Project Swaraksha: Leveraging Digital Runners to Facilitate Vaccination in Rural Areas

Introduction

Since May 1, 2021, adults ages 18 and older in India have been eligible to receive a COVID-19 vaccination. However, initial analyses show that adults in urban areas are 1.7 times more likely to be vaccinated than those in rural areas, despite that two-thirds of the country’s population lives in rural areas.¹

Registration for vaccination appointments are available only through the CoWIN app, which has led to lower vaccination rates in rural areas where access to internet and smartphones is limited. In addition, Misinformation regarding vaccination has also contributed to higher levels of vaccine hesitancy in rural India.

Project Swaraksha is a vaccination awareness program run by Anaxee Digital Runners—an outreach and data collection network—that works with digital runners to facilitate vaccination in rural areas. Digital runners (field staff hired by Anaxee) help to facilitate vaccine registration by conducting tasks such as collecting data, assisting with registration and appointments, and providing accurate information, thereby helping residents overcome barriers to vaccination and increasing coverage rates.

Background

Anaxee Digital Runners is an outreach and data collection agency based in Indore that operates in 26 states. Anaxee is building India's largest last-mile network of 250,000 digital runners who work on the ground to collect digital data and help corporations reach the remotest parts of India.

Digital runners are trained as part of Project Swaraksha. They begin by identifying villages with less than 10,000 people and low vaccination rates (less than 20% according to CoWIN platform) and then create a list of adults who have not been vaccinated. They counsel the villagers and explain the benefits of vaccination, assist people in getting registered on the CoWIN platform, help book vaccination appointments, and assist with downloading vaccination certificates. As of September 2021, about 3,000 digital runners have participated in the project and counseled 2.4 million villagers. Of these, more than 1 lakh villagers were vaccinated*, predominantly in Madhya Pradesh, Uttar Pradesh, and Bihar, along with 21 other states. The overall goal is to engage 50,000 digital runners and reach 10 million rural citizens, with an immediate goal to reach 1 million people by November 2021. Anaxee has signed a formal memorandum of understanding with the states of Nagaland and Meghalaya to expand the project.

How can you replicate/adapt this promising practice?

Build trust – Digital runners working with Project Swaraksha found that most rural residents feared disability or death because of the COVID-19 vaccine. Digital runners assured villagers that vaccines were safe and even shared their own experiences. During home visits, digital runners focus on the head of the family who is influential in encouraging the family to be vaccinated.

Bridge the digital divide – Smartphone access and internet penetration in rural areas is low; a survey conducted in May 2021 showed that six in ten rural residents did not know how to register on the CoWIN app.³ Digital runners are filling a technology gap in rural areas by assisting residents with vaccination registration, booking appointments, and downloading vaccination certificates. Their work also helps reduce the burden on government employees.

Target the younger population – Anaxee Digital Runners began by targeting younger populations who are influenced by social media posts that show people getting vaccinated. As more 18- to 25-year-olds get vaccinated, it becomes easier to encourage others to vaccinate, as their hesitancy shifts toward a “fear of missing out.”

What are the lessons learned from this bright spot?

Through Project Swaraksha, Anaxee Digital Runners are successfully addressing vaccine hesitancy and increasing vaccination rates by providing assistance in rural areas of India. Digital runners provide accurate information to villagers who may be hesitant to receive a vaccination, help residents register on the CoWIN app, book vaccination appointments, and download vaccination certificates. Digital runners earn an incentive of 50 Indian rupees (approximately US$0.67) for every successful vaccination conducted.

Project Swaraksha can be easily scaled up and replicated in almost all states as it requires only a tech-savvy individual and a smartphone.

Compared with other initiatives that work on vaccine hesitancy or vaccine registration for rural populations, Project Swaraksha addresses all aspects of vaccination including counseling, registration, booking appointments, and downloading vaccine certificates. The project has received US$1 million from CryptoRelief, with a goal to serve 10 million rural residents.

Stories from the field

“We have to meet a person at least two to three times, talk to them by phone, meet them personally, show videos, tell them about other villages before they [decide] to get vaccinated.” – Neeraj Pandey, Operations Executive and Digital Runner, Project Swaraksha

When the COVID-19 vaccination drive began in March 2021 in Madhya Pradesh for people aged 60 and older, residents of Balgara panchayat in Indore District were not interested in being vaccinated. Villagers did not think COVID-19 was a big threat in their community and had heard that COVID-19 vaccines caused death and illness. Low levels of education and rapidly spreading misinformation also contributed to their hesitancy to vaccinate.

Neeraj Pandey, an operations executive who worked in the panchayat, remembers being taunted, threatened, and cursed at when he made home visits to share information about the COVID-19 vaccine. He and the village officials used various strategies to encourage older adults to get vaccinated, including addressing their questions and concerns, engaging with community leaders, and providing educational materials such as posters and videos to explain how vaccines work. After a few months of community mobilization efforts, 93 percent of adults in the village have been vaccinated with the first dose. Those who are not yet vaccinated are pregnant, seriously ill, or were previously infected with COVID-19 and will get vaccinated later.

“Our panchayat did well because of the support of the Project Swaraksha team who went door-to-door and convinced people to come for vaccination. They also helped us by downloading the vaccination certificates, which reassured and encouraged more villagers to come forward,” – Vijay Upadhyay, Panchayat Secretary, Balgara, Madhya Pradesh

In Mon, the third-largest district in Nagaland, barriers to vaccination included traditional beliefs, misinformation, lack of access due to poor road connectivity, and the fear of losing daily wages due to adverse effects following vaccination. The district recently signed a formal memorandum of understanding with Project Swaraksha to overcome barriers and increase vaccination rates in the region.

We hope the partnership with Project Swaraksha will bridge the gaps, provide one-to-one counseling, deliver [accurate] information, dispel myths, and make the vaccination process easier for the beneficiaries as well as the healthcare workers through proactive coordination of the volunteers, and eventually ramp up vaccination coverage in rural areas. – Ilika Zhimomi, Sub-Divisional Officer (Civil), Office of the Deputy Commissioner, Mon District, Nagaland

How was this promising practice implemented?

Project Swaraksha is designed in a way that is simple, enabled by technology, and empathetic to the needs of rural Indians. The project used the following strategies to increase vaccination rates in rural areas of India:

Digital Runners as local ambassadors – Project Swaraksha engages with local tech-savvy individuals who work as digital runners on the ground to overcome barriers to vaccination in rural areas. The project equips them with smartphones that have the Anaxee mobile app, which provides training, data collection, monitoring, and analysis.
App-based training – Candidates interested in becoming digital runners apply for the project on the Anaxee app, which includes a training module in a question-and-answer format. After the candidate completes the training module, they complete an online assessment, and once they pass, the digital runner is authorized to work. Daily online Zoom training sessions are available to clarify queries from runners. A quality check team also gives feedback and performance ratings to the runners and conducts random checks.
Quality check and verification – The digital runners are monitored using technology and receive incentive-based payments on a weekly basis. Payments are completed after a vaccination is verified by the quality check team through a phone call or through the CoWIN portal.
One-on-one approach – Digital runners maintain a list of unvaccinated individuals, which is geotagged and updated on a centralized portal. Digital runners use the data to focus on people who are hesitant to vaccinate and spend time with them to understand their apprehensions and answer their questions. The runners also use the data to ensure that everyone who receives their first dose is notified to get the second dose.
End-to-end support for vaccination – Digital runners are deeply involved in the entire process of vaccination, not just registration. They locate vaccination camps being conducted in villages, book appointments for people, and support local authorities to organize these camps. On the day of the camps, they mobilize citizens and provide administrative support.

Overcoming challenges

Initial challenges included lack of trust by sarpanches (elected village-level leaders) or panchayat chiefs who expressed concern that digital runners would use the collected information about villagers for fraudulent activities. Villagers were also skeptical about why digital runners asked for their documents and one-time passwords (OTPs) for mobile registration. Digital runners gained the trust of sarpanches by showing them authorization letters from Anaxee and through their work done in other villages.

In places where vaccine hesitancy was high, villagers believed that vaccination caused death and illness and therefore did not want to get vaccinated. Consistent communication and counseling have helped gain trust among villagers and dispel myths about vaccination.

Anaxee looks forward to engaging and partnering with state and district-level administration to further their legitimacy, increase their coverage, and help the authorities to solve ground-level problems.

*Although the number of vaccinations cannot be directly attributed to the work of Project Swaraksha, the Anaxee team maintains a database of people who were counseled and subsequently received assistance downloading vaccination certificates.

Supplementary Material

1423.Project Swaraksha - Leveraging Digital Runners to Facilitate Vaccination in Rural Areas.pdf

Sources

Jha A, Bharadwaj D. Digital divide: More jabs administered in urban districts than in rural areas. Hindustan Times. May 15, 2021. Accessed August 22, 2021. https://www.hindustantimes.com/india-news/digital-divide-more-jabs-administered-in-urban-districts-than-in-rural-areas-101621027464279.html
Boston Consulting Group (BCG). Covid-19 Consumer Sentiment Research: India Survey Snapshot: Wave-6 – May 23-28. Mumbai: BCG; 2021. Accessed August 22, 2021. https://media-publications.bcg.com/COVID-19-India-Consumer-Sentiment-Survey-June2021-Wave6.pdf