Effectiveness of the “Arogya Ki Aur” Community based & Convergence-Driven Intervention to Improve Immunization Coverage in Tribal Areas: an Implementation Study from Central India

Abstract

Introduction: Achieving equitable immunization coverage in tribal and hard-to-reach populations remains a major public health challenge in India. Conventional service delivery models often fail to address last-mile barriers, including geographic inaccessibility, socio-cultural resistance, and weak beneficiary tracking.

Aim & Objectives: To evaluate the effectiveness of the “Arogya Ki Aur” model, a community-based and convergence-driven intervention, in improving immunization coverage in tribal areas of central India.

Materials & Methods: A quasi-experimental pre–post implementation study was conducted across 124 low-immunization villages in Betul district, Madhya Pradesh, including 16 high-priority villages. A total of 1,045 children aged 0–5 years were assessed. The intervention integrated three components: SHG-led Arogya Sakhi tracking, Health–Forest Department convergence for improved access, and Udaan tribal counsellors for behavior change communication. Data were collected through household surveys, U-WIN, and HMIS records. Changes in coverage were analyzed using Chi-square tests, with effect sizes and 95% confidence intervals estimated.

Results: Full immunization coverage increased significantly from 62.7% to 81.6% (absolute increase: 18.9%; 95% CI: 15.2–22.6; p<0.001). Dropout rates declined from 18.5% to 7.2%, and left-out children reduced from 11.9% to 6.1%. Greater improvements were observed in high-priority (+25.6%) and remote villages (+25.8%) compared to other areas. Equity gaps between remote and accessible populations reduced by 10.9 percentage points. The intervention demonstrated a relative coverage increase of 30.1% and a number needed to treat of approximately five.

Conclusion: The Arogya Ki Aur model is an effective, scalable, and community-driven approach that improves immunization coverage and reduces inequities in underserved populations. Its integrated design offers a replicable framework for strengthening last-mile immunization delivery in similar settings.