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Saving lives by providing vaccines in remote areas of Bangladesh

© UNICEF/2009/Saikat
Health Assistant Mr Nazrul Islam reviews baby Aisha's immunization history, with her mother Lipa, in Rehai-tara-pur.

by Sophie McNamara

MYMENSINGH, December 2009: Almost 40 years ago, Ansar Ali was a freedom fighter in Bangladesh’s liberation war. Today he is fighting for another cause that is crucial to his country’s future - the health of Bangladeshi children.

Once a month for the past 20 years, Ansar has provided his home in Rehai-tara-pur village, Mymensingh district, for use as an outreach immunization clinic. Women wearing colourful saris stand outside his door waiting for their babies to receive free vaccines against diseases such as measles, diphtheria, polio and hepatitis B.

Health Assistant Mr Nazrul Islam administers the vaccines and provides vitamin A supplements. There are more than 300 similar outreach centres in this sub-district alone. Poor transportation often hinders access to health clinics, so outreach immunization centres are established wherever there is a suitable space, such as in foyers of apartment blocks or urban slum shanties.

Wearing the traditional Muslim topi cap, Ansar’s weathered face breaks into a broad smile as he speaks about assisting the clinic on a voluntary basis. “I use the mosque microphone to let people know that the clinic is on. In the rainy season, when the whole village is surrounded by water, I collect people on my boat.”

Rehai-tara-pur village is considered a ‘hard to reach’ area. It is located on a char (river island) and there are no roads or even pedestrian bridges to the mainland. The closest health centre is about 50km away in Mymensingh city. The journey is difficult and can involve several hours of walking and boat rides. Villagers dream of having a local clinic, particularly when they have to carry people to the clinic at night.

Mymensingh is one of 15 districts that were identified in 2005 as having chronically low immunization rates. The UNICEF-supported ‘Reach Every District’ (RED) programme was launched to improve immunization rates in these districts by overcoming common barriers.

In Mymensingh district, the rate of fully immunised one-year-olds increased from 45% in 2005 to 81% in 2009 and is now the highest of the 15 districts. It recently received a Government award recognising its progress.

© UNICEF/2009/Saikat
Women gather round to listen to a family planning nurse after having their babies immunized

Mr Hilal Uddin, Mymensingh’s District EPI (Expanded Programme on Immunization) Superintendent, says before the RED programme began, there were problems with monitoring and staffing. The district is also home to many hard-to-reach areas, so transportation of vaccines, which need to remain refrigerated, was a challenge.

“Previously, one of the reasons for the high drop-out rate was because sometimes the vaccines just didn’t turn up, so people were discouraged from returning next time.”
Maintaining this cold chain is challenging, particularly given Bangladesh’s intermittent electricity. UNICEF assists by procuring cold chain equipment such as fridges, cold boxes and generators, and builds the capacity of staff to maintain the cold chain.

Mr Hilal says the introduction of auto-disable syringes, which can only be used once, was crucial in improving immunization rates. “Before the RED programme, we used to sterilise the syringes and reuse them. There were more side effects, such as infections at the injection site. When we switched to auto-disable syringes, the side effects went down and the acceptance of immunization improved. The drop-out rate came down significantly,” he says.

Health Assistant Mr Nazrul Islam is expecting 20 children at Ansar’s house today. The day before each monthly clinic is held Nazrul visits the homes of all women with babies aged under one, to remind them of the clinic. He also makes regular home visits to everyone in his area (about 2800 people) to provide health information. In a region where more than 40% of people are illiterate, this face to face communication is essential. Additionally, given that 85% of births occur in homes, his visit also ensures that no child who is the right age for immunization misses out.

UNICEF-funded pamphlets, posters and banners help spread the word about immunization. “I know that it’s important to get the babies vaccinated so that they don’t get measles. It’s good for their health,” says Lipa, 25, who walked three kilometres to reach the clinic today, carrying her four-month-old baby girl, Aisha.



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