Feature

Bridging gender gaps in immunisation race

Reeling from a series of public health emergencies, from wild poliovirus outbreak and cholera to Covid-19, Malawi’s health care delivery was hit hard in 2022.

Immunisation coverage of the third dose of the DPT vaccine dropped to 86 percent, the lowest since 2018.

The burden of zero- dosed and under-immunised populations also increased from three to six percent since 2019.

To leave no one behind, the World Health Organisation (WHO) supported the Ministry of Health to conduct a rapid gender, equity and human rights analysis to close the gaps.

The findings revealed that gender inequalities and unfavourable socio-cultural practices were silent barriers to healthcare services, including immunisation.

The finding show high illiteracy, especially among women, limit their decision-making power while child marriages and teen pregnancies reduced the ability to seek life-saving services, including immunisation.

Although most women were willing to have their children immunised, they needed authorisation from men to access services for themselves and their children.

Some of the health workers trained in gender-equal immunisation. | Ovixhlela Bunya

However, men were less targeted with immunisation information and often failed to provide informed consent.

Additionally, most interventions, including health education and information materials, had little consideration for the needs of persons living with disability.

WHO, with funding from Gavi, the global vaccine alliance, supported the Ministry of Health and Ministry of Gender, Community Development and Social Welfare to bridge equity gaps, starting with pilot initiatives  in Mangochi, Thyolo and Blantyre.

Health authorities conducted high-level dialogues with over 350 community gatekeepers, social workers, traditional and religious leaders to discuss cultural practices that hinder access to health services.

The stakeholders drew community-led strategies to guide the change process.

Esther Mughogho, a member of Thyolo District Gender Technical Working Group, says it takes everyone to ensure every child receives all routine vaccinations.

She states: “It is vital for men to understand the benefits of immunisation. Without their involvement and support, women and children will always be hindered. This starts with creating awareness on the importance of vaccines, the routine process and addressing of myths and misconceptions at family level, where all parties can understand the benefits and create a sense of responsibility.”

Mughogho reckons men can be reached in spaces where they meet to play games, do business or hang out.

She also advocates deliberate strategies to reach out to women in tricky environments such as the tea plantations of Thyolo.

“Women should not have to choose between engaging in economic activities and accessing vaccines,” says Mughogho.

Across the three districts, technical working groups and health teams met to share insights and align strategies to strengthen gender, equity, human rights and inclusive immunisation programming.

Clement Nyahara, chairperson of people with disabilities in Traditional Authority Machemba in Thyolo, said their barriers disproportionately affect women, adolescents and children.

“Strategies should be tailored to incorporate approaches that work for all,” he said. “People with disabilities are sidelined, health facilities are far and we are looked down upon and often exploited and humiliated when it comes to sexual and reproductive health”.  

He urges healthcare authorities to ensure information materials meet the needs of all, including persons with visual and hearing impairments.

Village head Waluma, from T/A Nchiramwera in Thyolo, was among the traditional leaders trained to address unfavourable cultural practices. He convenes roundtable meetings to discuss myths and misconceptions that hinder access to immunisation.

All voices are heard, she says.

“Misconceptions such as claims that vaccines reduce sexual desires and cause barrenness must be tackled with sensitivity and information that is timely and accurate for all to understand. If these are not debunked, some women will always be left behind for fear of divorce when they take vaccines,” says the chief.

She also encourages male involvement in health advocacy and rebukes religious leaders who discourage the faithful from seeking health services, including vaccines.

 “Such faith leaders should be engaged and be made champions to drive change,” suggests the traditional leader.

The Ministry of Health also trained peer-to-peer advocates to champion health-seeking behaviours in vaccine-hesitant communities.

Traditional healer Janet Maluwa is a traditional birth attendant. Following the training, she encourages pregnant women to seek healthcare services and refers them to the nearest hospital. She also discusses with them the importance of vaccines throughout pregnancy and routine vaccination for newborns.

Janet says women respect her tips as she is their hope when labour begins before they can reach a health facility.

This makes her their trusted referral link to health workers.

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