TBAs attending mothers meeting before polio round in Aligarh
By Shamila Sharma
Aligarh : With the strategy now focusing on reaching polio vaccine to the youngest and at the earliest, this critical western Uttar Pradesh district has hit upon a novel idea, to effectively engage trained birth assistants for tracking newborns for immunization.
The TBAs or ‘dais’ as they are traditionally known, are older women, from the community and the first to know about births, as even today over 80 per cent deliveries take place at home in most villages and small towns.
These women are the most trusted ones for both pre and post natal care of mother and child by the families and often partly responsible for the misconceptions about these practices.
“Though some TBAs had been helping in the programme, their contribution depended mostly on the rapport the community mobiliser of the area had with them. Their involvement was not structured, which is what we now aim for,” says Bhai Shelly, Training Coordinator for Social Mobilisation Network in Uttar Pradesh.
TBAs are now being effectively engaged, they promptly report births in their area to UNICEF community mobilisers, help as influencers to tell families about polio vaccination and participate in pre-round activities like mothers meetings where the need for polio immunization is emphasized.
The initiative, started in February, has had visible results with newborn immunization going up by almost 12 per cent in some areas.
Explaining how the plan to involve TBAs evolved and how it was carried out, Aligarh Sub-Regional Training Coordinator, Prem Kumar Singh says “the indicators in Aligarh urban were consistently poor. We were missing children in every round specially the younger ones”.
These areas were densely populated. The population was not static, frequently on the move and opposed to polio vaccination, bargaining for other health services or fearing ill effects.
It was very difficult to track newborns under these circumstances for the UNICEF community mobilisers who maintain records of all children up to five years, counsel families for polio vaccination and assist vaccinators during polio rounds.
TBAs were thought to be the best way out, he says.
“But the challenge was how to go about it. A skill enhancement orientation, increasing their knowledge about mother and child care, clubbed with polio was thought to be the best,” says Bhai Shelly.
The orientation was accordingly planned, with the tools mostly pictorial in view of the low literacy rate among the TBAs.
The first was held in the health centre of Upperfort, followed by Shahjamal, Mahfoz Nagar, Bhujpura, Ghanter Chowk and K K Jain colony. In all 50 TBAs were oriented.
An assessment of the participants showed 70 per cent had an experience of over 11 years but 84 per cent had never had any formal training. They were using broken pieces of cups to cut the umbilical cord. Most of them were unaware of the importance of breast feeding and immunization.
Post orientation, their knowledge about safer delivery increased; they started telling new mothers about the importance of colostrums and immunization of newborns.
Most importantly, their awareness on polio immunization increased and also their involvement in the polio programme.
There were visible outcomes of their engagement. K K Jain colony recorded a 12 per cent jump in newborn immunisation, reaching 90 per cent. Mehfooz Nagar and Shahjamal recorded eight per cent increase, touching 74 per cent and 91 per cent respectively.
TBAs too are happy. Fifty-year-old ‘Choti dai’, as she is fondly referred to by the people in Shahjamal, says “I did not know about colostrum, now I tell mothers about it. I also tell people to take routine immunization and polio vaccination as soon as possible.. I no longer ask them to keep the child away from vaccination for 40 days.”
“Now we know more about polio, how it spreads and how is can be prevented”, says 45-year old Munni, a TBA in Bhojpura.
Haseena and Noorjahan, TBAs in Upperfort area, attend mothers meet and also help as influencers.
After the success in Aligarh, TBA orientation is being replicated in other sub-regions.