Mumbai: Since April 2020, the Azim Premji Foundation has been engaged in responding to the COVID-19 pandemic and its effects, which has included
a. Providing humanitarian aid to those in need: 14.7 million people across 27 states and 3 union territories received food, dry rations, and personal hygiene kits.Over 630 millionmeals distributed
b. Enhancing access to livelihoods in rural and tribal areas: 8.3 million people being helpedwith livelihood generation across 13 states
c. Supporting the public health system and public-spirited hospitals in responding to the pandemic: healthcare support across 100 districts providing access to healthcare to over150 million people by setting up over 10,000 oxygenated beds, 1000 ICU beds and over100 testing centers
d. Large scale support to the public system to increase the speed and coverage of the Covid19 vaccination program – focusing particularly on disadvantaged/vulnerable communities and geographies, who are typically left out
The focus of the Vaccination Program has been in helping the state governments buildand manage their capacity to vaccinate, and to mobilize communities for vaccination.
Key elements of work included:
a. Assessment and augmentation of available infrastructure (cold storage equipment,carrier box etc.) as well as the human resources (vaccinators, doctors etc.) including training support – on-the-ground, at the Primary Healthcare Centre (PHC) level
b. Mobilizing communities for vaccination: Information dissemination, planning and logistics for ensuring convenient access, minimizing disruptions to livelihood, addressing hesitancy, working with village opinion makers, and providing ground level support for those in need of medical help
c. Program management: planning and executing the vaccination program along with PHCs at the ground, building accurate database of the population, using that to do targeted plans and implement weekly-daily schedules, enabling the logistics of the schedule, mobilizing the communities to match the schedule, and ensure appropriate follow ups for second dose
Coverage: As of December 24, 2021, we were supporting 3609 PHCs covering 10.2 Crore people.
This is across 25 States/ Union Territories and enabled by a program team of 1.2 lakh people on the ground including Project Managers, Community Health Workers, Data Entry Operators, and village level Volunteers.
Approach: The Vaccination Program is being directly implemented through our own organization in the seven states where we have our own on-the-ground teams, as well as through 280 partners across the country. The focus is primarily in rural and disadvantaged areas, and with the vulnerable or excluded populations of some cities.
The unit of support in rural areas is the Primary Health Centre (PHC), each of which cover a population of about 25,000-30,000, typically across 4-6 revenue villages; while in some states the unit of operation is a Community Health Centre (CHC), which may cover 150,000 to 250,000 people. The objective is 100% vaccination coverage. The unit of support in large urban areas is often ‘settlements’, which include slum populations, other vulnerable or excluded populations, or populations with limited access to PHCs. There is also a special focus to cover communities like transgender people, sex workers, manual scavengers, homeless people, migrant workers, etc.
Data Collection and Validation
The COWIN app is inadequate in planning a targeted vaccination program, as it does not have an address field i.e., it does not tag the vaccinated to where they live, and the PHC also doesn’t have a residence based consolidated data base.
At a PHC level, while we may know (for example) that 5000 people have received the first vaccine shot, it doesn’t provide any information on where they live within the 1000 sq km catchment of the PHC. It is also possible that people from outside the catchment area of PHC have come and taken their vaccine at a particular PHC. Hence, no planning or ground level mobilization is feasible with the COWIN/PHC level information. Access to accurate and clean data was essential. Hence, our ground level volunteers collected and validated household level data in every village under a PHC. All of it was then fed into a PHC level database with data from subsequent vaccination drives / camps are being recorded real time. Our IT system that we developed specifically, allows our Program Manager to build queries and help work with the PHCs to develop weekly vaccination schedules. We have also developed an app which allows our team on the ground volunteers to update the data directly on handheld devices, as the vaccination progresses.
Assessment of Capacity and Augmentation
For every PHC a very detailed capacity assessment was carried out – both in terms of human resources as well as hardware/physical assets support. Augmentation was done where required. Particularly, in difficult terrain, dispersed, hard to reach villages, the villagers are not able to travel easily to PHCs. Such locations need to operate camps on a mobile mode, where we are providing support of additional vaccinators as well as vehicles (jeeps/ vans/ autos) on camp days. These vans and teams (including PHC employees) are typically able to cover 5-6 remote villages thereby saving time for villagers – which is critical in convincing people to get vaccinated. This was one of the critical ‘logistical hesitancy’ issue that we have addressed.
On the ground mobilization, demand coordination and generation
Ground mobilization has focused on reaching out to people in addressing some of their core concerns, including issue of advanced camp information and basic medication post vaccination. We have chosen volunteers from the local community who are able to engage and connect locally rather than ‘visiting experts’. This mobilization matches the vaccination camp schedule – basically ‘plan schedule on convenience, and ensure that people are mobilized forthe camp, when it actually happens’. While vaccination hesitancy remains in certain pockets but are not as big a concern as it hasbeen portrayed. A significant aspect of the hesitancy was initially driven around unpredictability of vaccine supply resulting in loss of daily wages. Genuine issues of hesitancy (medical) were addressed through rigorous campaigns on ground, supported by local influencers like traditional leaders for tribal communities or elected representatives and village elders apart from one-on-one counselling and providing access to medical helplines in cases of emergency The success of our mobilization efforts hinged on the ability to schedule camps with adequate notice and coverage, with minimal waiting period and improved logistics – both on timing and location. The PHC staff do not have adequate capacity to do this – and our teams filled this gap. At each block (5-10 PHCs) we deployed 3-5 Program Managers who worked across PHCs and various external stake holders like the District Administration, Project Staff and the Database management teams In our assessment, Program Management, has been the most crucial point of our contribution.
It has needed high quality resources who can deal with unpredictability on the vaccine supply side and work with district administration in influencing the flow of vaccines to the most relevant camp and thereby optimize availability. It also needed expertise to deal with unusual situations, managing large teams of volunteers, establishing community relationships, and rigorous planning and execution.
The importance of (lack of) this highly planned and targeted approach has been evident in the heavy back log of second doses, and also how it has become increasingly difficult to cover each next 10 million first dose. In territories where we have operated – this has been addressed significantly.
The areas of intervention are seeing better availability of authentic data on eligible and left out people, which helps government agencies plan targeted camps and increase coverage. In pockets where hesitancy was high, the targeted use of local influencers has helped convince people to accept the vaccine.
In terms of effect, our work has tried to focus on areas which are more remote and hard to reach and are hence often neglected in such mass mobilization drives. Our teams have developed a very reliable, grounds-up database of vaccination details of residents in every village, maintained and managed by local volunteers. This real-time availability of information combined with our program management, along with deep on the ground mobilization, the local PHC has been able run more effective vaccination drives, optimizing of scarce resources like vaccinators and focusing on village specific target groups (e.g. residents whose 2nd shot is long overdue).
As of December 24, 2021, the Vaccination Program is supporting 3609 PHCs covering INR 10.2 Cr people. The program’s target was 3500 PHCs, which was crossed in December. This is across 25 States/ Union Territories and enabled by a dedicated program team of 1.2 lakh people.
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