Routine immunisation
By Alexandra Westerbeek KORHOGO, Côte d’Ivoire, 1 August 2006 – It takes about nine hours to drive from Abidjan – the commercial capital of Cote d’Ivoire – to the Northern city of Korhogo. Compared to the rest of Cote d’Ivoire, Korhogo seems to be almost as dry and dusty as it border countries Mali and Burkina-Faso. The city, which is surrounded by sacred forests and mountains, was relatively untouched by the war. However the provision of public health services has been seriously disrupted due to the crisis, particularly in the North and West of the country. 80 % of the 547 health units in these zones were closed after having been plundered or ransacked. The vast majority (85%) of the 3500 health workers based in these areas had left. It was a failed coup in 2002 that sparked a civil war which divided Cote d’Ivoire into a Government controlled south and a New Forces held north. Since the beginning of the conflict, public services such as schools and health centres stopped receiving support from Government. Humanitarian agencies like UNICEF had to step in to continue providing support to the population in desperate need of basic services. Constraints however continue to exist, specifically due to an insufficient return of qualified personnel. Nonetheless, certain health centres in large villages and in the town centre have sufficient medical staff to at least continue giving routine vaccinations throughout the period of fighting in the country. All the routine vaccinations which include polio, measles, yellow fever, tuberculosis, diphtheria, pertussis and hepatitis B are given freely to children under one year of age. Mothers, as well as infants, are given vaccinations against tetanus. The vaccination services are integrated with vitamin A supplementation, malaria prevention and iron folate. However, even here where health structures are relatively unaffected, UNICEF still has to put in place a system for regularly and efficiently giving routine vaccinations to children. Not only vaccines, but also fridges for storing them (also known as “cold chain”), syringes and safety boxes for used needles had to be given to primary health centres in sufficient quantities. UNICEF provides support to routine immunisation in 38 (out of the 70) districts throughout the entire country: from north to south and east to west. The Director of Health Centre in Korhogo, Dr. Abel Guede says, “UNICEF gave us vehicles and motorbikes which have enabled us to reach populations who live far away. During the first seven months of this year (2006) we have vaccinated 10130 children against tuberculosis (BCG) and 7799 children against measles.” Although many mothers and children are able to reach fixed vaccination centres in towns and large villages, Dr. Guede says it is imperative to increase outreach strategies bringing vaccines to people. Miriam, a five year old girl has walked with her 34 year old mother and ten siblings to a public health centre. Her mother is pleased that she can take her children to the health centre. Miriam shows proudly her vaccination book for which her mother makes sure that the appointments which are carefully noted. The mothers and children are waiting in line are clearly accustomed to the procedure of receiving injections. Miriam’s mother, who is pregnant again, receives a new syringe and queues for one of the nurses to administer the injection. Today is her fifth vaccine against tetanus, which will protected her for life. After she receives her injection, the empty syringe is dropped into a bright yellow safety box at the nurse’s feet. There is no incinerator at Korhogo, so the boxes are carefully collected and sent to a factory in the town of Ferke to be burnt. Although Korhogo’s routine vaccination system is functioning well, there are still problems. Health workers in small villages are having trouble refrigerating vaccines. Although UNICEF has provided refrigerators which are designed to run on both gas and electricity, doctors say there is a problem with transportation of gas bottles to the villages. Another serious problem lies in the supply vaccines which are brought from the commercial capital Abidjan. From time to time, certain vaccines are in short supply – country wide. Some time ago there was a shortage of the BCG and Tetanus vaccine in Korhogo. Fortunately UNICEF was able to assist the country with this sudden emergency and bought the required vaccines urgently. UNICEF Representative Youssouf Oomar states “The crisis has interrupted the disease monitoring system and reduced routine EPI (Expanded Programme of Immunisation) coverage. Preventable or easily-treatable diseases remain the main killers of Ivorian children and women, with malaria, measles, respiratory infections and malnutrition responsible for the vast majority of deaths. It is extremely worrying that latest statistics not only indicate a rise in maternal and infant mortality rates but also an increase in acute malnutrition among children, especially those aged under five. It can not go un-noticed that Miriam looks slightly jealous at her nine month old baby sister who received a free insecticide treated mosquito net, after she got her full set of immunisation. “I hope I can also use the bednet as we have many mosquitoes in our house”. The overburdened mother smiles and assures her that it can be shared by many. Since 2004, UNICEF has pre-positioned essential drugs, medical supplies and Insecticide-Treated Nets to cover 32 conflict-affected health districts and has rehabilitated most health districts, maternities, and health centres. This has facilitated the revitalisation of more than 89% of health structures in the targeted areas (North, West, Centre, South-West). 66% of the population now has access to a fully operational health centre within 5 km or at less than one hour walking distance. Miriam’s family is pleased. They only have to walk about one kilometre to come to the health facility. “I know that giving vaccines to my children will keep them healthy and that is why I am here”. Miriam and her ten – almost eleven very soon – siblings can be fortunate with a responsible mother like hers: They are ensured of the best start in life.
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