Chitipa health worker goes the extra mile

At Tondola Health Post, 20 kilometres south of Chitipa district, in the northmost part of Malawi, we find Sekani Kalengo carefully packing syringes, vaccines, and other medicines in the standard UNICEF-issue isothermal vaccine cold boxes into his car.
"You're lucky that you found me," he says after the customary introductions have been made. 
"I am heading off to Chisitu for a vaccine clinic," he explains as he gestures towards a range of mountains in the distant west. 
From the ensuing conversation, we learn that due to the scarcity of resources, Kalengo uses his personal car, a Toyota Vitz, to travel to the remotest areas around his station—Tondola Health Post—to administer vaccines. He uses his resources to fuel the vehicle in most cases.
As part of the USAID-funded Village to Village vaccination under the theme Vaccinate my Village, Kalengo is undertaking an outreach programme that sees him reach out to communities at least three times a week.
Kalengo, who has worked as an HSA for 14 years, says he uses at least 10 litres of fuel for each trip at the cost of 20,000 Malawi Kwacha. His monthly salary is 180,000 Malawi Kwacha. 
The 38-year-old married father of three says he is passionate about serving his community; hence he is willing to sacrifice his personal resources to deliver services.

"Although this affects my family's finances, but I have a job to do. If I do not reach out to these people, then I will have contributed to their problems if anything happens to them. 
"This is government work. So if the government says we should deliver the vaccines to the people, we have to find a way of reaching them. So that is why my friends and I just contribute to getting to wherever we have to be," he says.
In Malawi, due to resources constraints, particularly in the health sector, health surveillance assistants (HSAs) bear the weight of the health system burden, often using personal resources to cover gaps in the system.
Kalengo's colleague and fellow HSA Kate Chavinda, who often pools resources together with Kalengo, says the need to reach out to people in the villages is driven by a desire to serve.
"Our main goal is to reach everyone because Covid-19 is a dangerous disease. And since prevention is better than cure, we must ensure that the vaccine reaches everyone. For instance, there are elderly people in distant villages who can never make it to the health facilities. So the only way is for us to go out to them," she says.
Chitipa District Environmental Health Officer Sam Chirwa explains that Kalengo's efforts show his commitment and passion for the people he serves.
"This shows the passion of the HSA, who uses personal resources to deliver vital health services to the communities he serves, and this is pure dedication on his part," he says.
Chirwa adds that although the District Health Office sometimes provides fuel for the HSAs, it does not take into consideration the wear and tear of the vehicles. 
"As a district, we are very much appreciative of such initiatives because we have inadequate resources. For that cluster, we only have one motorcycle to cater to a population of over 14,000 people. So it is evident that we require additional resources," he says. 
Patrick Omar Nicks, UNICEF's Immunization Specialist, notes only HSAs deliver all of the services the health department is carrying out. 
"Their commitment and diligence in getting Covid-19 vaccinations to the nation's most rural areas are extraordinary. To administer Covid-19 vaccinations, UNICEF is not skimping on any services. 

"A few of UNICEF's highly effective initiatives include Vaccinate my Village (HtH vaccine) and Covid-19 vaccination express. To ensure high-quality service delivery and leave no one behind, UNICEF is directly addressing all HSAs," he says.  

In Malawi, HSAs serve an important function as a link between health systems and communities.

HSAs have played a role in the Malawi healthcare system since the 1960s.

Recruited initially as temporary 'smallpox vaccinators' and 'cholera assistants' in the 1960s and 1970s, and later playing a pivotal role in HIV and Aids outreach, HSAs have become a permanent fixture within local healthcare delivery systems. 

Today, there are over 11,000 HSAs in Malawi, providing a wide array of services to promote health at the local level, including health education, disease surveillance, immunization, sanitation assessments, and collection of vital statistics, HIV care, family planning, and malaria prevention.