Vaccination for Covid

With a routine immunisation coverage of 88 percent, AJK is one region that has remained polio free for the last two decades

Visiting Muzaffarabad after 16 years was quite an experience. The last I saw this place was when an earthquake of 7.6 magnitude shook the entire region on October 8, 2005.

After nearly 16 years the city seemed stronger. Its social indicators show that too. One of those is its literacy rate of 67 percent among its women compared to the national average of 51 percent.

Dr Bushra Shams, the provincial programme manager of Expanded Programme on Immunisation (EPI) Azad Jammu and Kashmir (AJ&K), the only woman in the country heading an immunisation programme, has health scores for children to prove her mettle.

With a routine immunisation coverage of 88 percent, AJK is one region that has remained polio free for the last two decades. “We are working on a war-footing to maintain, restore and strengthen immunisation,” she said.

But along with improving children’s health, Shams believes in making the workplace particularly comfortable for her colleagues, especially women. She is aware that women‘s voices often remain unheard.

Taking pride in her work in public health because “it gives life a meaning by providing one the opportunity to give back,” she says it gave her a lot of satisfaction working with the community. As programme manager, she has been working with the community for four years.

Last year, she says, proved far more challenging than earlier years. She says the Covid-19 pandemic has brought into full view the underlying gender disparities and barriers, at the household and community level. Already overburdened with work, women had to fight on several fronts: home, childcare, child education, care for the elderly and care for the sick with increased restrictions on movement.

“It was difficult but not impossible” to render services for Covid-19 during the lockdown. She says she allowed some of her staff to work from home and visit the office when convenient. Not only women workers were provided a pick-and-drop service to office, many were allowed to bring their younger children with them.

But despite women faring well on the education front and gaining financial stability, Shams says, in general, there was little sign of a change of mindsets among men. Many women continue to face harassment in all walks of life. “What needs to change is the idea that only women can do certain jobs.”

As a manager, she makes sure that women and girls everywhere can seize their full potential, take up active roles and are recognised for doing something valuable for their communities.

Sidra TulAin, who works for a UN agency says, “By setting boundaries for what women can and cannot do and what they must do, our society increases the burden that a majority of women carries.” In rural areas, for instance, some of the most back-breaking tasks in the field are assigned to women. It saddens her that even as women are doing all the work, their contribution often remains unaccounted for.

The Covid-19 pandemic brought into full view the existing gender disparities and barriers, particularly at the household and community level. Already overburdened with work, women had to fight on different fronts.

As for paid employment, Sidra believes we still have a long way to go before we are free from the binds of being either women or men. A majority of employers are politically correct in encouraging women to apply, but still prefer to hire men for a position because they are expected to put in longer hours, be willing to travel without restrictions and will not get pregnant. “I am proud to have been born a girl. I am sure that there will be a change in the society soon. Only then can we truly celebrate the Women’s Day,” she says.

A review by the World Health Organisation shows that globally girls and boys have the same likelihood of being immunised as there are no significant differences in immunisation coverage between girls and boys. However, in South Asia more boys are immunized than girls.

Experts say that when women are empowered, immunisation coverage increases. Countries with a high level of gender equity, as measured through the Gender Development Index, have higher immunisation coverage. According to Dr DS Akram, a pediatrics professor and chief of Health, Education and Literacy Programme (HELP), “in societies where women have low status and therefore lack access to immunisation and other health services, both girls and boys are less likely to be immunised.

Akram says there are “gender barriers at both caregivers’ end and health workers”. Women have a problem bringing their children to be vaccinated while for health workers the issue is that there are fewer women vaccinators than men. Adding more women to the programme can be a game changer as it is helpful in reaching out to and convincing the parents who refuse to get their children vaccinated.

As a Kashmiri woman sensitive about her region’s history, Shams explores the women’s perspectives on the conflict, works with them to identify the roles they can play in improving the situation for women and then reaches out to policymakers to advocate on behalf of the women. There are moments of frustration when women’s voices are not heard by decision makers. “Even now women are seen only as workers and not as decision makers,” she says.

A just society will not develop unless women are equipped with appropriate knowledge, skills and values for the overall development of the society. “The high female literacy rate in AJK makes our work easier as women here, compared to the rest of the country, are much more receptive to information coming their way,” says Mubashir Banoori of the Aiming Change for Tomorrow (ACT), a civil society organization working with the immunisation programme in Muzaffarabad.

At the federal level, the EPI is working together with the provinces to overcome gender inequities, to identify and address gender-related and other barriers to the access and delivery of health services. This includes accommodating the schedules of working women and taking into consideration other constraints faced by women.

Dr Akram Shah, the National EPI Programme Manager, says, “mother’s education is strongly related to her children’s vaccination and health. However, in remote and rural areas of the country, there are other factors as well, such as mother’s limited decision- making ability and limited control over resources. We need to ensure that our girls receive education, stay healthy and are economically empowered.”

He commends the women polio workers for doing a remarkable job as frontline workers. “I believe female health providers can contribute to increasing routine immunisation uptake, as they are perceived as better able to understand the needs of mothers and the barriers women face in accessing immunisation for their children,” adds Shah.

As we mark the International Women’s Day 2021 on March 8, meeting role models like Shams we can say women are better empowered today. They can take up any profession and work like men – and better.

The writer can be reached at

Vaccination for Covid