The challenging journey to reach Nepal's communities with vaccines

How dedicated health workers and a robust cold chain keep communities protected.

UNICEF
Healthworker Basanta Malla vaccinates a child in Doti District
UNICEF & U.S. CDC/UN0666584/Ngakhusi
19 August 2022

Doti District lies in a remote corner of far-western Nepal. Lush green meadows lie in the valleys here, beneath the hills that sweep their way through this region. As you look up from those valleys, you see communities in the distance, perched on top of the hills.

Reaching those communities with health care services isn’t straightforward. Bringing vaccines to the children and families that live in these villages and municipalities often requires steep climbs and navigating treacherous roads.

For Basanta Malla, that journey is a big part of her job. She’s an auxiliary nurse midwife and vaccinator at the Primary Healthcare Centre in Jorayal Rural Municipality. Basanta has been at the forefront of the efforts to expand the coverage of routine vaccinations in this region for 27 years.

Basanta Malla removes ice packs from a refrigerator
UNICEF & U.S. CDC/UN0666505/Ngakhusi
Basanta Malla holds up a vaccine vial
UNICEF & U.S. CDC/UN0666512/Ngakhusi

A challenging journey


Every month, Basanta and her colleague, Tilak Raj Joshi, will carefully place vaccines into a carrier box in the cold room at their healthcare centre. They’re then faced with a difficult journey, often on foot.

“Some of these places can take up to three hours to walk to, one way. The roads here are not paved, and taking vehicles can be dangerous, especially during the monsoon season,” Basanta explains.

Basanta Malla walking with her vaccine carrier
UNICEF & U.S. CDC/UN0685534/Prasad Ngakhusi
Basanta and Tilak walking up a hill
UNICEF & U.S. CDC/UN0685535/Ngakhusi
Basanta walking through some greenery
UNICEF & U.S. CDC/UN0666520/Ngakhusi

These healthcare workers often navigate landslides and flooding during the rainy season to reach the communities they serve.

“One of us usually goes ahead to check if things are okay while the other waits. They’ll then signal the other to follow if all is fine. That’s how we go on. You also have leeches to worry about among other things. We have to carry umbrellas and packs of salt in our hands to ward them off,” says Basanta.

Basanta Malla walks across rice paddies with a carrier containing the vaccines that are needed to protect children in the communities she serves.
UNICEF & U.S. CDC/UN0666567/Ngakhusi
Basanta Malla walks across rice paddies with a carrier containing the vaccines that are needed to protect children in the communities she serves.

Communicating effectively about vaccines


Despite the challenges faced on the journey, Basanta believes it’s worth it. For her, it’s rewarding to see how positive people are in the municipality of Jorayal about vaccines. She believes that’s primarily a consequence of effective communication and counseling from health workers like herself, who build trust in these services.

A routine immunization session taking place in Jorayal Rural Municipality.
UNICEF & U.S. CDC/UN0666531/Ngakhusi
A child being vaccinated
UNICEF & U.S. CDC/UN0666530/Ngakhusi

"We have been able to remind them of what things were like before vaccines were available - when people used to fall ill or even die of various vaccine-preventable diseases. Since vaccinations against these diseases started, we have seen a drastic reduction in mortality rates, especially that of children,” Basanta says.

Basanta Malla counsels Krishna Sarki, who has just brought her 4-day-old daughter to a vaccination outreach session.
UNICEF & U.S. CDC/UN0666533/Ngakhusi
Basanta Malla counsels Krishna Sarki, who has just brought her 4-day-old daughter to a vaccination outreach session.

A thankful community


Durga Ghartimagar is one of the mothers that is thankful for the long journeys these healthcare workers make to reach these communities. She knows firsthand what it’s like. Durga has walked over three hours to reach the vaccination clinic in the village of Upparkot, which lies in the Jorayal District.

Durga Ghartimagar on the final stretch of her journey to get her 3-month-old son Rhythm vaccinated during a routine immunization session.
UNICEF & U.S. CDC/UN0666582/Ngakhusi
Durga Ghartimagar on the final stretch of her journey to get her 3-month-old son Rhythm vaccinated during a routine immunization session.

With the midday sun beating down, Durga makes her way up the last hilly stretch that leads to the clinic. She’s carrying her 3-month-old son Rhythm in her arms.

“We were told that children were being vaccinated here today,” she says. “The last time we had come for his vaccination, the health workers had reminded us that we needed to come next time.”

For Durga, the walk might be long and tiring, but the opportunity to protect her child is invaluable. “Vaccines protect children from diseases, they build their immunity against illnesses and keep them healthy,” she reflects.

1-year-old Nitika is held by her mother, Nitu Nepali, as she receives her routine immunizations.
UNICEF & U.S. CDC/UN0666544/Ngakhusi
1-year-old Nitika is held by her mother, Nitu Nepali, as she receives her routine immunizations.

Nitu credits the healthcare workers and the female community health volunteers for the work they do. “They teach us about what the vaccines are, what they do, and how they will benefit the child,” she says.

NItu with Nitika
UNICEF & U.S. CDC/UN0666528/Ngakhusi
Nitika
UNICEF & U.S. CDC/UN0666552/Ngakhusi

A mothers’ group meeting to build trust


To help build trust in vaccines in this community, there’s a monthly mothers’ group meeting. Female Community Health Volunteers or FCHVs facilitate conversations, which help to educate caregivers about the various aspects of child and maternal health.

“It’s easy when everyone is there, in person, to talk about why children need to get these vaccines,” says Pashupati Joshi, who is one of the FCHVs. “The women in the mothers’ group really listen to what we’re saying, with great interest, and take that to heart.”

Pashupati Joshi facilitates a mothers’ group meeting in Jorayal Rural Municipality.
UNICEF & U.S. CDC/UN0666508/Ngakhusi
Pashupati Joshi facilitates a mothers’ group meeting in Jorayal Rural Municipality.

That sentiment is echoed by another FCHV, Sharada Madai. She says that that relationship building is essential when it comes to spreading correct information and increasing awareness. Sharada will additionally make the rounds in the community, visiting families personally to ensure that they’re aware of when it’s time to get their children vaccinated. Sharada believes that the importance of vaccines has now become ingrained in the minds of caregivers.

 

A robust cold chain is crucial


Getting vaccines to children in these remote communities requires a strong cold chain. The cold chain refers to a series of precisely coordinated events in temperature-controlled environments to store, manage and transport the doses.

To facilitate this, UNICEF has been working closely with Nepal’s government and key partners like Gavi, to expand and strengthen the country’s cold chain capacity.

Basanta Malla holds a vaccine vial
UNICEF & U.S. CDC/UN0666523/Ngakhusi
UNICEF Cold Chain consultant Aarati Poudel at the Dhangadhi Provincial Health Logistics Management Centre.
UNICEF & U.S. CDC/UN0666595/Ngakhusi

More cold rooms, refrigerators and freezers have been installed in vaccine storage facilities. And there’s been an increase in the supply of refrigerated containers and cold boxes that are used to transport the vaccines from these facilities to the communities often situated high on those hills.

FCHVs walking towards communities in Doti
UNICEF & U.S. CDC/UN0666575/Laxmi Prasad Ngakhusi

Basanta Malla admits that the process can seem long and arduous, especially given the equipment, knowledge and skills that are needed. “But I think we should count ourselves lucky that thanks to the technology, we have the ability to do all this and to serve families,” she says.

“Many of the children that I vaccinated when I first started this job have themselves become parents today. Seeing them bring their children to get vaccinated gives me a sense of great pride,” Basanta reflects.

UNICEF Nepal/2022/MShrestha