No dose to waste

For John Kuwanda, delivering vaccines to people at risk of preventable infections is a race against time.

“When duty calls, everyone has to sprint fast until we reach the finish line. There is no time to waste,” says the assistant environmental health officer in Rumphi district.

The immunisation coordinator starts his day by tracking vaccines in health facilities with more and those with too few or none. Then he ensures health surveillance assistants (HSAs) pack their vaccine carriers with necessary supplies, ready to deliver the doses to people who are unlikely to visit health facilities just for the jab.

As they hit the road, John is worried that following the rollout of COVID-19 vaccinations, his team of 183 HSAs under 21 supervisors could only deliver about 900 doses a week.

In November, UNICEF Malawi in partnership with the Ministry of Health and Kamuzu College of Health Science (KUHES) dispatched a branded minibus to take the vaccines closer to those who need them. The initiative was made possible through funding from various partners including UNICEF Germany.

“The vaccination van is a big boost. Access to the vaccine has expanded to the point that we now vaccinate 900 in one day, not a week, because it takes them to place where the people are instead of waiting for them to come to health facilities which are far,” he explains.

The district has received two more vans since the arrival of the vaccination express supported by UNICEF—one deployed by USAID and another by the Story Workshop.

However, John and his team are not just contented with putting the vaccines on the wheels. They have embraced new goals for each to ensure no dose expires amid the spiking fourth COVID-19 wave.

During a visit on December 21, he summoned vaccination supervisors in Rumphi to brief them about a new challenge called “finish a vial”.

“When you take a vaccine bottle, make sure every dose is put to good use,” he challenged them. “Vaccines don’t come cheap, so we need to use them to protect our people instead of leaving them to perish.”

For him, a dose wasted is one too many for the country mostly supplied by the Covax facility with support from donors.

 “The loss of doses was high shortly after the rollout of COVID-19 vaccination, so we challenged them and said every HSA would receive a lunch allowance after finishing two vials for 20 people. Now we give them the modest allowance after finishing a vial for 10, as do our colleagues in Mangochi district,” says John.

The finish-a-vial campaign motivates the community health worker to go far and vaccinate more people.

“The express vaccination exercise reached the highest number on 17 December when we vaccinated 920 people in 15 centres, but we can more than double the figures if all 183 HSAs are involved in the finish-a-vial initiate. Some 1 830 will be vaccinated if each just finishes one,” he explains.

The district has also drawn a new strategy to flood a village with HSAs for days until all adults aged at least 18 are vaccinated.

Innocent Chiweza, senior HSA at Bolero Health Centre in Rumphi District, says there is no excuse for vaccines to expire while the fourth wave is biting harder. The team leader for the express vaccination campaign in the district’s best-performing zone sees to it that vaccines, syringes and other necessary supplies are adequate before the HSAs depart for the field, with some heading for hard-to-reach areas on motorcycles.

“When we were offering the vaccines in health facilities, the uptake was low. Taking the vaccines to communities regardless of geographical barriers has taught us that when you motivate and involve the HSAs that Malawians know and trust, people are willing to get the vaccines we thought they didn’t want,” he says.

The registers show that the four teams deployed by Innocent vaccinate 500 to 600 people a day.

“Working with motivated HSAs has helped us reach tricky and strategic areas where the vaccine is needed by people who shun health facilities because of long trips and transport costs.

The tricky terrains include Mbweziwe and Bondi, where rocky hills and valleys make roads impassable for off-road vehicles.

 “The branded minibus carries three teams and drops two on the way to busy markets where we vaccinate more. The fourth team goes to hard-to-reach areas by motorcycle. The incentive motivates us to finish our vials,” he says.

And the major winners are people like Florence Nkhonjera, a woman the team vaccinated in Kaiwale Village on the way to Bembe, a busy market that gets busier on Wednesdays.

“Covid-19 is deadly, but health workers say vaccinated people face a lower risk of dying from the disease. This is not good enough unless they take effort to ensure many Malawians have access to the vaccines as I have today,” she said after getting the first AstraZeneca vaccine by the roadside in her village.

For Dr. John Phuka, from KUHES, the innovations that propel the vaccine express crews to vaccinate more amid myths, misconceptions and misinformation is “a story of teamwork and partnership that creates hope that it is possible to deliver health services close to where people live”.

The former co-chairperson of the national COVID-19 response states: “We involved the HSAs because they are foot soldiers at the front of the COVID-19 war in the areas where they work. They know how to communicate, navigate and engage their communities.

“The Finish-a-Vial initiative is a modification of this. If they go far, they vaccinate more while earning the lunch allowance. It’s a win-win strategy.”