We welcome commitments made at yesterday’s Global Vaccine Summit to immunise the hardest-to-reach children. But what’s needed now to make this a reality?
In this post Mohamed Yussuf, who manages of our programme in Ethiopia’s Somali region to strengthen routine immunisation, describes how his team is reaching children and mothers in remote communities with life-saving vaccines and other essential healthcare.
Vaccine-aware: Zahra’s story
Awareness of the benefits of vaccination has traditionally been low in Harawa district in Ethiopia’s Somali region.
But now that has started to change.
Zahra belongs to a pastoralist community in the Somali region. Dependent on their livestock for their livelihood, families like hers traditionally move from place to place in search of water and pasture for their animals.
The community has limited access to education and health services. The nearest health post is far away and is dogged by service interruptions due to stock-outs of drugs and vaccines and a high turnover of service providers. And it does not provide birth services; Zahra gave birth at home, assisted by the traditional birth attendant from the village.
When her first child was born, Zahra didn’t even think of getting him vaccinated.
But change is happening. When Zahra was pregnant with her second child, a health extension worker in her village, who was trained by Save the Children, came to her house and taught her about the dangers of vaccine-preventable diseases and the benefits of getting her children immunised.
She also learned about the importance of health checks during pregnancy. Zahra visited the nearest health post for antenatal care and was given a tetanus vaccination.
And she has made sure that her newborn son, Mucaad, has been given his full schedule of vaccinations right from the second day of his life.
“Without Save the Children I wouldn't have known about diseases like measles, polio and pneumonia, and my health post would have continued not stocking the vaccines my baby needed,” says Zahra. “Now I can inform other mothers in my community to vaccinate their babies – and I can show them how healthy Mucaad is and tell them that there is nothing bad with vaccinations.”
Challenges to routine immunisation in the Somali Region
Routine immunisation protects children from serious illnesses, like measles and pneumonia. But in Ethiopia there are stark inequalities in access, with children in remote areas at risk of missing out and falling ill as a result.
The Somali Region has some of the lowest immunisation coverage in the country. According to the mini-Demographic and Health Survey 2019, pentavalent vaccine coverage is 72% on average nationally but in the Somali Region just 26%. And for the pneumococcal vaccine, while national coverage averages 67%, again it is much lower in the Somali Region – just 23%.
It’s not hard to understand what underlies this huge gap. The region suffers from poor infrastructure and a weak health system. An additional challenge is that, while many people here are nomadic pastoralists, like Zahra, government health systems are not set up to respond to their particular needs.
Many pastoralist communities have settled over time, but the weak health infrastructure in pastoralist regions of Ethiopia means they still struggle to access health facilities. Chronic supply issues and poor-quality services are a huge challenge. Many health facilities don’t provide vaccination due to a lack of refrigerators, a lack of trained service providers, interruptions in vaccine supplies and a lack of electricity. Demand for vaccination is low due to a lack of understanding – or misunderstanding – of the benefits of vaccination.
How we’re strengthening immunisation services
Since 2017, Save the Children has been implementing the GSK-funded Immunization Strengthening Project in eight woredas – or districts – of the Somali Region. Target woredas were chosen because they all have low vaccination coverage – and high numbers of unvaccinated children.
To address challenges in the supply of immunisation, our project has:
- provided more than 20 vaccine refrigerators to kickstart vaccination services in health facilities without a cold chain
- established outreach vaccination sites to bring the service closer to the community who live far from the health facility
- provided enhanced routine vaccination services for communities residing in hard to reach areas
- supported transportation of vaccines from the woreda health office to every health facility in the implementation woredas.
Alongside these steps to improve the supply of vaccines, we have looked to raise the demand for vaccination in the community. We have trained religious leaders, schoolteachers, students and health extension workers, and with their help, engaged communities’ awareness of the importance of vaccination. Health extension workers have been particularly critical in informing mothers like Zahra about the dangers of vaccine-preventable diseases.
The project has also been building the capacity of service-providers to improve the quality of vaccination services, by providing skill-based trainings and supportive supervision.
Taken together, our interventions have contributed to vaccination coverage going up by over 10% in all the woredas where we work.
Sustaining project gains
We are also working with regional and woreda-level government officials and experts during project planning, implementation and monitoring to ensure government ownership and to sustain the gains from the project. The Pastoralist Health Extension Program, which is the main vehicle for delivering immunisation programmes in Somali Region, is severely under-resourced. We will continue to advocate for increased allocation of resources.
The global challenge
The momentum of the Global Vaccine Summit on 4 June 2020, with donors committing to a fully funded Gavi for the next 5 years, must now accelerate action. There should be a renewed focus on equity and on closing the gap in vaccination coverage, so that children like Mucaad, living in the hardest-to-reach areas of the world, have access to life-saving vaccines delivered through strong primary health care systems.
Life-saving vaccines