Bringing vaccinations and health services to remote areas
Maganja da Costa, Mozambique – Standing in a queue with hundreds of other women and children, Zaira Xavier and her four children wait expectantly to be vaccinated under the shade of a mango tree.
It is an important day for Xavier, who concedes she has found it difficult ensuring the survival of her eight children in the remote village of Namaruvua, over 200 kilometres from Quelimane, the capital of the central province of Zambezia.
This time she has not had to trek on foot for hours for healthcare because a mobile unit has brought a range of health services to her community, including vaccinations, vitamin A, weighing and de-worming for children under five years.
A nurse and a pharmacist are available with drugs to treat a range of easily identifiable illnesses. The nurse weighs the children outside, near the tree where the vaccinations take place. She puts the babies one by one in a weighing scale attached to a branch.
Nearby, health activists put on a play about the importance of family planning. The audience is mostly women who laugh and clap as they see how one of the woman actors is devastated to discover she is pregnant yet again.
Many of the women, who have on average six children each, can identify with her sentiments, including Xavier. “My body is so tired,” she says. “I got married just after my first menstruation and since then I have given birth almost every year. My eldest boy is 16 years old.”
Xavier has come with four of her eight children for vaccinations and health checks. But she has forgotten all of their health cards at home. Xavier illustrates many of the challenges facing Mozambique, which has one of the highest under-five mortality rates in the world. Some 152 children out of every 1,000 do not survive to celebrate their fifth birthday.
UNICEF supports the targets set by the Ministry of Health to at least achieve 80 per cent routine vaccination among infants and eliminate neonatal tetanus.
Although much has been achieved since the launch of Mozambique’s Expanded Programme of Immunization (EPI) in 1979, there are still significant numbers of children and women who do not benefit from life saving vaccinations and even basic health care. Over half of the country’s 20 million people still do not have access to health care. Many of those, like Xavier, live in isolated rural areas.
The Government of Mozambique and its partners have therefore worked on a new plan for immunization, called the Global Immunization Vision and Strategies (GIVS) for 2006-2015.
The goal is not only to reach more people, but also to introduce new technologies and newly available lifesaving vaccines, such as the Haemophilus Influencae vaccines (HIB) among under five-year-olds as well as to integrate vaccinations with other health services.
UNICEF EPI Officer Bertrand Jacquet explains that UNICEF support will focus on a new government approach called RED (Reach Every District), especially in remote communities like that of Xavier.
Besides offering vaccinations and other health services in fixed posts, health authorities will carry out more outreach services with health mobile units. The units carry with them special cold boxes which keep the vaccines at the right temperature for 24 hours because most of these isolated areas have no electricity.
Jacquet says that the staff of the mobile units must plan ahead with the community to decide which day and time to come. “It must be the community who decides when it is the best for the health team to visit.”
Training of health staff is also a major challenge. “We need more quality health care and an improvement in data monitoring and evaluation so that the data can be used as a basis for action,” says Jacquet.
The other major challenge explains the Head of the vaccination programme in Zambezia Jose Pondeca is the lack of education among the mothers themselves. “Most of the mothers now know it is important to vaccinate their children, but some of them still do not understand that they must keep the right calendar for vaccinations.”