While Mukhtari 1.0 asked what vaccinators carry into the field, Mukhtari 2.0 asked something different: does that actually change what communities feel about them?

Building on the emotional resilience and skills-based foundation of its predecessor, Mukhtari 2.0 expanded CFAW’s behavioral and community engagement work into new territory- measuringwhether training vaccinators in empathy-centered practice can actively shift community trust in vaccines. The project was developed in collaboration with ReD Associates with support from EPI Sindh. This was executed across high-risk Union Councils in Malir, Sindh from May 2025 till December 2025.

Vaccine hesitancy isn’t a knowledge gap only, it’s a trust gap. Communities don’t resist vaccination because they don’t know it exists but because something about the system, the delivery, or the person at the door hasn’t earned their confidence. Hence, Mukhtari 2.0 was designed to investigate where that trust breaks and whether targeted frontline vaccinator training can help rebuild it.

The project embedded a rigorous community-level study into the intervention. The 45 control group vaccinators from the previous study were divided into an intervention group who received the Mukhtari training including arts-based methodologies and motivational interviewing with an explicit trust lens and a control group who continued with routine EPI practice. Their catchment communities were surveyed in parallel- reaching 800 caregivers of children aged 5 and below across both groups (401 in intervention, 399 in control); at baseline and end-line, approximately four months apart.

The trust survey, fielded directly with caregivers in both groups, gave the clearest evidence for the project’s central question. Among caregivers contacted by an untrained vaccinator, overall trust declined by roughly 4 percentage points between baseline and endline. In contrast, trust remained steady among those contacted by a trust-trained vaccinator. Statistical modelling estimated that contact with a trained vaccinator was associated with 3.61 percentage point relative gain in trust, an effect driven by the improved health system views. The protective effect was most evident in caregiver’s belief in vaccine promise, where trained contact showed a 5% increase in trust and vaccine delivery and untrained contact faced a 7.4% point decline. In other words, training did not need to manufacture trust from nothing. It needed to stop trust from eroding, and on that measure, it worked.

Alongside quantitative psychosocial scales including the Warwick-Edinburgh Mental Wellbeing Scale and the Rosenberg Self-Esteem Scale, and a Motivational Interviewing knowledge test, the project also incorporated large-scale household surveys, in depth household interviews, challenge mapping using paintings created by participants, and trust vs resistance sessions to surface the emotional and systemic landscape vaccinators navigate through daily. The data showed that the intervention worked most for those who needed it the most. Vaccinators who entered the training carrying the heaviest emotional load, the ones closest to burnout, scoring lowest on wellbeing and self-esteem range showed the most significant recovery. The proportion scoring in the low self-esteem range dropped from 4.5% to 0% whereas, the minimum wellbeing score improved by 68% at post-test1 and 93% at post-test2. For a frontline workforce operating under persistent pressure with very little institutional support, these are not small shifts. They represent something real changing in how these individuals experience their own work.

Vaccinators are being asked to build public trust in a system that, in many ways, has not built trust in them. By naming this contradiction, this process shows where change begins; Mukhtari 2.0 is not an endpoint. It is a foundation that could shape how this work grows because there is a fine line between trust in vaccines and trust in the people who deliver them. It shows that vaccinators don’t just need training but to be genuinely held before they do that for the public.