Insuring future lives with injections

By Wanangwa Tembo:

Somewhere at Miyowe in Kasungu North West, Wyford Mngulu, a health surveillance assistant (HSA), has a busy day.

He has to attend to a horde of pregnant women accompanied by their husbands that have flooded Miyowe Under- Five Clinic for antenatal services and later turn to lactating mothers with their children clutched at the backs, waiting to have their babies vaccinated.

Modester Mndolo, a Mother Care Group (MCG) chairperson, joins the women. She is on her routine duty of providing health and peer education on the importance of hospital deliveries, risks associated with home deliveries and the importance of vaccination for under-five children.

MCGs are well trained community volunteers who support service delivery, advocate and mobilise resources for healthcare. Each MCG comprises 30 members and a group village head.

Specifically, these groups are responsible for tracing those that default on antenatal and neonatal visits, conducting sensitisation and advocacy meetings on maternal and neonatal healthcare services and registering newly born babies and pregnant women.

“As women care groups, we conduct campaigns to ensure that mothers take their under-five children for immunisation against various diseases as required by health standards.

“Additionally, we do not encourage home deliveries in this area. We have by-laws that punish those that refuse to have their children vaccinated or reject hospital deliveries, so, we mobilise pregnant women to seek antenatal services and that they must deliver in hospitals,” Mndolo says.

Since the 2009 World Health Organisation (WHO)’s ban of traditional birth attendants conducting deliveries, various reproductive health stakeholders led by the Ministry of Health have been conducting campaigns, urging women to deliver in hospitals.

WHO also launched an Expanded Programme on Immunisation (EPI) in 1974 which marked the beginning of global efforts to use immunisation as a public health intervention.

Likewise, as a way of domesticating the efforts, stakeholders in the health sector, including the Ministry of Health, are leading campaigns calling for mass immunisation of children.

Under the EPI, six vaccines were then recommended for children under two years and these included diphtheria, whooping cough, tetanus, measles, poliomyelitis and tuberculosis.

Mndolo says MCGs like hers at Miyowe understand that immunisation is an effective tool for controlling and eradicating life-threatening infectious diseases, hence their efforts to mobilise households to have their under-five children inoculated.

“Vaccines reduce and eliminate many diseases that would otherwise kill or severely disable people as was the case with previous generations. A good example is Smallpox which completely got eliminated because of vaccines.

“With vaccination, there is a guarantee that some of these diseases that wreak havoc today will not be there to harm our children,” she says.

According to Mndolo, their group was hatched following a training they underwent with support from the Malawi Health Equity Network (Mhen) in 2018.

Healthcare campaigner Mhen is implementing a Health Systems and Immunisation Strengthening (HSIS) project to contribute towards the achievement of Malawi health targets for Sustainable Development Goals of ending preventable deaths of new-borns and children that are under five years of age by 2030.

The HSIS project, funded by the International Vaccine Alliance (Gavi) through the Ministry of Health, also aims at achieving participatory health governance to ensure that barriers to equitable and quality immunisation are reduced, enabling women, children and communities to access quality immunisation services and healthcare and improved quality and uptake of immunisation services.

According to Mhen Monitoring and Evaluation Officer, Florence Khonyongwa, the project seeks to contribute to strengthening the capacity of integrated health systems to deliver immunisation by resolving health constraints; increasing the level of equity in access to services and strengthening civil society engagement in the health sector.

“We want to improve access, quality and utilisation of Essential Health Package (EHP) services, including immunisation, with focus on populations systematically missed due to geographical, socio-economic and cultural barriers,” Khonyongwa says.

“Mhen together with EPI under the Ministry of Health established and trained MCGs in hard-to-reach areas and urban slums of the nine districts where we are implementing this project.

“The nine districts were identified as having low immunisation coverage and the MCGs were established to accelerate immunisation uptake,” she adds.

Apart from Kasungu, the project is also being implemented in Blantyre, Lilongwe, Mchinji, Dowa, Ntchisi, Kasungu, Mzimba South, Mzimba North and Chitipa.

Khonyongwa says MCGs have been established in hard-to-reach areas characterised by geographical barriers; inaccessible road networks and bridges; isolated and scattered settlements; communities with economic activities hindering people’s access to healthcare services and religious beliefs prohibiting its members to access immunisation services among others.

“In Lilongwe, Blantyre, Mzuzu and Kasungu, the MCGs have also been established in urban slums with low immunisation coverage.

“Currently, we have a total of 196 MCGs and we are happy with what these women are doing, and it is not surprising that the demand for vaccines is high,” she says.

The current Malawian Expanded Programme on Immunisation prescribes basic vaccination to include whooping cough, tetanus, measles, poliomyelitis rotavirus and Pneumococcal Vaccine among others.

Other vaccines that are administered to children include those against chicken pox, diphtheria, influenza, measles, hepatitis and malaria.

Malawi is one of the poor countries with high infant and mortality rates owing to factors such as low education for women, inadequate antenatal visits, poverty, households having large numbers of children and general lack of vaccines.

With increased immunisation coverage largely through the efforts of MCGs, infant mortality rate has however plummeted to 32.57 deaths per 1000 live births down from 37.8 in 2020.