As the adage says prevention is better than cur, people in Kasonga, a community sandwiched by the vast Zomba Mountain range in Traditional Authority Malemia are determined to have all their children immunised from vaccine preventable diseases.
Hilda Makumba is the Chairperson of Kasonga Mother Care Group (MCG), which was formed in October, 2015 to monitor and advocate better immunisation services in the community, an initiative orchestrated by Malawi Health Equity Network (Mhen) through its immunisation civil society platform.
“The mother care group we have established here at Kasonga has improved childhood health, with 755 under-five children immunised. At first, some women did not understand the importance of having their children immunised. I can tell you now that no woman would refuse to have her child immunized,” she says.
However, Kasonga has a poor road network, rugged mountainous terrain and no mobile phone network due to the huge mountain range surrounding it. Despite the geographical challenges, the community is unfazed and decided to write a letter to the Ministry of Health’s Expanded Programme on Immunisation (EPI) copied to Zomba District Health Office lobbying government to improve services.
“It was in April, 2016, we wrote a letter to government requesting a refridgerator to keep vaccines in a cool environment and a new motorcycle. We have no motorcycle for the health surveillance sssistants, just imagine a year has now elapsed since Zomba District Health Office recalled an old broken down motorcycle to have it repaired but it has not returned despite several reminders,” Makumba laments.
The Kasonga MCG, which has now morphed into three groups of Tigwirizane, Tiyanjane and Tikondane, has a 34 members mainly consisting of 30 women who are tracing defaulters – those who have not immunised their children.
Mhen is upbeat that every child will be immunised in the community as this is a right to health. Global Alliance for Vaccines (Gavi) 2011-2020 Action Plan notes that in some countries, coverage of measles-containing vaccine in rural areas is 33 percent lower than in urban areas.
In addition, the measles vaccine coverage rate for the richest fifth of the population in some countries is up to 58 percent higher than for the poorest fifth.
“Coverage can also be very low in settlements of the urban poor, especially in cities with transitory migrant populations, and in indigenous communities. Geographical distance from health centres is not the only determinant of low coverage; inequities are also associated with other socioeconomic determinants such as income levels and the educational status of the mother,” reads in part of the plan.
Flora Tewesa is a member of Kasonga MCG and supports the idea of the letter, saying that lack of a fridge to store vaccines cooler has a negative impact as vaccines get wasted, thereby missing children to get immunised.
“We need the refrigerator urgently so that vaccines are kept in a good condition, how can our children get immunised when vaccines go bad due to high temperatures?” she wonders.
Some of the MCG members were hoping that government could sort the problem urgently while others blamed the Zomba District Health Office for lack of commitment to improve immunisation in the community. Kasonga is currently served by three health surveillance assistants (HSAs) who have to travel long distances to facilitate outreach sessions and administer vaccines at Kasonga and arrive very tired due to lack of a motorcycle.
It is not by coincidence, the programme support rationale (PSR), a comprehensive proposal document for Malawi submitted to Gavi for financing, revealed that Zomba achieved a low coverage of 86 percent in the Human Papilloma Virus (HPV) vaccine trial that saw the district being outmuscled by Rumphi which scored 94 percent in the demonstration. The HPV vaccine was trialled in girls aged nine-13 and is aimed at preventing cervical cancer.
Madalitso Juma is one of the HSAs working at Kasonga and concurs with members of MCGs that lack of transportation and cold storage for vaccines present a huge challenge in the successful delivery of immunisation services.
“I think the letter written by the members was a right thing to do, we face huge challenges to conduct immunisation outreach and immunise children. As you can see, this area has a mountainous terrain and is very hard to reach, at least if we can have a motorcycle and a fridge to keep vaccines and prevent them from perishing, it will greatly help”, he observes.
Juma notes that Kasonga has well-trained HSAs but their work is being hampered by lack of transport and cold storage for vaccines.
“As of now, government is making sure that there is steady supply of vaccines but transportation and cold storage remain a challenge. The mother care groups are doing a great job, I have seen a remarkable improvement in the numbers of children getting immunised, even husbands are encouraging their wives to take their children to get immunized,” he adds.
The PSR notes that immunisation coverage for newly introduced vaccines such as Rota have improved while polio experienced low coverage due to nationwide stockouts. Overall, it notes that due to high immunisation coverage, the burden of major vaccine preventable diseases such as polio, measles, neonatal tetanus, whooping cough and diphtheria have been reduced
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