The Underserved Strategy had its genesis after a polio outbreak in Uttar Pradesh (UP) in 2002, when it was realised that although Muslims made up only 17% of the state’spopulation, they represented 59% of the children being paralyzed by polio. Muslim communities in UP are some of the most underserved in India; they are often poor, marginalised, and excluded from basic health services. In the early 2000s, rumours had taken hold that oral polio vaccine (OPV) was ‘haraam’ and part of a Western campaign to sterilize Muslim children. In 2002, a Muslim child was five times more likely than a non-Muslim child to have not received even one dose of OPV. It was a wake-up call. The challenge was to win the support of religious leaders and generate community ownership of the polio programme.

Working with Muslim Universities

The Underserved Strategy began in 2003 and by late that year formal partnerships had been struck with respected national Islamic universities including Jamia Millia Islamia University and Aligarh Muslim University. The oral polio vaccine was tested by the medical college at Aligarh Muslim University and the university publically declared that it was safe. Jamia Millia Islamia University also produced the ‘green advocacy booklet’, a collection of verses of the Koran promoting child health and hadits (sayings of the prophet Mohammed) in support of polio vaccination.

Madarsas & Mosques

Partnerships have since been built with 500 madarsas and Muslim institutions across north India. Religious leaders have become an integral part of the polio programme, taking personal responsibility for ensuring their congregations understand the importance of vaccinating children against polio. In high-risk areas of UP, around 85% of mosques make announcements for polio advertising the date of ‘Polio Sunday’ ahead of the campaign and again on the first morning of the round. Imams have appeared on local television making public service announcements urging parents to vaccinate their children and have provided written endorsements of the polio programme. Imams often give the first polio drops to a baby at their local fixed-site booth, as the ceremonial start to a polio immunization round.

Coordinators & Influencers

25 District Underserved Coordinators have been hired and deployed in high-risk areas in Uttar Pradesh and Bihar. They are the focal point between religious leaders, the SMNet and the rest of the polio programme; holding regular ‘Interface Meetings’ with local Imams and key community influencers. The influencers are respected elders, often those who’ve made a pilgrimage to Haj, who can be called upon by community mobilizers to speak with parents who are refusing to vaccinate their children against polio.

Religious Gatherings

A major element of the Underserved Strategy is to ensure the message to vaccinate children against polio is front and centre at major religious gatherings. At mass congregations around the time of Eid, for example, up to five million people are exposed to polio announcements, with large banners promoting vaccination hung prominently through the site. Other important religious events such as Urs are used as opportunities to target thousands of people at high risk of polio in one place. Banners are strung up, brochures and booklets distributed, community mobilizers counsel parents and vaccination teams are deployed to vaccinate children at the event. District Underserved Coordinators make sure that whenever there is a large religious gathering, polio vaccination is a part of it.

Migrants & Nomads

The Expanded Underserved Strategy now covers other marginalised groups, such as migrants and nomads. Research has shown that the children of these groups are also much less likely to have received enough doses of OPV to have adequate immunity to the virus. Migrant populations are being tracked, and partnerships have been formed with the owners and managers of businesses that employ transient workers, such as at brick kilns and construction sites, to ensure that sites are included in immunization micro plans, and that toilets and an adequate water supply are provided.