Reaching the Hard-to-Reach: Immunization Activities for Roma Children in Albania
Although immunization coverage is above 95 per cent for children in Albania, reaching that last five per cent remains a challenge – the remote, poor and ethnic minorities comprise those “hardest to reach.” Whether it is because they are not registered, not aware, lack access to appropriate services, or a face combination of constraints, there continue to be small gaps in vaccination coverage. In any case, a recent outbreak of 10 cases of measles among the Roma community demonstrated not only the challenges but the end result of not reaching the “hard to reach.”
As recently as July, 619 Roma children were vaccinated with MMR in two districts of Albania ( Elbasan and Saranda) . Originally part of a government plan to reach marginalized groups, the campaign was accelerated once the 10 cases of measles in a Roma community were identified and confirmed. This has been an area free from measles since January 2002. This reveals that, in spite of a good national average, special attention must be paid to “hard to reach” population groups.
Meetings with Roma community leaders and local authorities were held to inform them of the situation, raise awareness and seek their collaboration to ensure that all eligible Roma children were reached. Meetings were also organized by the IPH (Institute of Public Health) team, along with district epidemiologists and health care workers. Roma leaders and parents raised their concerns about the health of their children and matters of general health. Most decided that one of the best ways to reach out was to turn their own homes into vaccination points, an innovative and generous gesture of community caring. At the same time, door-to-door screening of all eligible children was conducted, which also presented an excellent opportunity to raise awareness among families to the importance of immunization. Vaccination activities lasted for 10 days, during which 13 teams of vaccinators reached 94 per cent of the targeted 657 children between 1 and 14 years of age.
AS noted, the Roma communities in Elbasan and Saranda were very helpful and interested in the health of their children. Furthermore, they responded favourably to general questions about their children’s health and provided key information on their attitudes about services. This information helped to shed light on the need to improve the flexibility and adaptability of health services to the different communities as well as the need to augment immunization activities with additional health activities.
The successful organization of these activities was due to the close collaboration between IPH and local health authorities. UNICEF supported logistics and supervision components, with the Government of Albania absorbing the cost of the remaining expenses for vaccines and related supplies. Future plans are in the works to maintain activities within the “hard to reach” populations, in part based upon an already completed mapping exercise that has helped to further identify and clarify “hard to reach” populations.