Swasti | Covid-19 Playbook

VaxNow in
Bommanahalli!

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Vaccines Are
For Everyone!

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Vaccination Hesitancy:

Many community members are also hesitant to get vaccinated due to lack of sufficient knowledge dissemination and awareness and an inability to access nuanced, trustworthy information about genuine questions and concerns. A few reasons that lead to increased hesitancy and indifference are misconceptions, negative messaging, fears, social and gender barriers.

I am old and live with my grandchildren who are very busy and don’t have time to take me for the second dose. I came here with help from a neighbour but now I don’t have a phone and the OTP has gone to my grandson who is not responding. I will have to return without vaccination. I am not sure if I can come back again.

I am a woman. I do not have permission to get vaccinated from my family. We are unsure of its long-term impacts

I am not sure of its safety. My friend fell sick after getting the shot. I would like to observe first.

My mother had a heart surgery six years ago and I am not sure if I should her to get a vaccine. I don't know if it will react with her current medication or make her condition worst.

PLOT: PROBLEM STATEMENT

No One is safe till EveryOne is safe

Marginalised Communities are most likely to be left behind when Vaccination Outreach Programming is top-down and designed for the general population. A large proportion of the population needs protection and access but also special considerations and an enabling environment for that access to be experienced.

There are typically 2 pronged issues:

Significant and real inequities in Access
Information asymmetry leading to low vaccine demand and hesitancy due to
- Low perceived need for vaccination
- Low perceived risk of COVID-19

Low perceived risk of COVID-19

No One is safe till EveryOne is safe

It is imperative to consult with community representatives - at every step, at every phase.

In order for marginalised communities to have access to health care, the following conditions must be met:

1. Ensure safe and affordable transportation to access healthcare services in this case, COVID-19 vaccination centres
2. Use vaccination camp to conduct regular health checkups and referrals
3. Community Systems Strengthening for Health Systems Strengthening

Definition of community representative

A community representative is a member of a community who has been nominated by the said community to represent its interests.

The role of the community representative is to represent the interests of the community and involve the community in decision-making processes, for instance, by attending local committees and advocating for the communities needs and wishes for change (Goswami, 2020).

Nothing for us without us

We have learnt that the best and most effective ways of planning for and rolling out Vaccination for the most marginalised is to ensure that the design is

Community-centric and localised.
Able to direct the flow of resources (e.g., people, money and materials) where they are most required.
Attentive to fluid and frequently changing ground scenarios and address information management and coordination.

PURPOSE AND OBJECTIVE

The Vaccination Drive Playbook offers guidance to help community organisations implement the vaccination drive for vulnerable populations at the local level in partnership with other NGO/CBOs, Medical/Clinic teams, volunteers. The document outlines the steps required for conducting the community vaccination drive and details out the activities that can be undertaken for smooth planning and rolling out of the vaccination drive.

In the playbook you will find:

Set of activities to conduct the vaccination drive
Summary checklist
Team role matrix
Tips and tricks

The playbook divides the entire process into 3 Acts, which are as follows:

Act 1
- Scene 1 : Planning phase
- Scene 2 : Pre-vaccination phase
Act 2 : Vaccination phase
Act 3 : Post-vaccination phase

Stronger Together

PEOPLE

Who are the People?

COMMUNITY MOBILISERS

Role:

Correcting the information asymmetry
Generating trust
Matching demand and supply
Identifying the most vulnerable who are likely to fall through the cracks

What do they need?

Build their trust in the vaccine
Train to be able to relay key messages about vaccines and have nuances conversations with those that are hesitant
Reliable information on where and when and how many vaccine doses are available
Connection to resources for availing services for special needs cases (also helps improve their standing in community and generate trust)
Digitally savvy to support online registrations if needed

Who can they be in your community?

Who can they be in your community?
Religious leaders
Frontline CBO/NGO workers with close community ties
Self help group members
Ashas and angan vadi workers
Teachers from local schools known to parents
Panchayat members

LEVERAGING COMMUNITY CONNECTS

Local leaders, youth groups, religious spaces (if not contentious) can be leveraged as resources and their involvement could help mobilise individuals who otherwise would not access care at health centers. Local resources for transport for those that can not afford it can also be mobilised.

CLINICAL TEAM:

CLINICAL TEAM: Doctors, Nursing staff, Ambulance staff

What do they need to know:

If the clinical teams are not used to working with vulnerable populations it’s important to have sensitisation sessions (importance of providing respectful care and its impact)

Not assuming people have all the information or able to find it and therefore providing pre and post counselling on what to expect (fever, flu like symptoms etc.),
When to come back for the next dose, ask if there are any questions and respectfully answer any questions or concerns, however basic they may seem.
For special populations such as elderly, people with disabilities, sex workers, trans population that have specific health related questions and poor experiences interacting with health systems, clinical teams should be briefed on how to answer them most sensitively.
- Due to COVID many people have not accessed clinical care even if they needed it so if special population camps are being organised, having additional areas where general clinical concerns can be addressed could be very beneficial for these populations.

Many of those with alcohol dependency returned from the vaccination camp without taking the vaccine because their questions about reactions with alcohol were not answered or they were told that they could not drink for long periods if they took the vaccine.

NON-CLINICAL STAFF:

Who are they: Local volunteers, Frontline staff from NGO/CBOs, Self Help Group members, Youth Club volunteers, Civil defence staff such as home guards and others can perform critical functions such as crowd control, data entry, supporting those with special needs, ensuring safety of VPs and respectful treatment, ensuring COVID appropriate behaviours etc.

What do they need to know:

Importance of providing respectful care
Digital literacy for those doing data entry
Both male and female volunteers should be available at camps
Understand how to escalate any issues
Familiar faces and trusted volunteers are key for making sure very marginalised populations feel comfortable

Situationally aware camp management:
Anticipate interference and disturbances and have community leaders and senior managers at hand who can handle issues as they come up.

Security: Using or alerting local police or other security agencies during large camps is key to ensure safety of staff and beneficiaries. Dynamics of certain populations with security forces must be considered to ensure people do not avoid camps due to their presence.

Team Role Matrix

Role Title	Station/Number of People	Responsibilities
Community Mobilisation	-	Provide information on vaccine drive in communities - date, location, which vaccine, eligibility, etc. Address vaccine hesitancy and or any related concerns Collect the required information from the interested members in a predesigned format
Crowd Management	At the gate - 2/3	Identify the beneficiaries based on the list and identity proof Ensure the member is wearing a mask and wearing it properly (covering the mouth and nose completely, ideally double mask) Direct the member to sanitise their hands or guide them to the washing station Educate about COVID safety protocols to be observed in the location Inform and guide the walk-in member based on the contingency plan Guide the member to the next station or room.
Queue Control	2/3	Ensure that the people waiting for registration or vaccination are following covid appropriate behaviours - social distancing, wearing masks properly, etc. Guide them to the next station

Role Title	Station/Number of People	Responsibilities
Registration	2/3	Collect the identity proof of the member and register on CoWIN
Verification	1	Verify the member on CoWIN against their identity card
Medical	Medical professional - 1 professional - 1/2	Ask the member about any existing health issues to understand whether they are contraindicated for vaccine Explain the reason to the member and guide them to the coordinator, if they are not eligible Incharge of providing vaccination for the members Educate the member about side effects of vaccine and adverse reactions associated with COVID-19 vaccine Guide them to the observation room or station

Role Title	Station/Number of People	Responsibilities
Observation	In the waiting room or station - 1/2	To oversee the waiting members Provide them the vaccination certificate or token Ensure social distancing is maintained Address their concerns and questions Provide group counselling on key information for vaccination such as the date of second dose, common and normal to have fever, body ache, diarrhoea for two days after vaccination etc. (use script) Provide screening for common NCDs such as diabetes and hypertension when people wait, if possible Guide and report them to the medical team in case of any adverse reactions or side effects Provide contact information for follow-up support
Coordination	1	Ensure the end-to-end coordination of all activities on the day of the vax drive - mobilisation through completion of vaccination Ensure documentation happens properly - registered vs vaccinated, segregated data, ineligible members, etc Coordinate with the local departments in the event of any contingencies Ensure that adequate food and water are provided for the field teams Ensure that the location is sanitised after the drive ends
Safety	1	Ensure the site is a hazard-free environment Ensure that emergency exits, fire and other hazards safety measures are in place Ensure that other members of the staff are aware of the safety measures and guidelines Stop or prevent any unsafe acts that seem dangerous or unhealthy

Accessible | Affordable | Available

Places

How to choose the right place to set up a vaccination camp?

In partnership with community representatives, choose the location of the vaccination centre that is most convenient and safe for them.
The centre should also have an accessible drinking water facility, medical care, privacy curtains and washroom.
If the centre is not within minimal walking distance of the community, ensure that the centre is accessible at the lowest possible fare. This may involve looking at local transport solutions such as shared autos/tuk-tuks, cycle rickshaws, tempo traveller vehicles and others.
- Travel schedules, pick up and drop locations - will need to be discussed with the community members to ensure the timing is suitable for the community and loss of wages is minimised. Coordinators will need to be identified to ensure the smooth operation of the travel plan.
- Contact details of coordinators will need to be shared for coordination with the community representatives to ensure fast, efficient, safe, and cheap transportation.
Ensure that both the transport and centre are accessible for people with disabilities. If that is not possible, alternative arrangements need to be made - this may involve discussing with the Medical Officer at the vaccination centre to explore alternatives such as Mobile Vans

Process Workflow

Planning Phase	Pre-Vaccination Phase*	Vaccination Phase	Post-Vaccination Phase

Partner Identification	Advocacy campaigns & IEC materials	Ensure Vaccination site is ready	Follow ups
Decide population group to vaccinate	Availability of supplies and materials	Verification	Data verification
Location Identification	Team identification and training	Registration	Team debrief and next steps
Approvals and permissions	Internal team consultation on necessary actions	Vaccination Observation/ Waiting Vaccination Process	Sanitise site, dispose waste

*Listed activities doesn’t have to occur in same sequence and can even occur simultaneously

Planning

Partner identification
Decide target population to be vaccinated
Estimate numbers that can be mobilised and methods of mobilisation
Location identification
Approvals and permissions from local authorities

Pre-Vaccination Phase

Internal team consultation
Advocacy campaigns and targeted demand generation
Finalize and prepare IEC materials
Team identification and role designation
Team training.
Ensure availability of required infrastructure
Provision for Shamiana and other arrangements

Vaccination Phase

Team arrives in advance/ on time
Camp site is ready to conduct operations supplies, labels, materials are in place, etc.
Verification at entry
Registration on CoWIN app
Verification post registration
Vaccine administered

Post- Vaccination Phase