Connecting local responses around the world
The Indian Institute of Public Health, Shillong (IIPH) and the Public Health Foundation of India (PHFI) with support from the International Initiative for Impact Evaluation (3ie) is undertaking a study involving community engagement approaches for increasing immunization coverage among children in India. The objective of the study is to assess the impact of a novel community engagement approach in improving immunization coverage rate which has remained stagnant over the last 5-6 years. For example, national level full immunization coverage rate has gone up only 4 percentage points- from 61% in 2009 (Coverage Evaluation Survey) to 65% in 2015 (Rapid Survey of Children).
Most of the existing immunization related interventions are geared towards addressing supply side challenges such as ensuring better immunization services and more focused implementation, deploying more health workers across health facilities, and introducing ASHA workers to establish the link between health facilities and communities. Community engagement approaches to improving immunization can increase demand and potentially affect quality of immunization services. Existing community engagement programs mostly focus on communication, and the communities are not actively involved in the planning, monitoring and surveillance activities. But participatory engagement of communities can help identify barriers to desired outcomes and thus might lead to sustainable solutions.
This proposed community engagement approach is formally known as SALT. The idea of SALT originated at the Constellation, a NGO with their head office in Belgium. Constellation is our implementation partner on this project. The intervention will be implemented in the villages of Assam by local NGOs under the guidance and supervision of Rituu B Nanda and Bobby Zachariah belonging to India Competence, a member organization of Constellation. We are delighted to have this partnership with Constellation and looking forward to work with Rituu and Bobby.
The acronym SALT stands for Stimulate, Appreciate, Learn, and Transfer. The intervention starts with visits by local trained facilitators to communities that are randomly assigned to receive the SALT intervention. The goal of the facilitators is to bring the community together to discuss the common values they share. The facilitators then stimulate the discussion with the objective of building a common dream around the community. In our context, this would be the dream of healthy children in the community and immunization as a component can contribute to healthy children. Once the community embraces the dream, a self-assessment exercise starts, under the guidance of the facilitator, in order to understand where the community stands today with respect to its dream. Then discussion will evolve around what actions need to be taken in order to fulfil the dream. The community itself comes up with the action plan, based on its strengths and resources. This is followed by the action phase and the review process. Facilitators then bring communities together to share with and learn from each other. This process is formally known as the ‘learning festival’. Then the community revisits the dream, review of self-assessment happens, community revises the action plan, followed by the action phase, sharing and learning from each other, and so the cycle continues.
The study site is Assam, a north-eastern state of India. We selected 3 districts from Assam- Kamrup rural, Bongaigaon, and Udalguri. Districts were selected using stratified random sampling in such a way that they represent Assam with respect to vaccination coverage-related outcomes and their socio-demographic correlates.