Vaccinating Children who never were Vaccinated: A Continuous Challenge for a Chief of Immunization
In the health district of Ampanihy, in the south-west of Madagascar, the head of the Expanded Vaccination Programme gets involved in strengthening vaccination activities to reduce the number of children who have never received vaccines.
Vaccination of a child during an advanced strategy
It is a tough task but not an impossible one that awaits every day Célestin ZAFIMANONJY, head of the Expanded Vaccination Programme of the public health district department in Ampanihy in south-western Madagascar. In his constituency, 95% of children under the age of one must be vaccinated to protect them against deadly diseases. This 54-year-old father has shown ingenuity in achieving his goal and circumventing constraints that sometimes make it difficult to perform his work.
Indeed, it will soon be ten years since he assumed his role in the community. He works closely with 26 basic health centres serving nearly 474,018 people, including almost 17,000 children aged 0-11 months.
As head of the Expanded Vaccination Programme, Celestin ZAFIMANONJY has several responsibilities including the management of vaccine stocks, supervision of these basic health centres and supervision of the health workers working there. His works also consist in monitoring vaccine-preventable diseases as well as data analysis, research and implementation of strategies to achieve the objectives of the programme.
“To ensure the smooth running of the expanded vaccination programme, I engage particularly in the supervision of health workers,” says Célestin ZAFIMANONJY. “I strive to provide on-the-job training during field supervision, guidance and district level meetings. In addition, I make it a priority to share feedback after reading the reports received or after performance analysis. Finally, I try to correct practices that do not comply with the required techniques and standards immediately,” he explains.
But these are functions that face challenges every day. Célestin ZAFIMANONJY highlights the flagrant shortage of materials such as computers to systematise tasks and facilitate follow-up. The same applies to means of transport, when he points out that access to basic health centres is a barrier to the administration of vaccines for children. The means of transport are almost non-existent for health workers and yet, nearly 54% of families live more than 10km from the nearest basic health centre.
59% of target children received at least one vaccine in 2023
This does not discourage Célestin ZAFIMANONJY. According to his analysis, the performance of his district in terms of vaccination coverage depends closely on the implementation of advanced strategies. Thus, intensive vaccination activity in April 2023 raised the proportion of children vaccinated with DTCHepHib3 – a combined vaccine that protects against diphtheria, tetanus, whooping cough, hepatitis B and against diseases caused by the bacterium Haemophilus infuenzae – by 25%, compared to January 2023.
“For the last quarter of the year, it is expected to reach up to 31% of children who have never been vaccinated through the implementation of three more rounds of advanced strategies,” he said.
UNICEF Madagascar – with the support of Gavi, the Vaccine Alliance, and the French government – is working with the government of Madagascar to provide and make available vaccines for children who have not received any vaccine since birth, in the southwest region and in eight major towns, where the majority of these children are concentrated. The main strategies implemented are: strengthening advanced strategies and integrated intensive immunization activities related to routine immunization of children and vaccination against COVID-19, improving the cold chain of vaccines at all levels, integrating vaccination with other primary health cares, especially at the community level, stimulating demand and community engagement in favour of health, especially immunization.
Health workers on their way to implementing the advanced vaccination strategies
Integrated advanced immunization strategy session at a remote health centre site
