Improving Immunization Timeliness through Traditional Drum-Beating Initiative

In rural India, many barriers exist to full immunization coverage. Topographic constraints, such as walking long distances in hilly terrain, crossing bodies of water, poor road conditions, lack of transport and more deter caregivers from visiting outreach sites on time. Community health volunteers are forced to go door-to-door to inform caregivers about the arrival of the vaccination team at the outreach site.  As a result, in these hard to reach areas, children do not receive vaccines on schedule and remain vulnerable to deadly diseases. 2018 data shows that the major barrier for full immunization coverage in India is awareness and information gaps. 

To overcome these challenges, JSI, in collaboration with the state government stakeholders and a local NGO, tested a unique, culturally appropriate, low cost, scalable method of disseminating information about the arrival of the vaccination team at the outreach site on designated vaccination days. Drum-beating has long been a part of the local culture, used to indicate an important event, such as weddings and festivals. Drumbeats travel through mountains and forests, informing parents that vaccination teams are at the outreach site.

 “It is a sound long forgotten but of late is being heard once again in these areas. To the villagers, it is a familiar sound. One that brings hope and happiness.”

Without vaccine timeliness, full immunization coverage is not possible. If a child does not receive subsequent doses of a vaccine within the recommended vaccination schedule, the child remains susceptible to deadly, vaccine-preventable diseases. Delayed vaccination in children was an issue for these communities, leading JSI and partners to conceptualize a different method for community awareness.

The intervention was piloted in Rajpura and Shillai of the mountainous Sirmaur district in the state of Himachal Pradesh, targeting a population of almost 300,000 people. The process included a baseline survey to assess the current status of immunization coverage and timeliness, the sensitization of caregivers, conduct orientation of frontline health care workers, and engage communities in the selection and orientation of drumbeaters. A special tune was developed and the drum-beating intervention was implemented for one year, followed by an end-line survey to assess outcomes. Pamphlets and other awareness materials were disseminated as part of the initiative. 

The drummers are community members who are familiar with the terrain, which maximizes their contribution in the absence of sufficient numbers of health workers and community mobilizers per community. To ensure the reach and quality of the drum beating for all caregivers, field coordinators visited the sites and talked to them, surveying the effectiveness of the drum-beating as a communication tool. The data was then analyzed and corrective measures were taken as necessary. 

The results of the end line assessment indicate improvements in immunization timeliness, and confirmed drumbeating a source of mobilization and awareness intervention. A marked increase in the timeliness of vaccination delivery was found in the end line assessment, compared to baseline data. At end-line, qualitative data found that community mobilizers and health workers recognize drumbeating as an effective method of communication. Word of mouth messages increased, due to the curiosity and enthusiasm the drums have stirred up amongst the villagers. The state government endorsed this community-based approach and will continue the initiative in these blocks with its own funding. Given the success and ease of this intervention, there is a proposed expansion to geographically similar districts to show further evidence of positive outcomes at scale.

In the world of immunization, innovation often means the latest technology in service delivery and mobile apps for quality improvement and communication for immunization. In this context, JSI and partners are proud to have developed an alternative innovative concept; one that is an inclusive, scalable, low-cost method of communication that incorporates cultural traditions and engages the communities under a common goal.

Written by Molly Ferguson