Improving Routine Vaccination Timeliness in India by Systemically Announcing the Arrival of Outreach Teams

Drum beating has long been a part of the local culture, used to indicate important events such as weddings and festivals. It is at the heart of this research-based initiative, which began with a baseline assessment conducted in both blocks in May-June 2018 to ascertain the coverage and timeliness of immunisation of infants. This was followed by identification and orientation of drum beaters and sensitisation of community mobilisers on drum beating. To facilitate this part of the process, JSI partnered with a local non-governmental organisation, Social Action for Rural Development (SARDA). Microplanning was done from June-July 2018 to tag drummers to specific outreach sites, as per the routine immunisation microplans.

The drummers are community members who are familiar with the terrain, which maximises their contribution in the absence of sufficient numbers of health workers and community mobilisers per community. They experimented with sounds that would signify the arrival of routine vaccination outreach teams to the villages, combining one well-known sound that is associated with children with another sound to make it specific to vaccines. In this way, the drumeats became a familiar reminder, traveling through mountains and forests to inform parents that vaccination teams are at the outreach site.

Implementation of drum beating took place from August 2018 - July 2019, during which time drum beaters performed the recognisable tune to announce immunisation sessions one day in advance and then again for the arrival of the vaccinator to the site. This activity was accompanied by printed signs displayed at the Panchayat (local government) buildings. The drum beaters were given an identifier (jacket) with a slogan to attract attention while they beat the drums, as well as printed pamphlets in the local language with messaging on immunisation to distribute during their visits to the villages.

After the completion of implementation, an endline assessment was conducted in July-August 2019 to assess the impact of the intervention. Overall, the data showed improvement of timeliness of vaccination (children aged 0-11 months) in both Rajpura and Shillai blocks. For example, in Rajpura, the children receiving Bacillus Calmette-Guérin (BCG) vaccine outside of 28 days (i.e., beyond the cut-off age for BCG vaccination) at endline was reduced by half compared with baseline. In Shillai, children receiving BCG after the cut-off age was reduced by two-thirds. Qualitative data found that community mobilisers, health workers, and managers recognised drum beating as a method of communication for improving immunisation timeliness. Word of mouth messages increased, due to the curiosity and enthusiasm the drums stirred up amongst the villagers.

Soon after the endline assessment, a dissemination meeting was conducted at the state level for stakeholders and partners to share the findings. State officials were said to be enthusiastic about the results and decided to use this communication method in the forthcoming Intensified Mission Indradanoush (IMI - a campaign to improve routine immunisation coverage). A video was also developed and shared in multiple platforms (see below), including the regional Demand Hub meeting in Kathmandu, Nepal in early October 2019.

Given this experience, there is a proposed expansion to geographically similar districts to show further evidence of positive outcomes at scale. JSI believes that this approach could also be beneficial also for new vaccine introduction (such as the recently rolled-out rotavirus vaccine).

Immunisation and Vaccines

In rural India, many barriers exist to full immunisation coverage, including topographic constraints in reaching local healthcare centres. Challenges with access to vaccine services, such as long walking distances (particularly in hilly terrain), the need to cross bodies of water, poor road conditions, and lack of transport, deter caregivers from visiting outreach sites on time. Community health volunteers must go door to door to inform caregivers about the arrival of the vaccination team at the outreach site. As a result, in these hard-to-reach areas, many children do not receive vaccines on schedule and remain vulnerable to deadly diseases.