Proximity is not access. A service can be a ten-minute walk away and still not be for you.
Kalamahadeva had 495 households and sat about 18 kilometres from the block centre. The sub-centre was roughly 600 metres away, and generally only five or six nearby families used each routine immunisation session. Most eligible families were not being reached.
So the problem was not geography. Community communication by the ASHA and the Anganwadi worker was weak, and a session narrowly focused on injections was not functioning as a village platform anyone recognised. The gap was in relationships and organisation inside the service system.
In February 2011 a DEHAT block coordinator joined the ASHA and the Anganwadi worker for household visits to families with children under two. On 3 February they held a meeting, supported by a teacher from DEHAT’s Rural Girl Child Education Project. Together they planned to turn the next routine immunisation session into a full Village Health and Nutrition Day.
On 5 February the Anganwadi worker, ASHA and ANM arrived and divided the work. The Anganwadi worker weighed pregnant women and children and distributed supplementary food. The ASHA mobilised families. The ANM immunised and counselled. Two Village Health and Sanitation Committee members supported the outreach. Pregnant women, young children and adolescent girls came.
Twenty-six children under two and nine pregnant women were immunised. Thirty-two children received vitamin A - eight aged nine to twelve months, twenty-four aged one to five.
The jump from five or six families did not come from one person’s effort. Families responded, a teacher opened community connections, committee members mobilised, three frontline workers coordinated their duties and the health service supplied the clinical work. DEHAT facilitated the household dialogue and the joint planning.
One busy day is not a permanently strengthened system. It is proof that the people already present could reach many more families when they planned together and treated the session as a village platform rather than a technical event at the edge of the settlement.
Proximity is not access.
Get the Three Workers in One Room First
A planning meeting, household visits beforehand and a session designed as a village event. No new team members, no new facility. The services were already funded.