Case studies

Immunisations for All

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In the village of Ayar in the Bhojpur district of Bihar, the Musahar community – a particularly excluded dalit group – were not receiving immunisations and other healthcare services because the healthcare professionals would not touch or visit them. Thanks to the work of PACS and partner Yatharth, the villagers formed a Community Based Organisation and successfully petitioned against this unfair treatment. Today, the health centre functions properly and the villagers are receiving the immunisations, ante-natal care and other services that are rightfully theirs.

Caste discrimination

Close to 7 decades after Independence, discrimination against Scheduled Castes (otherwise known as dalits) is widespread and ingrained in the psyche across India, particularly in the rural areas of Bihar.

Even within the dalit community there is social stratification, and the Musahars are the lowest amongst dalits – looked down upon by everyone.

600 Musahars live in Ayar village. Being socially and economically marginalised, they are caught between survival and despair. Until recently, the villagers, especially the Musahar women and children, have been the victims of stark discrimination in the area of health, denied services on account of their caste. This discrimination has led to an increase in maternal and infant mortality in the village.

 Babies in Ayar village used to be deprived of health services, like immunisations, because the health workers would not visit the community.

Scared of immunisation

Though the village had an Anganwadi Centre under the government’s Integrated Child Development Services (ICDS) scheme, the ASHA (Accredited Social Health Activist) and ANM (Auxiliary Nurse Midwife) responsible for providing health services to Mums and children at the centre, belonged to upper caste communities. They never visited the village because they considered Musahars as untouchables.

When questioned by the Musahars as to why she wouldn’t deliver her services to them, the ASHA said openly that the Musahars were unclean and that they stank.

Under the ICDS scheme, children are entitled to immunisation against six preventable diseases: poliomyelitis, diphtheria, pertussis, tetanus, tuberculosis and measles. Pregnant women should also receive vaccination against tetanus to reduce maternal and neonatal mortality.

However, due to the lack of attendance by the ASHA and ANM, the villagers had never received these vaccinations and did not know why they were so important. “We women were so scared of immunisation,” recalls Phoola Devi, one of the mothers in the village.

Demanding their health rights

In 2012, under the PACS programme, Yatharth visited the village and formed a Community Based Organisation called Adhikar Chetna Manch (Rights Awareness Forum) to unite people and encourage them to demand their rights.

During one of the monthly meetings of the Manch, the issue of the ANM and ASHA not visiting the hamlet was brought up. When Yatharth representatives spoke with the ASHA regarding the complaints, she denied the charges against her and told them that the villagers were lying.

Supported by Yatharth, the Musahars collectively wrote a signed petition against the ASHA and submitted it to the Medical Officer in Charge of the block. The administration took corrective steps immediately by sending a mobile vaccination team to the village and also sent a punishment order to the ASHA.

 The members of Adhikar Chetna Manch – the Community Based Organisation formed by Yatharth and PACS – meet every month to discuss issues in the village.

Improved health care services

Due to such prompt action, the health scenario in the village is changing.

“Yatharth taught us about several government schemes related to health like availing RSBY [health insurance] smart cards and the services of Anganwadi Centres and Primary Healthcare Centres, which are free and beneficial to us,” says Rameshwar Ram who is leader of the Manch. “Now, the ANM and ASHA are coming to our area regularly and many women and children are getting vaccinated on time.”

Thanks to their awareness raising work, Phoola is no longer scared of immunisations: “Now we know the benefits and we take our children to the Anganwadi to be immunised.”

The ANM and ASHA are also providing antenatal checkups and promoting the message of maintaining good health and hygiene.

Demanding other rights

In addition to improved healthcare, other things are changing too.

“Today, as a result of PACS programme, the people here are raising relevant issues on health, education and livelihood and conducting autonomous protests in their effort to disrupt untouchability and to assert their own space,” says Ramesh.  

“We have realised that it is important to gain consciousness, to build pressure, to snatch our rights. Otherwise we Musahars will forever remain on the periphery, neglected and exploited.”

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