Braving the Seas in South Sulawesi to Immunize Every Child

As the sun rises over the horizon and large waves crash against a small blue boat, Abdul Razak, known as Aca, carefully checks the box he is carrying once more to ensure none of the life-saving vaccines inside are missing or left behind.

Aca, the Immunization Coordinator at the Bontosunggu Community Health Center in Selayar Islands in the South Sulawesi Province, is heading to a nearby group of islands to conduct routine immunization for children. He is no stranger to making long and often difficult trips by sea to remote areas for the sake of children’s health.

Aca used to work on Jampea Island, a 12-hour journey from Selayar Islands. “Accessing the Posyandu [health clinic] was very difficult because of the weather. When it rained, my motorbike sank in the mud," he recalls. He often had to deliver two rounds of vaccines to cover immunization needs for a few months, to avoid vaccines being unavailable during poor weather conditions. “If we didn’t do that, children would miss out on their immunization.”

Aca’s efforts are part of maintaining the essential “cold chain” – the delivery system that keeps vaccines safe and effective from the moment they are made until they are given to children. This process is crucial because if vaccines get too warm or too cold, they can lose their potency and thus their ability to protect against diseases.

He works closely with Rahma, the Immunization Manager for the Selayar Islands District Health Service, who ensures vaccine supplies are ordered and delivered from the provincial warehouse in Makassar, a journey that can take up to 18 hours. When the vaccines arrive, Aca must choose the right time to travel to ensure they are not inside the cold box too long. He must also manage various weather disruptions that can make his trip treacherous.

With 16 years of service in healthcare, Aca is deeply dedicated to improving immunization. Coverage of basic immunization in Selayar—88.8 per cent for infants and 72.4 per cent for toddlers—remains below national targets, leaving children vulnerable to preventable diseases. Some areas are so isolated that health workers can only access them once a year, forcing them to find creative solutions to keep vaccines viable.

"As an archipelago, Selayar Islands is logistically challenging, especially in certain areas that can only be accessed at specific times of the year. We have two 'seasons’ which affect the weather, creating strong, heavy winds and waves, limiting access,” explains dr. Husaini, M.Kes, Head of the Selayar Islands District Health Service in South Sulawesi. “To improve the immunization services, we must ensure efficient cold chain management and place officers there.”

UNICEF is a key partner in the Government of Indonesia’s effort to maintain the immunization cold chain in various regions, especially in remote areas like the Selayar Islands. This requires close collaboration with the South Sulawesi Provincial Health Service, ferry operators, the Navy and other stakeholders.

With the support of the Canadian Government through the CanVAX initiative, UNICEF is facilitating the purchase of essential equipment, including cold rooms and vaccine refrigerators, while also providing training for health workers to ensure the effective maintenance of cold chain systems and the efficient management of vaccines.

"Healthy children can avoid various threats, such as stunting, malnutrition and other diseases that can be prevented by immunization,” says Husaini. “We hope that immunization can make children more immune to various diseases that are becoming more dangerous every day.”