Reaching Every Last Child with Immunisation

Its one of the key drivers in child health programmes within Save the Children, and I have just had the great privilege of seeing what that means ‘on the ground’ in Shomolu District, Lagos Nigeria.

Save the Children is involved in the Stop Diarrhoea Initiative (SDI) in Nigeria. The under-five mortality rate in Nigeria is 109 per 1,000 births with 10% of these due to diarrhoea. The SDI initiative involves the WHO/UNICEF 7-point plan for the prevention, control and management of diarrhoea, and the administration of rotavirus vaccine is one of the critical elements of this intervention.  Rotavirus vaccine introduction in other parts of the world has made a real difference to child mortality due to diarrhoea.

To determine whether our pilot area was ready to introduce the vaccine, we needed to carry out an immunisation assessment. Hence I found myself in Lagos for 10 days following up the project team training on immunisation which I had delivered, with supervising the immunisation assessment surveys of the primary health clinics (PHC) and the District Health Office, not to mention problem solving the technical hitches with the data  collection tools I had developed. Was it the heat and humidity……?

In this overcrowded district with poor housing and inadequate sanitation, it was humbling to see how different things were, both for the beneficiaries and the healthworkers, compared to the UK. My first visit for piloting the assessment was to a health facility holding a large free open air clinic covering everything from eye screening to blood pressure and diabetes checks. The ‘patience’ of the ‘patients’, often elderly or with small children in tow, sitting out under an awning for hours waiting, made me so aware of my own impatience if I have to wait even 15 minutes for a GP appointment!

Inside the clinic, the facilities are basic and old. Its dark and the paper filing sits precariously in old bookcases. Patience indeed must be required to find medical records, but when only some of the mothers have their child’s immunisation card, how else do the healthworkers determine which vaccines they have definitely already been given?  A few of the clinics were newer so a more conducive environment is sometimes there, though the facilities within them may not be – one of the newer clinics did not even have a solar refrigerator, meaning that immunisation clinic days required a trip to another clinic to pick up supplies in a vaccine carrier for the day – added work, but not value added! The ubiquitous ceiling fans were present in most clinics but I never saw them working; the electricity is often cut and repairs to broken equipment may put a strain on the system. Fans are not a priority in such an environment, when the mothers who bring the immunisation cards can use them as paper fans for themselves and their little ones. I did not feel so bad then about bringing out my own paper fan.

Charts on the wall describing measles surveillance (measles kills!) or monitoring the clinic’s immunisation coverage abound, and the healthworkers conscientiously provide their reports up to the district every month. However, putting things in the right column and understanding of how to use the information they gather to identify and address problems still needs some work. Then for all those mathematicians out there, how do you trust the calculation of a % (coverage of target population) when the national census provides one figure for the population but the state claims a figure twice as high?!

And yet amongst it all, it was so affirming to see the healthworkers determination to do their best, and to hear the mothers advocating for vaccination within the Focus Group Discussions.

So now I am back in the UK, immunisation assessment complete, data analysed, draft report written, and in 3 days my PULSE assignment will have ended. The PULSE Re-entry information encourages us to think about volunteering in our NGOS going forward, so maybe this won’t be the end of an incredible 6 month voyage of discovery for me! Ethiopia anyone……..

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