This article, in which reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunisation in Africa, focuses on the issue of wastage of Covid vaccines and the likelihood of Malawi harbouring false vaccine wastage fears due to lapses in data processing time. RICHARD CHIROMBO writes.
Nsanje District Health centres are like improvised structures; they have no specialists and none is located within five kilometres (km) of the other, as stipulated by the World Health Organisation (WHO).
Worse still, none is located within eight kilometres (km) of the other, despite the country’s health policies providing for a distance of eight km.
“It is difficult for us to access healthcare services because health centres are located far away from where we stay. In my case, I last went to Nkolimbo Health Centre three-and-a-half years ago, when I was admitted to the facility when I had a bout of malaria,” says 62-year-old Linda Sauzande Nyachithambo.
Surprisingly, she is one of the people vaccinated for Covid in Senior Chief (SC) Malemia’s area.
SC Malemia himself was vaccinated for Covid in 2021, becoming one of the traditional leaders in the Southern Region district, which serves as the border between Malawi and Mozambique, to be vaccinated for Covid.
“Yes, there are misconceptions about Covid vaccines but all of them are baseless. I did not have any health effects when I, and family members, received Covid vaccines. I have been encouraging people to get vaccinated for Covid to avoid cases where they are hospitalised due to Covid related complications,” he indicates.
No wonder, then, that, when a mobile van visited a camp for flood survivors in Nsanje District on February 1 this year, some of them volunteered to get vaccinated for Covid.
Traditional, religious and healthcare service providers have joined hands in mobilising people to get vaccinated in the district, especially after Malawi became one of the countries to incinerate 19,610 doses of Oxford-AstraZeneca vaccine in May 2021.
“We do not want a situation where we destroy Covid vaccines again because, in other parts of the world, people are looking for the same vaccines but they are not always available or, if available, not always in the right quantities,” he says.
Malawi has been putting extra efforts in ensuring that no Covid vaccine incineration activity happens again.
Just in November last year, when it became clear that about 20,000 doses would be destroyed as the expiry date was due on December 31, the government invested extra resources in public sensitisation campaigns, resources that would have been used for sealing gaps in cold chain system that ensures that vaccines do not go bad in storage facilities.
According to Head of Malawi’s Expanded Programme on Immunisation Mike Chisema, when it became apparent that vaccine hesitancy would culminate in vaccine wastage, they engaged an extra gear that saw them spending $850,000 [approximately K700 million] to ensure that all the remaining vaccines were utilised.
However, when The Daily Times visited health facilities such as Kalemba, Chipwembwe, Kanyimbe, Nkolimbo, Nkhande, Mchacha, Kamphala, Kalemba and Nkhande in Nsanje District, it found that turnout to vaccination centres averaged 20 per day during the three days of the visit, which was far better than in other vaccination centres in Malawi.
However, there would be slight differences between the number of people registered as vaccinated for Covid in hardcopy books and those registered as vaccinated in the data base.
At one health centre, for example, the hardcopy register had 18 names of people who had been vaccinated for Covid but only six names had been processed.
Nsanje District Health Office spokesperson George Motwa said he needed to verify with his seniors to establish what exactly was happening.
In Mchinji District, which serves as the border district with Zambia, the situation was not different; there were some disparities between information at some registration centres and information in the database, which happens when all information has been fed into the central system for the district.
However, Extended Programme on Immunisation Coordinator Davis Sambikeni indicated that immunisation efforts were going on well.
“We have 26 Covid immunisation established centres in the district, we run outreach clinics monthly and we ensure that all the information on Covid is rightly processed. That is how we are able to know that we have over 52,000 vaccinated people,” he says.
In Mzimba District, which is one of Malawi’s biggest districts by land area, one would similarly expect some time before all information pertaining to Covid-vaccinated people is collated.
This is because, like in Nsanje and Mchinji, there are, on average, at least four people assisting an individual from the point they stand on the queue, get vaccinated and submit their details— after which the process of sending the information processing starts.
In this case, the number of those vaccinated is always higher than the number of registered people in the system— an anomaly that seems to be a national problem in Malawi.
However, Mzimba DHO spokesperson Sam Chirwa indicates that healthcare officials have made progress in vaccinating people for Covid-19.
“Basically, we have been using a number of strategies and these include: Static clinics (health facilities), outreach clinics (integrating with routine childhood immunisations), door-to-door vaccinations in the villages as well as in urban locations. As of late, we embarked on ‘Express vaccination’ in mobile markets and trading centres to support the existing strategies.
“At one point, all the strategies were working very well, especially, during the second and third waves of the Covid pandemic. However, Express Vaccination proved to be very effective followed by door-to-door vaccination. From the onset of vaccination in March 2021, we targeted to reach out to 39,000 people by December, 2021 taking into account the rate of vaccination per day,” he says.
However, Chirwa says the district health office does not have enough vaccinators. There are 169 vaccinators who are Health Surveillance Assistants against a population of 246,514. Additionally, there are no specific structures for Covidvaccination.
“The vaccination is integrated with other immunisation services offered under Reproductive, Maternal, New-born & Child Health (RMNCH),” he indicates.
This means segregating Covid information can take some time, resulting in some delays in relaying timely information of Covidvaccination.
When, in January this year, a Ministry of Health document indicated that some districts had fared badly in Covid vaccine administration, some district officials cried foul, notably Thyolo District Health Officer Arnold Jumbe.
He indicated that the Covid data system they are using required training for users, something that had not been done at the time.
“We, as a district, have some data that have not been recorded in the system to be translated into percentages. This is happening because the systems are new; so, most of our data managers have not been fully trained in using the facility.
“We are sure if all the raw data that we have were to be recorded, we were not going to be the last on the list. We, as a district, are trying our best to sensitise community members to the issue of vaccination,” Jumbe said.
Ministry of Health spokesperson Adrian Chikumbe says, considering that a number of people are involved in assisting an individual who seeks Covid vaccines, it could be understandable if there were delays in processing information.
“We, as a ministry, will look into the issue and see how best to make Covid vaccination programme a success,” Chikumbe says.
Malawi Health Equity Network Executive Director George Jobe says, going by the statistics, there is a need for the country to speed up data processing time in order to have an accurate picture of progress made in vaccinating people.
Otherwise, time is fast running out for Malawi to meet the World Health Organisation Covid vaccination target of 70 percent of the population by June 2022.
With only four months left to the deadline, only 779,845 Malawians are fully vaccinated for Covid, making the need to register more people even more urgent.
Under such circumstances, there is no time for vain delays, be it in vaccinating people or processing information.