Dev Kumari, an accredited social health activist (ASHA) worker employed under the National Rural Health Mission (NRHM) in Badaun district, western Uttar Pradesh, is satisfied. “At the peak of the second phase of Mission Indradhanush (September 11 to 16), I was able to perform my work efficiently,” she says, of the immunisation programme launched by the Ministry of Health and Family Welfare in 2014, targeting children below five to bring them under the Universal Immunization Programme (UIP).
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Contributing to her efficiency is an immunisation wheel, a job aid that helps frontline health workers calculate dates for childhood vaccinations. “The third phase will begin in October, and I hope to be as productive,” said Ms. Kumari, whose primary job is to be a health promoter at the village level.
The immunization wheel, called a teekakaran chakra in Hindi, is a simple plastic-laminated cardboard construction developed and funded by the Clinton Foundation, under the Clinton Health Access Initiative (CHAI). It consists of two discs, placed one on top of the other, one bigger than the other, and attached with a rivet. The smaller one has details of the vaccines and arrows; the larger one has a calendar with days and months.
Health workers register a child’s birth in what they call the ASHA diary. They use the wheel to match a birthdate to the first vaccine. The rest of the dates for year one of an infant’s life (for immunization at 1.5, 2.5, 3.5, and 9 months) fall into place, without the need for manual calculation. There is a pictorial indication of whether the vaccine is a jab (syringe vector) or will be orally administered (drop vector).
Introduced as a pilot just after COVID-19, the tool was rolled out to 1,66,975 ASHA workers across U.P.’s 75 districts, by the State government in August 2022; 1,83,600 wheels were distributed. The U.P. health department has been working with the foundation in pursuit of at least 90% immunization coverage.
“It used to be a difficult task to calculate the due date of vaccinations of newborn babies during vaccination drives. With the vaccine wheel, we are able to do it within seconds and prepare the list. It helps us inform parents about dates quickly, so we can spend more time talking to them about the benefits of a particular vaccine (also written out on the card),” said Kumari, who has passed Class XII.
“Many ASHA workers, educated till Class VIII or X, have increased their speed of work with the wheel. In the year since its use, they are now able to achieve targets of 95% vaccine coverage in the first year of birth,” said Mohammad Aslam, district immunization officer (DIO), Badaun. Training is imparted by the foundation at the district level to block-level health officials, who in turn train ASHA workers.
The vaccine wheel also has details of the vaccines for pregnant women and for babies from 16 months to 24 months, leading up to the fifth year. There is information about the benefits of timely vaccination that health workers can give parents.
