In ZMQ Development ran the Sakhee Project in Maharashtra, a targeted pilot—funded by Gavi—designed to raise childhood immunization among migrant families who often avoid officials because they lack documents or fear enforcement. Instead of relying only on formal health teams, the project hired local trans women, known in the program as Sakhee didis, to do door‑to‑door outreach, explain vaccine schedules, and physically accompany caregivers to immunization sessions.
What happened – Outreach teams averaged about 40 households a day, visiting migrant settlements and meeting families at their doorsteps. – Over the pilot period roughly 1,500 children across three cohorts received at least one vaccine dose. Health workers reported better two‑way communication where a Sakhee didi was present—families were more willing to ask questions and to come back for follow‑up doses. – Outreach combined practical help (finding families, translation, accompanying caregivers) with relationship‑building: the didis helped reduce fear of officials and brought a culturally attuned approach to routine vaccinations.
Why it mattered – The model lowered both logistical and social barriers: accompaniment eased the anxiety of undocumented households, and trusted peers helped counter misinformation and stigma. That translated into higher attendance at sessions and improved follow‑up for multi‑dose schedules. – The pilot also created dignified, paid roles for a marginalised community. By placing trans women in public‑facing health outreach, the project delivered public‑health benefits while contributing to social inclusion.
Challenges and limits – Migrant life complicated outreach: language differences, irregular work hours and high mobility made scheduling and follow‑up difficult. – Organizers note the pilot yielded positive signals but stopped after its planned term; a formal evaluation of scalability and cost‑effectiveness is ongoing. Decisions about funding, broader rollout and integration into routine services remain unresolved. Sustaining results would require clear financing, system integration and policies to protect outreach workers and the communities they serve.
Social dynamics and safety – Early stages met suspicion—some residents feared harm or kidnapping, reflecting wider stigma toward trans people. Over time those attitudes shifted: program staff report households that initially refused access later invited didis in for conversation. Police records show no security incidents related to outreach operations.
What this suggests for policy – Engaging trusted local actors can bridge gaps that formal systems struggle to close. Pairing outreach with accompaniment addresses both the practical and psychological hurdles to vaccination. And when outreach creates legitimate employment for marginalised groups, it can produce health gains alongside social benefits. Whether these lessons can be scaled depends on the forthcoming evaluations and on securing funding and institutional support.
In short: the Sakhee Project offered a promising, community‑centred approach to reach hard‑to‑reach families and to combine health service delivery with inclusion. Its pilot results are encouraging, but further assessment and concrete commitments will determine whether the model can be expanded.