WCARO CÔTE D’IVOIRE
Increasing outreach strategies for Ivorian children
It takes about nine hours to drive from Abidjan – the commercial capital of Côte d’Ivoire – to the northern city of Korhogo. The city, which is surrounded by sacred forests and mountains, was relatively untouched by the war. However, the crisis seriously disrupted the provision of public health services, particularly in the north and the west, as 85 per cent of the 3,500 health workers left and 80 per cent of the 547 health units were closed after having been plundered or ransacked.
It was a failed coup in 2002 that sparked a civil war which divided Côte 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 the 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, a number of health centres have enough medical staff to at least ensure routine immunization of children less than one year of age against polio, diphtheria, pertussis, tetanus, measles, tuberculosis, yellow fever and hepatitis B. Mothers and infants receive tetanus toxoid injections. Vitamin A and iron/folate supplementation as well as malaria prevention is integrated with immunization.
However, even in Korhogo where health structures are relatively unaffected, UNICEF still has to put in place a system for regularly and efficiently immunizing children. UNICEF supports routine immunization programmes in 38 (out of the 70) districts throughout the entire country.
“UNICEF gave us vehicles and motorbikes which have enabled us to reach populations who live far away. Although many mothers and children are able to reach fixed vaccination centres in towns and large villages, it is imperative to increase outreach strategies bringing vaccines to people,” says Korhogo Health Centre Director Dr. Abel Guede.
Miriam, 5, walked to the public health centre with her mother, 34, and 10 siblings. Her mother is pleased that she can take her children to the health centre. Miriam shows proudly her vaccination book in which appointments are carefully noted.
“They tell us that our children have to be immunized so they don’t get sick. They also teach us how to take care of them, to boil water before drinking, and to keep the food clean,” says Miriam’s mother with a smile, as she is tying one of her children on her back.
The mothers and their children are waiting in line, clearly accustomed to the procedure of receiving injections. Miriam’s mother, who is pregnant again, has received a syringe and is queuing for her fifth shot of tetanus toxoid, which will protect her for life. After she receives the injection, the empty syringe will be dropped into a bright yellow safety box at the nurse’s feet.
“The crisis has interrupted the disease monitoring system and reduced routine EPI (expanded programme on immunization) coverage,” says UNICEF Representative Youssouf Oomar. “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.”
Since 2004, UNICEF has pre-positioned essential drugs, medical supplies and insecticide-treated mosquito nets to cover 32 conflict-affected health districts and has rehabilitated most maternities and health centres. This has helped revitalize more than 89 per cent of health structures in the targeted areas (North, West, Centre, South-West) and give 66 per cent of the population access to a fully operational health centre within 5 km or less than one hour walking distance.
Miriam’s family is pleased. They only have to walk about 1 km to reach the health facility. “I know that immunizing my children will keep them healthy and that is why I am here.” Miriam and her 10 – almost 11 very soon – siblings are fortunate to have a responsible mother. They are ensured of the best start in life.
© UNICEF Côte d’Ivoire/2006