“Why didn’t you get your child vaccinated during the last vaccination drive?” asks the man playing the role of the vaccinator. “We hail from the Northern Areas; there was too much trouble in our area to worry about vaccination,” replies the woman playing the role of the errant mother. The scene was enacted in the conference hall of a hotel in Karachi as part of a training exercise. The participants were government employed vaccinators who have been working under the Expanded Programme for Immunisation for the past 20 years, keeping our children safe from all the dreaded childhood diseases.

“It’s a wonderful opportunity to receive a refresher course,” says Abdul Majid who has been a vaccinator under EPI since the beginning of the programme in 1990. “Many new vaccines have been introduced as well as new methods and it was high time for us to brush up on the skills.” Majid’s enthusiasm reflects the attitude of the other trainees, all of whom seem to welcome a chance to receive some formal training.

“This training broke the years old mind sets, opened new horizons for improving the vaccination practices. This has also instilled commitment and zeal for making some difference in the lives of the people of Pakistan” is how Lubna Hashmat, CEO Civil Society Human and Institutional Development Programme (CHIP), the civil society organisation (CSO) providing the training, views the initiative. Working for the uplift of the marginalised communities, it was able to carry out a training of the magnitude required.

The funding to the CSO, for this immense undertaking was provided by EPI/ Ministry of Health with financial support of Global Alliance for Vaccines and Immunisation, popularly known as GAVI. “Partnering with 15 CSOs, working in the health sector, the Ministry aims to strengthen the network of CSOs for achieving Millennium Development Goals (MDGs) 4 & 5. Since the past two years, these CSOs are supporting immunisation and maternal and child health care services in their target communities in selected districts of Pakistan,” says Dr Altaf Bosan, National Programme Manager, EPI, Ministry of Health.

“The training focussed on, among other things, the importance of record keeping in order to keep vaccinated children in the system to ensure that they receive their repeat doses,” added Hashmat, regarding the aims and goals of the programme.

A comprehensive manual, compiled by the CSO with technical support from the EPI Cell and World Health Organisation, available in Urdu as well as in Sindhi provides step-by-step instructions regarding each of the vaccinations in the programme. In addition to technical details, such as understanding the different types of vaccines and their method of administration, the manual also addresses the bigger picture of how to maximise coverage and reach out to the greatest number of children. The training during the workshops meanwhile, addresses the issue of interpersonal skills, better communication and counselling techniques and aims to gear the participants to deal in an effective manner with the people they approach.

Planned in two sessions, the vaccinator training programme covered 72 districts across the four provinces as well as 10 towns of Karachi, in the last two months. A total of 2,500-2,800 vaccinators will be trained by the end of the sessions.

“People, by and large, know about the importance of vaccines,” says Mehrunissa, who has been working in Karachi as a vaccinator for the last several years. “But there are times you have to know how to address certain concerns they may have or answer their queries.” This is where activities like role-play can help.

Matriculation (science) is the basic qualification required to apply for the post of an EPI vaccinator. Once selected, the applicants receive a four-month training certificate from a Government Medical Faculty. However, EPI has now introduced further training for vaccinators on the job which includes an understanding of diseases in terms of micro organisms, bacteria, virus, fungus, incubation period, quarantine vector carriers, source of infections, etc. Calculation of health indicators, social mobilisation and National Immunisation Days are some of the other topics that shall be covered.

People like Majid and Mehrunissa and scores of others like them have been performing their duty with the utmost dedication and grace under pressure; thanks to this initiative they now have a chance to groom their skills and bring a new dimension to their work.