Sociological Analysis of the Role of Community Health Workers (CHWs) in Improving Immunization Uptake in Bihar

This paper will socially analyze the Community Health Workers (CHWs or Accredited Social Health Activists (ASHAs)) and their impact on increasing the routine immunization uptake of children in Bihar, India. Bihar has universal socio-demographic barriers such as low literacy levels on the part of the mothers, rural-urban inequality, and vaccine receptivity based on local cultural beliefs, which hinder universal coverage despite the national Universal Immunization Programme (UIP). Using a qualitative research design that includes 200 workers of the ASHA in four districts of North Bihar (Darbhanga, Madhubani, Samastipur, and Sitamarhi) the study unveils that in bridging the gap between formal health services and families that cannot be reached, ASHAs use social capital and community trust as well as grassroots knowledge. But their productivity is severely limited with unstable incentive-driven compensations, overloading multi-sectors, and the institutionalization of gendered labor by disvaluing it in a patriarchal community and bureaucracy. This paper postulates that sustainable immunization coverage in Bihar requires policy changes which go beyond the focus of individual incentivization of equitable compensation, professional value as well as a strong institutional support to the CHW cadres.