A middle-aged woman in a sari shakes a finger at her daughter-in-law, who holds her toddler close. “There is no need to get the child vaccinated,” says the older woman. She is convinced that her granddaughter will suffer scarring and infection if she receives an injection.
“When I have told you once not to go… then it means NO.”
But soon after, another woman intervenes. She is an ASHA—an accredited social health activist, trained to act as a health educator and promoter. The ASHA accompanies the mother and child to the village clinic for vaccinations against life-threatening diseases: diphtheria, polio, hepatitis B, and others. Later, the ASHA brings the affronted mother-in-law to talk with the auxiliary nurse midwife who delivered the vaccines. The nurse allays her fears about vaccine safety and side effects.
Putting primary health care in the hands of the people
Thousands of people in rural Uttar Pradesh watched these scenes play out in a video called “Is It Safe to Get My Child Vaccinated?” Immunization rates are especially low in the state, where only 51 percent of children received all recommended vaccinations in 2016. Across India, vaccine-preventable illnesses account for 20 percent of child deaths.
In an effort to boost both awareness and demand for vaccination in Uttar Pradesh, PATH partnered with a community-based organization on a year-long series of videos called Projecting Health. By equipping community members with new tools to improve health for mothers and children, the approach is shifting the driving force for change from health experts to the community.
Run by a local organization, Nehru Yuwa Sangathan Tisi (NYST), the intervention did just that. With support from NYST, community members wrote scripts, operated cameras, and acted in the health promotion videos.
ASHAs then screened the videos and facilitated discussions at mothers’ group meetings and other events. Over the course of the intervention, they showed the videos more than 1,500 times and reached almost 14,000 people—including those in outlying villages.
In a project designed to boost vaccination rates, local residents wrote scripts, operated cameras, and acted in health promotion videos. Photo: Branded Filmz.
Reaching the unreached
At PATH, we use human-centered design principles to break down barriers to accessible, responsive, high-quality care. Our goal: equip individuals with the tools and information to take health into their own hands.
We also recognize the importance of evaluating every project we undertake. The Projecting Health intervention was creative and ambitious, but did it work? Among the general population, the video screenings prompted an insignificant lift in vaccination rates. But in harder-to-reach, more marginalized communities, childhood immunizations jumped by 23 percent.
Why the difference? Many ASHAs said the intervention encouraged them to visit hard-to-reach families and communities, sometimes for the first time. The videos made their jobs easier, while steady support and supervision from NYST ensured they consistently identified and traveled to socially isolated places.
As shown in the video, mothers rely heavily on ASHAs to inform them of when and where to take a child for vaccination. By increasing contacts with ASHAs, the project boosted access to and uptake of services.
A holistic lens
Projecting Health also identified barriers that had nothing to do with access to health care, but rather, its quality. Some health workers had received poor training or lacked access to retraining. Improper vaccination techniques caused bruising and boils in vaccine recipients. At some clinics, staff offered no ibuprofen or paracetamol to mitigate discomfort from the injections.
The project also highlighted the importance of the family context: in Uttar Pradesh, the choice to vaccinate is not a mother’s alone. As the video showed, husbands and mothers-in-law are important decision-makers.
By identifying these barriers to vaccination, the project highlighted the importance of a responsive design process in primary health care interventions. To reach more communities, we must apply a holistic lens—one that prioritizes people, their needs, and their constraints. By continually refining our approach and testing our messages, PATH and partners can improve health equity for even the most difficult-to-reach communities.
