Discovering Hidden Homes in Naipura, Ghaziabad

Rapidly urbanizing industrial city Ghaziabad Bordering Delhi, Ghaziabad city in Uttar Pradesh faces challenges like inadequate infrastructure, migration, income inequality, and high population density. These stressors contribute to serious public health deficits such as low routine immunization (RI) coverage, inadequate sanitation, poor nutrition, and high home deliveries.

While Uttar Pradesh has attained 99.41 percent Full Immunization Coverage, Ghaziabad’s district average at 68.7 percent falls significantly below the state-average city performance according to FY 2023-24 HMIS data.

UNICEF, in partnership with JSI (R&T) Foundation under the Gavi Zero-Dose partnership, has been entrusted the challenge to increase RI coverage. For maximum impact, the focus is on areas with high incidence of zero-dose children and families showing vaccine-avoidance behavior. Monitoring data (WHO/UNICEF) narrowed down a total of 255 ASHA areas to 200 across 80 urban sub-centers and UPHCs. One such area was Naipura, with 2,492 residents, mostly migrant daily laborers from Scheduled Castes.

Using Participatory Approaches

The CSO team undertook a transect walk led by the Cluster Coordinator and community members. As they walked through narrow lanes and observed daily routines, they discovered two lanes which the link worker and ANM were unaware of. Consequently, no Community-based Village Health Sanitation and Nutrition Day sessions had been conducted there, as it was a total blind spot for the health system for at least the last two years.

These houses, hidden in narrow lanes, meant dozens of children had been deprived of basic health services, including immunization. To understand this better, a social map of Naipura was created, incorporating these newly discovered lanes—covering 150 households—with inputs from community members.

“Transect walk and social mapping are powerful community engagement tools that help understand social and spatial topography of area, mingle with community and identify challenges and opportunities.”

Mobilizing Action

Findings were shared at Block and District Review Meetings. The District Immunization Officer responded swiftly, appointing ASHA Pinki, deploying a head-count survey, and initiating special immunization sessions at locations easily accessible to missed communities. The survey revealed an increased number of 3,291 children aged 0–5 years including 84 VAB or ZD children. Following capacity-building for frontline workers, a rolling program of interpersonal communication, influencer engagement, and home visits commenced.

Action and Results

• Service Delivery: Two special immunization sessions were held, and 50 children were vaccinated on-site.
• Micro plan Integration: Arun Studio was designated a permanent session site, with sessions occurring every fourth Saturday.
• Equity Impact: Young mothers like Jyoti and Rani expressed relief and gratitude for the first immunizations in two years and a newfound trust in government services.

A Mother’s Perspective:

“No immunization had been taking place in our area for the past two years, no one came to our area. We are poor so it was difficult for us to go to private facilities. My children have finally received immunization and the protection from diseases.” — Jyoti, a local mother

Moving Forward

The future must build on this success—replicate human-led mapping, reinforce frontline mentorship, and embed community voices at every level.

Ganeshi Purwa, a marginalized village located 13 km from Bidhnu block office and 48 km from the district headquarters in Kanpur Nagar, was identified as one of the high-priority ASHA areas based on monitoring data from WHO and UNICEF. The area, primarily inhabited by farming families from the Loniya (OBC) community, had a high burden of Zero-Dose (ZD) and VAB (Vaccination avoidance Behavior) Families. To address this, JSI R&T Foundation, under the UNICEF-supported GAVI Zero Dose initiative, launched a focused routine immunization (RI) program in 200 such ASHA areas among which Ganeshi Purwa was one of the ASHA area identified.

Among the families in Gneshipurwa Village was Raju, a daily wage laborer, and his wife, who had long hoped for a daughter. Their daughter, Rakhi, born on August 19, 2024, became central to this story. Having previously seen their son Lekhraj fall ill after a Penta-1st vaccine, the couple feared immunization. When Rakhi developed a mild fever after her birth dose, it confirmed their worst fears. Raju became hostile to health workers, refusing further immunization, and ASHA Rampyari felt unsafe continuing visits.

The case came to light during a block-level training session for frontline workers, where ASHA Rampyari shared her experience as part of a workshop organized by JSI on technical and interpersonal communication skills. The training helped boost her confidence, equipping her with empathetic counseling techniques and strategies to effectively handle resistance within the community and importance of within 24hrs follow up visit. Motivated by the session and supported by Cluster Coordinator Preeti, she resumed her efforts to engage with the family.

Understanding the need for trusted voices, JSI identified and oriented Ankush Ji, a respected ration dealer, as a community influencer. During the orientation of Influencers, all the influencers, ASHAs, ANMs, and AWWs discussed the importance of immunization and were provided with data on ZD children and VAB families.

On March 5, 2025, Ankush Ji visited Raju’s home with ASHA Rampyari. Speaking as a trusted community member rather than an outsider, he gently reassured Raju and addressed his financial concerns, even promising timely ration support if the child fell ill again.

Despite initial hesitation, repeated visits and conversations-built trust. On March 22, 2025, Raju finally brought Rakhi for her Penta 1 vaccine.

Outcome: 

As a result of the intervention, Rakhi received her Penta 1 vaccine on March 22, 2025, followed by Penta 2 on May 24, 2025. ASHA Rampyari conducted timely follow-up visits within 24 hours of each dose, providing paracetamol and counseling the family on post-vaccination care. Rakhi experienced only a mild fever after the first dose and recovered quickly, which reassured her parents and built their confidence in the vaccination process. During a follow-up interaction, Rakhi’s mother expressed her gratitude, saying, “We were scared, but now we know the vaccine is safe. The ASHA and bhaiya (Ankush Ji) explained everything patiently. We will complete all doses for Rakhi.” This case illustrates the powerful impact of training frontline workers in effective communication, enabling ASHAs like Rampyari to handle resistance with empathy and confidence. Additionally, the involvement of community influencers, such as Ankush Ji, played a critical role in bridging the trust gap between healthcare providers and hesitant families. Today, Raju once fearful and resistant is a strong advocate for immunization in his community, actively encouraging other families to vaccinate their children and seeking information on Rakhi’s upcoming doses.

Way forward 

Rakhi’s story underscores the importance of scaling and institutionalizing community influencer models and FLW communication training. Expanding this dual strategy—empowering health workers with interpersonal skills and engaging community influencers can build trust, address resistance, and ensure that no child remains unvaccinated in hard-to-reach or hesitant communities.

“From fear to faith—Raju’s journey is a testimony that trust, when nurtured by the community, can turn resistance into resilience.”