Battling fake news is life saving for 'zero dose' communities
Gaps in knowledge mean gaps in health
Hodan Hussein, a mother of six from Wajir County in northern Kenya, explains that in her community, “the main reason people don’t visit the health facility is the distance, it’s too far. It takes five hours just to get to the main road, then you have to take a taxi.”
Improving access to health clinics is a key priority for UNICEF Kenya, especially when it comes to improving vaccination rates, because eliminating childhood killer diseases, such as polio, requires 100% vaccine coverage. No one is safe until everyone is safe.
With support from the Bill and Melinda Gates Foundation, UNICEF has designed a unique programme which tackles not only the physical barriers to healthcare, but also the invisible cultural barriers, which prevent nomadic communities, like Hodan’s, from having faith in health services. DICE (Demand Intensification Community Engagement) is the blueprint for a new approach to ensure everyone in society has access to facts, as well as to vaccines.
Fake news spreads faster than any disease
Hodan says “We used to receive government vaccines but we had no idea what they were for. We didn’t know the importance. We actually assumed the health workers were just giving us water in order to get paid. I never thought the vaccines could have such an impact on the child’s health. All we heard from the community before was that it causes flu.”
Just as the office watercooler has become synonymous with gossip in western culture, the water point for camels and cattle has become a popular centre of conversational exchange for Kenya’s pastoralist communities. These stop-off points can also be the epicentre of harmful myths and fake news though. DICE has turned this challenge into an opportunity, by sharing life-saving health information, organising community dialogue sessions and bringing services to the people whom otherwise would have been out of reach.
Dangerous misunderstandings
There’s long been a misconception in Africa about the word ‘sterile’, which when used in clinical terms, simply means a clean safe needle with which to inject vaccines such as the BCG. A dark myth prevails, a hangover from colonialism, where many communities still genuinely fear that vaccines are an attempt by white people to stem the African population. They fear they are being ‘sterilised’.
These are the tricky misinterpretations and nuanced conspiracy theories that need space to be aired, and ultimately discounted, by the community. Certainly, the nomadic elders and area administrators working with DICE agree there is an aspect of religious belief that associates vaccination with family planning. Their role is to help debunk false rumours, using their community standing as respected voices.
Sheik Mohamed, a local Imam working with DICE project, recalls hearing members of his community discussing how immunization causes paralysis and other side effects in children.
“I try to demystify myths and misconceptions revolving around immunization services, by talking with people in town or at the mosque”.
Entire communities cut off
Many areas DICE now serves have not been offered any services for up to 13 years, since violence and insurgency started to spike on the Somali border. Mohammed Dayib, a nurse working with DICE near the border, protests that “All humanitarian aid was withdrawn because of insecurity in this area”. Isolation always spells an increase in child and maternal mortality and the spread of killer diseases, not only because access to treatment is physically impossible, but also because information is out of reach for these nomadic people, who are also ensconced in surviving Kenya’s worst drought in 40 years.
“Just yesterday I was called out when a mother delivered in the bush and had complications. They were going to slaughter a goat and give her the blood to cure her. I had to manually extract the placenta which had been inside her for two days.” Mohammed shakes his head in wonder at how this mother survived.
A blueprint for intensifying community demand for health
Ahmed Mohamed is an Imam and water committee chair, he says, “DICE came during this critical drought, where people can have their children assessed for malnutrition at home and be given plumpynut if needed. Minor ailments are also treated. Mothers who have delivered at home get a visit from the outreach health workers, the child is vaccinated, and you can prepare to get a birth certificate for your child. That’s the difference. The services are brought close to us”.
Ayub Duale, UNICEF’s Social Behaviour Change Officer outlines that “It’s the first time UNICEF has integrated services such as vaccines and birth certificates and taken them to nomadic settlements in this way. It was crucial to fix the zero-dose burden to improve immunization coverage, because you can’t control nomadic behaviour”.
Yakub Abdow Ali represents Fafi sub-county, Garissa County, in the community engagement, one of almost 100,000 people reached through DICE’s series of community feedback discussions. “We have never seen such a meeting before where forgotten cross border communities are gathered together”.
DICE mapped 994 nomadic settlements and 2,294 points of interest, such as waterpoints, livestock markets or duksis (nomadic koranic schools). It conducted 167 vaccine outreaches, traced 990 defaulters, visited 7,497 households, trained 1,370 community champions and held 940 feedback sessions. 111,208 people from the community helped to design the programme.
Ahmed Mohamed, the Imam, reflects on his own childhood. When I was nine years old, I was with my mother at the water point near Wajir Town. I got my BCG and polio vaccine but my younger brother ran away and hid in the blankets on the camel’s back. The health worker saw him rustling and grabbed him and gave him the vaccination!” This is the history of vaccination in Wajir county: At first vaccination was forced, then it was offered but with too little information “and now, there is full consent with community champions” laughs Ahmed. “The difference is clear for all to see”.
