Introduction
The COVID-19 pandemic, combined with an already high burden of disease, malnutrition, and lack of health care, has exacerbated the vulnerability of India’s tribal populations. The rise in vaccine hesitancy during the COVID-19 pandemic can be attributed to rapid spread of misinformation through social media platforms and a general lack of awareness about the safety and benefits of the vaccine. In villages with a tribal majority in the Dharni and Chikhaldara blocks of Amravati District in Maharashtra, many were under the impression that getting the vaccine or being infected with COVID-19 were equally deadly; consequently, despite medical advice to the contrary, they refused the vaccine.
“In our villages, people still summon hakims and bhoomkals [traditional healers].” – Dr. Dayaram Jawarkar, Pediatrician, Sub-District Hospital in Dharni
“For the first time, the villagers were flatly refusing. They've never rejected my advice before.” – Mamta Sonkar, Primary Health Center Counselor
In response, the Integrated Tribal Development Project (ITDP) office in Dharni (a township of Amravati District, Vidarbha Region, East Maharashtra) developed a series of videos and other accessible communication materials featuring prominent members of the communities including primary health center doctors, neighbors, and politicians. These materials were shared with communities to provide accurate information about COVID-19 and to debunk myths surrounding the vaccine that lead to vaccine hesitancy. Language and locally produced messaging were key factors when engaging with the tribal population. Hindi and Marathi are not the primary languages in the region, so it was critical to produce public health communications in the local language. Additionally, communications created by and coming from members of the community were more trusted and authoritative. Videos and other awareness materials were therefore communicated in Korku, an endangered language that is spoken widely in the region.
ITDP worked closely with tribal communities to bring clear, authoritative, accurate, and trusted public health information about the benefits of COVID-19 vaccines to underserved, hard-to-reach populations in Amravati District. Officials from ITDP also coordinated with private hospitals and companies to make oxygen concentrators and cylinders available during the pandemic. How can you replicate/adapt this promising practice?Information, education, and communication – Culturally relevant communication materials helped ease vaccine hesitancy among the Korku villagers. Communication took place via a series of videos and plays in Korku, the language that people were most familiar and comfortable with; just as important, the speaker was also a member of the tribal community. These factors helped allay long-standing mistrust of public health systems in remote tribal areas. Strategic Placement of Vaccination Centers – Moving vaccination centers to open spaces where people could see members of neighboring communities getting vaccinated also helped instill confidence in the COVID-19 vaccine. |
Background
Around one-third of the world’s tribal and indigenous population lives in India: according to the 2011 census1, they represent nearly 9 percent of the country’s population. In the state of Maharashtra, in central India, tribal populations make up nearly 10 percent of the state’s population. In Melghat Region, Amravati District, the tribal population comprises about 77 percent of the population. The blocks of Dharni and Chikhaldara in this region are classified as Scheduled Tribes (ST) with a tribal majority population.
The tribal populations in the blocks of Dharni and Chikhaldara face many challenges when it comes to accessing health care, including hilly terrain, relative geographic isolation, limited resources and health care infrastructure, and lack of providers. The COVID-19 pandemic has magnified these adversities—especially when it comes to access to vaccination.
What are the lessons learned from this bright spot?
Misinformation about COVID-19 vaccines, spread through word of mouth and particularly social media, has caused vaccine hesitancy in populations around the world. Rumors that the vaccines cause death or other health problems have reached even the remotest parts of India. One of these remote regions with a tribal-majority population is Melghat in Maharashtra, about 80 kilometers from the city of Amravati—too far and too remote for the government’s vaccination campaigns to reach.
“Their homes deep inside a forest, Melghat's tribals can hardly be expected to read posters about COVID-19.” – Dr. Dayaram Jawarkar, Pediatrician, Sub-District Hospital in Dharni2
Amravati was reported to be one of the first districts in India to have witnessed the second wave of COVID-19. The local officials from the state ITDP office in Dharni identified people with symptoms and tested them while making arrangements for hospital beds and oxygen concentrators. Local doctors then collaborated with ITDP to address vaccine hesitancy among the tribal population. They realized that the key to dramatically increasing vaccination coverage among those who were eligible was to first establish trust among the community and then use culturally relevant and accessible communication strategies to relay their messages.
“I told them I could travel and attend a small meeting without fear because I am already vaccinated.” – Maya Mane, Chikhaldara Tehsildar (Revenue Officer)
Launching a Video Series to Curb Vaccine Hesitancy
In April 2021, ITDP office in Dharni (under the leadership of Dr. Mittali Sethi, Sub-Divisional Magistrate and Project Officer) began developing a series of videos on vaccine awareness and safety. The creative documentation team at ITDP collaborated with health care providers and villagers to create a series of videos featuring prominent members of tribal communities—including health care practitioners, officials, and neighbors—talking about the benefits of vaccination. An important feature of these videos is their language: Korku, one of the most endangered languages in India and the most-spoken language in Amravati’s tribal communities.3 Public health information presented in this familiar, trustworthy language not only cleared up myths and answered common questions regarding the COVID-19 vaccine but also helped build a sense of trust between the villagers and health officials. Officials disseminated the videos via various platforms such as WhatsApp and at town squares to encourage people to get vaccinated.
Still from a youtube video on Project Office, Dharni’s channel
Vaccinating Members of Neighboring Communities
Another important strategy adopted by officials was vaccinating the Balai community who lived among the Korkus and were more open to vaccination. The officials vaccinated Balais in front of Korkus, thereby giving them confidence that vaccines cause no harm. In addition, people from neighboring villages came to Melghat to be vaccinated, which was encouraging to the local population.
“People in other parts of the district knew those in Melghat were not keen on getting vaccinated. So, they drove down here and got the jab. We showed this to the locals and told them how outsiders were taking away their share only because they were reluctant.” – Dr. Chandan Pimpalkar, In-Charge Medical Officer, Tembhrusonda Primary Health Centre, Chikhaldara Block, Amravati
How was this promising practice implemented?
Culturally Relevant Messaging
The ITDP’s videos were recorded in the local language, Korku, and featured trusted health care providers and members of the community such as Dr. Dayaram Jawarkar (Pediatrician, Sub-District Hospital in Dharni), Mamta Sonkar (Primary Health Center Counselor) and Dr. Chandan Pimparkar (Doctor, Tembhrusonda Primary Health Center).
“The persuasion by talathis (revenue department village officials) and police patils (village police officials) of these villages played a key role” - Maya Mane, Chikhaldara tehsildar
Innovative Methods of Media Distribution
The first episode of an eight-video series (YouTube channel4), uploaded on May 2, 2021, has gathered nearly 1,900 views. At first the videos attracted a small number of views due to limited access to smartphones and internet in the region, but nongovernmental organization workers active in Melghat played the audio aloud in many villages using amplifiers. As a result, vaccine hesitancy decreased, and people began trusting vaccines and the health care providers.
By May 6, 2021, Chichghat, a village in Chikhaldara block had vaccinated all 110 eligible residents. Additionally, during the last two weeks of May four more villages in the same block—Bahadarpur, Ruiphata, Chinchkheda, and Kakadari—had also vaccinated 100 percent of eligible adults (between 85 and 150 people each) at day-long vaccination camps.5 Even the younger population in the region is eager to get vaccinated. According to a sub-divisional officer, they are receiving requests to hold more vaccination camps in villages but are constrained by a limited supply of vaccines.6
Boosting Community Confidence
The authorities moved vaccination centers to open spaces in villages so that people who were hesitant to vaccinate could see their neighbors and others being vaccinated. Villagers also set up small but beautiful pandals (temporary shelters) at these places, usually close to a tree where people could sit and be monitored by the medical team after vaccination. Officials also made sure the vaccination camps felt like festivals, sometimes using music or ITDP videos. After many people went home first to eat before their vaccination, authorities also began offering biscuits and water at the events.
Open air vaccine sessions
Empowering Village Heads
Another strategy adopted by local officials was to conduct meetings with the sarpanches (village heads) and encourage them to devise their own vaccination strategies. For example, during a meeting in May 2021, Nisha Bhilavekar, a 22-year-old Korku girl and the sarpanch of Diya village, spoke about her strategy to create a COVID-19 task force to disseminate awareness-raising messages and build trust with the community.
Nisha Bhilavekar conducting vaccine awareness sessions
A week later, Diya village registered the highest single day of village vaccinations in Melghat Region. Nisha Bhilavekar led the way by being the first one to get vaccinated on that day and continued to conduct registrations and encourage other people until the end. Such extraordinary stories of leadership and responsibility are abundant from the villages of Dharni and Chikhaldara.7
“When I see people like her on the field, I know that these villages are going to chart out a path that is unique to them and they will grow so beautifully that we will be pleasantly astounded.” – Dr. Mittali Sethi, Sub-Divisional Magistrate and Project Officer, ITDP Dharni8
Supplementary Material
Sources
- Office of Registrar General & Census Commissioner, India, Ministry of Home Affairs, 2011 Census Data. Accessed October 3, 2021. https://censusindia.gov.in/census_and_you/scheduled_castes_and_sceduled_tribes.aspx
- Iyer K. Remote Tribal Village Shows How To Fight Vaccine Hesitancy. India Spend. June 7, 2021. Accessed October 1, 2021. https://www.indiaspend.com/covid-19/remote-tribal-village-shows-how-to-fight-vaccine-hesitancy-753840
- Sethi M. Lessons on vaccination communication from a remote region in Maharashtra. The Indian Express. July 15, 2021. Accessed October 1, 2021. https://indianexpress.com/article/opinion/columns/lessons-on-vaccination-communication-from-a-remote-region-in-maharashtra-7405054/
- Project Office Dharni YouTube channel. Accessed October 1, 2021. https://www.youtube.com/channel/UCwUDubL4eq8N6PzqJGw0IdA
- Arya S. After reluctant start, Melghat has first fully vaccinated village of Maharashtra. The Times of India. May 24, 2021. Accessed October 1, 2021. https://timesofindia.indiatimes.com/city/nagpur/after-reluctant-start-melghat-has-first-fully-vaccinated-village-of-state/articleshow/82891589.cms
- Biswas P. How authorities battled extreme vaccine hesitancy in remote Amravati villages. The India Express. May 25, 2021. Accessed October 1, 2021. https://indianexpress.com/article/cities/pune/how-authorities-battled-extreme-covid-vaccine-hesitancy-in-remote-amravati-villages-7328470/
- Biswas P. Maharashtra: Vaccine-hesitant Melghat village sets inoculation record as panchayat members lead by example. The India Express. June 13, 2021. Accessed October 1, 2021. https://indianexpress.com/article/cities/pune/pune-vaccine-hesitant-melghat-village-sets-inoculation-record-as-panchayat-members-lead-by-example-7356367/
- Mittali Sethi Facebook page. CovidStories #3 Meet Nisha Bhilavekar. June 12, 2021. Accessed October 1, 2021. https://m.facebook.com/story.php?story_fbid=10222472317430998&id=1661441390