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Madagascar, 13 June 2011: UNICEF and GAVI work to protect health gains for young children

© UNICEF Madagascar/2011/
An infant is vaccinated at a local clinic. Thanks to UNICEF support, the country has been able to decrease its child mortality rate by 60 percent over the past two decades.

UNICEF’s equity-based approach to achieving the Millennium Development Goals aims to reach the poorest and most vulnerable children and families with cost-effective interventions for sustainable progress. Here is one in a series of stories that make the case for equity.

By Suzanne Beukes and Shantha Bloemen

ANKARIERA, Madagascar, 13 June 2011 – It is late morning at Ankariera health centre. The small three-room clinic – the only facility in a 10 km radius – is ready for a busy day.

UNICEF's Suzanne Beukes reports on a critical vaccination campaign in Madagascar.  Watch in RealPlayer

Mothers with small infants clutch their pink child health cards outside the centre, as they seek shade from the hot sun. Next to the clinic, older women and men gather with different produce they have brought to sell at the adjacent weekly local market.

Standing amid it all is paramedic Hantamalala Ramanandraibe, the health centre’s sole health worker. Only in the job a few months, she’s responsible for an estimated 4,600 people.

She does everything from vaccinating adults and children to delivering babies. It is a tough job for this dedicated young woman. She has no running water or electricity at the clinic, and has very limited contact with the nearest referral hospital.

“As it is market day today, everyone comes to the clinic,” says Ms. Ramandandraibe calmly. “So today I am going to do consultations and family planning vaccinations all at the same time."

Safeguarding child survival

Over the last two decades, Madagascar has been one of a handful of countries to reduce its child mortality rate by 60 percent. The mortality rate for children under the age of five has fallen from 167 deaths per 1000 live births in 1990 to 58 per 1000 live births in 2009. This has been achieved in part by the successful implementation of the country’s national immunization programme.

© UNICEF Madagascar/2011/
Hantamalala Ramanandraibe, a paramedic at a health centre in Anakariera, southern Madagascar. She is the only health worker at the clinic, which serves 4,600 people.

Yet many of these gains are under threat and recent data indicates a downward trend. Political crisis has resulted in a government which is not internationally recognized and a subsequent drop in development assistance.

Prior to the crisis, around 70 percent of Madagascar’s budget was financed through development aid. Government spending on healthcare reached a 10 year low last year of just $2 per person. “If we don't manage to sustain the rate of coverage, we're in danger of seeing the childhood mortality rate go up again,” says Marie Therese Baranyikwa, UNICEF Madagascar Immunization Specialist.

Equity-based efforts

UNICEF, Global Alliance for Vaccines and Immunization (GAVI) and the World Health Organization are working to keep the national immunization programme operational and give every child the protection he or she needs from deadly yet preventable diseases such as tetanus and hepatitis B.

This is particularly important for the poorest and most vulnerable children, as UNICEF makes a concerted effort to reach marginalized and disadvantaged communities in order to achieve the Millennium Development Goals with equity.

GAVI – a global health partnership funded by governments, foundations, the private sector and other agencies – finances new, affordable vaccines for the world’s poorest countries. “The reality is it is the poorest countries which need the most help, yet are often the most challenging as they have the weakest health systems and limited funding to afford new vaccines,” says GAVI Media Manager Ed Harris. “Yet immunization is one of the most straightforward and successful ways to save a child’s life and reduce child mortality.”

In Madagascar, GAVI funding is promoting safe injections and introducing new vaccines such as the Pentavalent vaccine, which prevents five childhood killers – including tetanus and diphtheria – in one jab. With additional funding, a new vaccine against pneumococcal disease will be introduced next year.

Vaccines to remote areas

At the central vaccine warehouse in the capital city of Antananarivo, a dedicated team manages the country’s national distribution. Marius Rakotomomga, Head of Vaccination at the Madagascar Health Department, is grateful for the new two cold rooms provided by UNICEF that keep their central stock of vaccines safe and at the right temperature.

But he worries about other logistical challenges they face in getting vaccines to the country’s 700,000 children under the age of one. “We do not have sufficient resources,” he says. “We also only have one truck and have to rely on commercial flights to move the vaccines around the country.”

Funding from partners like UNICEF and GAVI has been critical in keeping the health system going and ensuring vaccines reach the remote health centres, like Ms. Ramandandraibe’s clinic in Ankariera.

Shortage of funds means the capacity of health workers has also been stretched, leaving many health posts and clinics without staff. To help mitigate this, UNICEF and GAVI help support routine vaccination campaigns and bi-annual mother and child health weeks, where thousands of health workers go door to door to supplement vaccines offered weekly at health clinics.

Critical investment

UNICEF has doubled expenditure on immunization to cover the gap in national funding, arguing there is no choice but to ensure the system does not collapse. “The consequences of an epidemic are very grave and complications for Malagasy children are severe,” explains Ms. Baranyikwa. “They are already vulnerable and poorly nourished.”

This critical investment in vaccines is helping ensure that Madagascar’s children are protected. Back at Ms. Ramandandraibe’s clinic, another young mother brings her baby in for vaccination. There is no doubt that this small life-saving intervention today will ensure a healthier life tomorrow.



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