Immunisation: Communities get control over their children health
by Ruth Ayisi Cocamissava, Gaza province - Angelina Machava is still in mourning; she knows what it means not to have enough money for the health care of her children. Machava, a single parent of four children, lives in the remote village of Cocamissava, in the southern province of Gaza, over 10 kilometres away from the nearest rural health centre and a safe water source. Public transport is infrequent and even when it is available, Machava does not have any money. She has no plot of land of her own. She works on a neighbour’s machamba (plot) who only gives her and her family food at the end of the month. Machava has also regularly walked the long distance to the health centre when her children were sick or needed to be vaccinated. She managed to ensure that all her children have been fully vaccinated. Even during the 16-year civil war, which ended in 1992, Machava remembers how she made sure that her eldest daughter, her only child at that time, was vaccinated at the right intervals. “Then, transport was not possible at all. It wasn’t a question of money, but because of the regular ambushes it was too dangerous. I was living in the bush, so we would have to walk quietly through to get our children to the nearest safe health centre.” The only time when Machava did not manage to make the journey to the health centre, it ended tragically. That was just one year ago. “I didn’t have money, so I looked after my daughter at home.” The three-year-old girl was suffering from diarrhoea and breathing difficulties. Without any medical care, she finally died. Machava is still in mourning, wearing a black headscarf. Outside the small one-room rural first aid post, staff from the district health centre are setting up a variety of services. The midwife has just finished giving a talk to a crowd of mothers under a tree about childcare, nutrition, prevention of cholera, sexually transmitted diseases (STDs) and HIV/AIDS. The nurse has now moved to the verandah of the first aid post – where she has hung weighing scales. A nurse has set up a table on the other side of the verandah for medical consultations. The mothers, with their babies and yellow health cards, are patiently queuing up under the hot sun. Inside the first aid post, pregnant women are examined on a makeshift bed – it is actually the stretcher part of an ambulance–bicycle, which is used to carry women in labour to the health facility. Just about 10 metres away school children are lining up under a tree to receive a tetanus vaccine from a health worker. They watch with frightened faces as the mothers are first taking their babies for routine vaccinations. Alberto Mabote, the head of the provincial Expanded Programme of Immunisation (EPI), explains, “With the ’Monthly Village Health Days’ (as they are known) – the health centre staff are planning with communities in remote areas how best to offer a quality health service, which is both preventive and curative and fully in line with the needs of the community.” “In the past, we might come and nobody is around because they are farming. But now the community meets with its leaders beforehand and decides on the date and time, and it is the community that decides the services it needs.” Supporting the Government’s efforts to improve early child health care is a UNICEF priority in Mozambique, says Bertrand Jacquet, UNICEF officer for EPI. “Community participation is key to the success of it. Although since the end of the war vaccination rates have increased gradually over the years in the rural areas, a significant number of children are still missing out.” Official figure show that in 1997 only 36 per cent of the children in the rural areas were fully immunized compared to 56 per cent in 2003. Mozambique has still one of the world’s highest mortality rates for children with almost one in every five dying before their fifth birthday. Rosa Mubango, a community worker based in the village, helped mobilise the community. She explains that the community met to decide the date and time. They chose 9am, so that they could farm first. “It wasn’t difficult. They were keen to come to the health day.” In the morning, Mubango just went around the community blowing a whistle to remind everyone, but she says most mothers were prepared already. Mubango proudly calls over her only surviving daughter, now gown up, who has brought her own baby to be vaccinated. Mubango says, “I know this is very important. I lost my three other children to illnesses. We didn’t have such health days when my children were young.” Angelina Machava is also looking satisfied. She has just had Ceasaro weighed and has been given tablets to treat his malaria. When asked what she liked about the day, Machava says apart from receiving treatment for Ceasaro, “I’ve learnt new things today. One thing I am surprised about is that the nurse told us that if you are HIV positive you can be helped to prevent passing the virus to your baby. I will tell my friends about this, and that we should get tested.”
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