Immunisation
Coverage improving but still low The national Expanded Programme of Immunisation has made good progress in recent years. Immunisation services have been expanded, the capacity of health workers has been improved and there has been a major increase in the availability of vaccines and equipment. As a result, the proportion of one-year old children immunised against the six main vaccine-preventable diseases – polio, measles, tuberculosis, diphtheria, pertussis and tetanus – has increased from 47 per cent in 1997 to 63 per cent in 2003. Overall immunisation coverage, however, remains low and is unequal, with 81 per cent of children immunised against all six diseases in towns and cities compared to 56 per cent in rural areas. Disparities also exist between households, with 45 per cent of children from the poorest households immunised compared to 90 per cent of children from better-off households. Out of the six main vaccine-preventable illnesses, measles poses a particular threat. Measles attacks children’s immune systems and exposes them to a host of diseases. A large measles epidemic affected 45,000 children in 2002/2004. The Ministry of Health carried out the country’s largest ever nationwide vaccination campaign in 2005, which also included polio vaccination. Coverage rates for both measles and polio were increased to 95 per cent.
Reaching the vulnerable The Ministry of Health, supported by UNICEF and other partners, strives to prevent and control the outbreak of vaccine-preventable epidemics. Vulnerable children living in remote areas with low immunisation coverage rates are the main focus of interventions. UNICEF’s involvement revolves around helping the Government strengthen routine immunisation services as well as mass vaccination campaigns. This is achieved through government capacity building for improved service delivery, provision of technical expertise and financial support for polio eradication, measles control and neonatal tetanus elimination and support for funding applications for the Global Alliance for Vaccines and Immunisation (GAVI). GAVI is a global alliance dedicated to providing all children with access to vaccines. At the central level, UNICEF supports the Ministry of Health in the management of the national EPI programme as well as in the development of policy guidelines and national implementation plans. Provincial and district health authorities and health centre staff receive training in financial and programme management of EPI activities at local level. The cold chain system is supported with training of technicians and supplies such as refrigerators and cold boxes. Monthly Health Days – where mobile health teams conduct outreach activities – are supported to reach vulnerable children who do not have access to health clinics. De-worming is integrated into Monthly Health Days to prevent children aged 12–59 month from becoming anaemic as a result of intestinal worm infestation. UNICEF and other partners also support the Ministry of Health to implement the Reach Every District Approach (RED), a major strategy for improving routine immunisation in hard-to-reach and under-served areas. RED also provides an entry point for other health interventions, such as nutrition or malaria prevention.
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