Reaching every child with life-saving vaccinations

19 April 2023, Kratie – Mother-of-two Chin Nida knows that routine vaccinations are one of the most important ways to protect her children in their first years of life. Her eight-month-old son has been vaccinated a few times, yet she says it’s not always been easy to meet the appointments set by the health centre. 

“I take my son to get vaccinations because I think it’s important to prevent my child from getting polio, tuberculosis, meningitis, and other deadly diseases,” she says. “But it’s always been a challenge to take him to the health centre because it’s about nine kilometres from my house and I have no transportation.”

Vaccines are considered one of the best and safest ways to protect children against life-threatening diseases and in Cambodia have helped contribute to a significant reduction in infant and under-five mortality rates over the past two decades. Today, over 90 per cent of children are reached with life-saving vaccinations. However, inequity is still high in some areas, and 8 per cent of children have not received any immunizations at all, many coming from remote areas, ethnic minorities, and urban poor and migrant communities.

Chin Nida lives in rural Kratie, where many mothers still face challenges accessing the essential services offered by local health centres, including the pre- and post-natal services they depend on to ensure the best start for both mother and baby. In the mountainous northeastern provinces, poor road conditions, lack of transportation and long distances to the nearest health centre prevent many pregnant women and young mothers from getting regular checkups as recommended by health workers or may miss appointments scheduled for themselves or their children.

Nida says that outreach volunteers who form part of the Village Health Support Group (VHSG) visit her at her home to reinforce the importance of keeping the appointments and inform her of the outreach events that health workers organise to bring their services closer to the community.

“When I missed the schedule, a VHSG volunteer reminded me to take my child to get vaccinated,” she says. “I will take my child to get vaccinated in the next round when the health worker and volunteer bring the vaccine to my village.”

Som Mala, director of Kantout Health Centre where Chan Nida receives her care, says that the number of patients seeking regular pre- and post-natal care at the health centre has improved in recent years in large part to the efforts VHSG members, who act as the link between the community and essential health services. 

“It’s changed a lot through the decades,” he says. “Before, many mothers gave birth at home. Now, almost every mother in the village delivers at the health centre. I think the reasons for this change are the training and knowledge provided to the parents, the capacity building for the health workers and volunteers, and outreach health services provided to the villages and hard-to-reach areas.” 

He says that because of the distances that villagers need to travel to reach the health centre, the VHSGs, of which there are around 30 under the coverage of Kantout Health Centre, play an important role in raising awareness of the importance of routine vaccinations and good nutrition, delivering reports back to the health workers as well as referring pregnant women to give birth at the health centre. Many may also receive their first vaccine dose but do not complete the full course because parents worry about the side effects, so health workers and VHSGs work together to make sure that caregivers understand that children need all doses to be fully protected. Kantout Health Centre serves around 8,000 people across 23 villages, including around 200 children under one year old.

“Long distances pose the top challenge for us when it comes to educating and consulting with pregnant women,” he says. “On top of that is when they drop out after the first or second of their children’s jabs. Because they sometimes get a fever after the first jab, the mother thinks the vaccine makes their children sick. What we do is try to educate them every time they come to the health centre so they make more of an effort to come for a pregnancy check-up and get their children vaccinated.”

In Kratie, the combined efforts of health workers and outreach volunteers to identify and reach every child with life-saving vaccinations have helped reduce the zero-dose burden, the percentage of unvaccinated dropping from 10 per cent in 2014 to 3 per cent in 2021. In even harder to reach provinces like the mountainous Ratanakiri, however, more than half of children are still missing out. Zero dose children are considered those who have not received a single dose of the diphtheria-tetanus-pertussis (DTP) containing vaccine, which is usually scheduled at six weeks of age.

Chen Yong, VHSG member and Deputy Chief of Chetr Borei district, has been a volunteer for over twenty years. She says much of her work depends on building trust with the community, as when she first started out many were sceptical or unwilling to attend the events, trainings and meetings organised with local groups like the Commune Committee for Women and Children (CCWC) alongside health workers to support women throughout their pregnancy and through their newborn’s early years. 

“During the monthly women’s support meetings, we work to strategically raise awareness of vaccinations and figure out how to deal with challenges like transportation or other difficulties,” she says. She sometimes offers to take villagers to the health centre herself to make sure they don’t miss their appointments. “In the village, I know everyone and everyone knows me, so we look out for each other. Now they have better knowledge about taking good care of their kid’s health and well-being.”

UNICEF works closely with the Ministry of Health to ensure that life-saving routine vaccinations are accessible to all children under two years old. UNICEF supports the National Immunisation Programme by procuring vaccines and cold chain equipment, strengthening cold chain and vaccine management systems, and building capacity of health workers. The programme focuses on reaching hard-to-reach populations, including those living in remote areas, urban poor and migrant communities as well as ethnic minorities, by strengthening community engagement with the VHSG network in order to raise awareness and educate communities about the importance of vaccinations.

During the pandemic, additional support for outreach volunteers and health workers kept children protected in even the most remote and difficult-to-access areas and helped keep vaccination rates high. Today, UNICEF continues to support efforts to help children catch up on any immunizations they may have missed and to identify and reach children who have not received any vaccines at all. Healthcare workers are also trained to support pregnant women and young mothers with nutrition and breastfeeding counselling, among other pre- and post-natal services.

“Routine vaccinations save children's lives,” emphasises Dr. Raveesha R. Mugali, UNICEF Immunization Specialist. “In Cambodia, the number of people seeking essential vaccination services for their children remains high, and vaccine confidence is strong. This achievement is the result of the efforts and progress made by the Ministry of Health and its partners in expanding national immunization coverage. However, there are still a few missed communities, including the urban poor, migrant groups, ethnic minorities and those living in very remote rural areas. UNICEF is committed to working with the national authorities to ensure equal access to vaccines for all, regardless of geography, ethnicity, or socio-economic status, so that no child dies from a preventable disease.”

It’s a joint effort to identify and reach every last child, says Som Mala, and to make sure mothers like Chin Nida not only know that vaccines are the best and safest way to protect against diseases such as measles, diptheria and typhoid – but, most importantly, that they are actually able to access those vaccines for their young children.

“I’ve really appreciated health workers, volunteers, and the villagers themselves, who have been working together to spread knowledge in the village,” he says.