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Case study: Reaching the Koshi basin and other forgotten populations

Reaching the Koshi basin

Child kiln worker

Those work in India’s brick kilns has been described by BBC News as “the most poverty-wracked communities of India.” Vulnerable to slavery and abuse, they are often difficult to find – especially those who live in remote regions, like the workers of the Shiva Brick Kiln.

Nestled in the Koshi River Basin in the Khagaria district of central Bihar, the Shiva Brick Kiln is home to a community of migrant workers and their families. Until the Routine Immunisation (RI) programme arrived in 2009, a health worker had never visited the kiln before.

The RI campaign was part of the polio endgame in India – ensuring that vaccination against the poliovirus reached everyone, everywhere. Making India polio-free depended on this, as just one case can lead to a resurgence of the disease in communities where immunisation levels are low.

Across India, community mobilisation efforts saw marginalised populations – seldom included in health outreach efforts – be vaccinated against polio. Such populations include migrant workers and resistant families.

An intensive effort went underway to immunise them. Efforts particularly targeted the 107 blocks of Uttar Pradesh and Bihar, which accounted for 80 percent of the country’s 741 wild poliovirus cases in 2009.

Under the 107 Block Operational Plan, community mobilisation coordinators became an integral part of vaccinating India’s forgotten populations against the deadly disease. Accompanying RI programmes were efforts to reduce risk factors associated with polio transmission: namely, the promotion of exclusive breastfeeding (which improves a child’s immune system), encouraging the use of oral rehydration salts and zinc in responding to episodes of diarrhoea, and the promotion of hygiene practises such as handwashing to improve water quality and sanitation.

In the Shiva Brick Kiln, signs were posted announcing the RI programmes. The same occurred across the country, in other areas often underserved by public health efforts. In this instance, they would not – and could not – be excluded. The eradication of polio in India depended on it.

Education on the importance of immunisation against polio and other methods to protect against the disease was a core tenet of these programmes, one which was of particular importance when dealing with resistant families.

As highlighted in The History of Polio in India, social mobilisation efforts targeted the Muslim community (which was reluctant to accept the vaccine) by securing the support of local religious leaders. Monitoring and immunising migrant populations leaving endemic states was also a vital part of ensuring that polio did not resurge in regions of the country where it had been dealt with.

The eradication of polio in India marked the consummation of a hard-fought battle that was also hard-won. The importance of social mobilisation efforts at the level of India’s most marginalised and forgotten communities cannot be understated in how we remember the end of polio in India – and in ensuring that the disease does not resurge in the country in future.

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