Around 10 am on a Thursday, a mitanin (community health volunteer) and an auxiliary nurse make their way to Jharawaya village in Muchnar gram panchayat in Chhattisgarh’s Dantewada, 310-odd km from the state capital Raipur. Armed with vaccine boxes carrying preventive shots for Japanese Encephalitis, the small team arrives at a nullah fed by the Indravati river, where the motorable road ends. The village is still 5 km away and they walk over a low, narrow bridge to reach their destination, where a group of 10 children are waiting at the anganwadi centre for the shots. During monsoon months, when the nullah swells up and often drowns the bridge, the health workers say they wade through the waters to reach the paras (neighbourhoods).
About 55-km away, in Toyalanka village, anganwadi worker Bindu Sodhi says her assigned area is “half-a-day’s trek”. “I have to walk 10 km to reach the houses on the hill. When immunisation programmes begin, the nurses inform me at least two days in advance or else by the time I trek up, everyone has left for collecting mahua flowers or for other activities in the jungle,” Sodhi says.
As India prepares to roll out the vaccine for Covid-19, resolving issues of accessibility such as these is a priority for the government. Like in large parts of the country, Chhattisgarh has been successfully carrying out year-round vaccination drives under the Universal Immunisation Programme. “The state has achieved over 90% immunisation despite the pandemic,” says state immunisation officer Amar Singh Thakur. However, the officer admits “issues of accessibility” and “last mile connectivity” have prevented 100 per cent success, apart from the lack of awareness, tribal customs, preference for traditional medicines over injections in interior parts of the state — all issues which could also come up during the Covid-19 vaccination drive. Dantewada district has had over 5,000 Covid-19 cases (43 active now) and 15 deaths so far.
In Gadhmiri, mitanin Malati is among the over two lakh healthcare workers registered on a state government portal for the Phase-1 Covid-19 vaccination drive. A crucial link between the nurse and locals, the mitanin has been assigned around 100 families in her para, spread out over 4 km. “We were trained for the Covid-19 vaccination drive and taught about social distancing, among other things. Our ancestors have followed that concept for years,” laughs the mother of three, speaking in Hindi and the local Halbi languages. She says there are some families that make excuses, “but I take the children anyway”.
In Chandenar village, Sukalu Bai, 55, says she has “managed” to convince residents of her village about the benefits of vaccination. “Earlier, mothers worried that the shots would give their children fever. I would explain things to them, even scold them. Now, they all understand,” says the grandmother of five.
“In preparation for the Covid-19 vaccination, we have collected data of all healthcare workers, including mitanin, anganwadi workers, and medical staff of private hospitals, and it is being uploaded on a portal for easy access. We are also working on increasing the cold storage points,” says officer Thakur. The state currently has 630 cold storage points with more than 80,000 litres of freezing capacity, believed to be sufficient for the first phase of the Covid-19 vaccination.
While Thakur says the state has sought more cold chain points and walk-in coolers for Sarguja and Bastar regions, sources in the government claim that the cold chain points being set up can only provide temperatures between 2-8 degree Celsius, which won’t help if the Covid-19 vaccine requires storage at sub-zero temperatures.
“A lot depends on the final drug that the Centre procures. Apart from last-mile connectivity, transportation and administration will be a challenge,” said an official involved in the process.x
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