed as he had to take his wife and child to the health center.
Jameshwar Mallick, who has been driving one of the autorickshaws that transport the vaccines for the past five years, is also a male ally. "I talk to my friends about immunization benefits and tell them how proud I feel to transport the vaccines," he said in an interview as he loaded the cold boxes in his autorickshaw at the Chandanpur health center. "I know I am contributing to helping women and children survive."
Swapna Majumdar is an independent journalist based in New Delhi and and writes on development and gender.
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