At the north eastern tip of Kasungu District, near the border with Mzimba, sits Manjondo Village, telephonically disconnected from the rest of the district.
By all criteria, this community on the eastern edge of Traditional Authority Simlemba is a true definition of a hard-to-reach area as it has poor road connectivity due to its hilly terrain.
With no cellphone signal, Manjondo Village is actually incommunicado, mostly relying on motorcycles to navigate the difficult terrain in search of better social services such as healthcare elsewhere in the district.
“Our nearest health centre is at Simlemba, some 18 kilometres from here. Elsewhere, this would be regarded as a short distance, but not with us here as you can see the terrain.
“The topography has made it difficult for us to have good roads and this disadvantages us in many ways, and the lack of cellphone signal worsens it all,” says Group Village Head Manjondo.
Long distances to healthcare facilities contribute to high immunisation default rates among under-five children under the age of five, health authorities say.
“That is now a death sentence for children living in such localities,” Manjondo says.
Since the World Health Organisation (WHO) launched the Expanded Programme on Immunisation (EPI) in 1974 to mark the beginning of the global efforts to use immunisation as a public health intervention, stakeholders in the health sector have been leading campaigns for mass immunisation of children as a way of domesticating the efforts.
However, children in hard-to-reach areas such as those in Manjondo have not received the services on equal footing due to geographical barriers.
Such communities also harbour entrenched myths and beliefs that derail immunisation efforts largely due to lack of knowledge on the importance of vaccines because service providers have not been taking information to the places.
To bridge such gaps, the Malawi Health Equity Network (Mhen) is implementing a Health Systems and Immunisation Strengthening (Hsis) project to contribute to the achievement of the country’s health targets for Sustainable Development Goals of ending preventable deaths of newborns and children under-five years of age by 2030.
The Hsis project, which is funded by the Global Alliance for Vaccines and Immunisation (Gavi) through the Ministry of Health, also aims at achieving participatory health governance to ensure that barriers to equitable and quality immunisation are reduced, enabling women, children and communities to access quality immunisation services.
As part of the activities under the project, Mhen has facilitated the establishment of mother care groups (MCGs) as community-led mobilisation structures drumming up support for the vaccination uptake.
Gloria Banda chairs Manjondo MCG and gives an account of the 30-member group’s achievements since its establishment in 2019.
“We started our work in 2019 after being successfully trained by Mhen. At first, we had doubts if we could manage to conduct successful mobilisation considering the so many beliefs existing in our community.
“However, we quickly earned trust from the members such that we took a leading role in demystifying myths about immunisation. The response has been overwhelming such that we are happy to report our significant contributions towards reducing child deaths in our area,” says Banda.
She adds that despite challenges such as mobility, the women have successfully invaded homes, gathering information of pregnant women and under-five children in the villages and mobilising them for immunisation.
“We are grateful to the chiefs who understood this initiative and gave it their full support. Their voice has also helped to deal with some of beliefs that were frustrating the efforts on vaccination,” Banda says.
Joseph Saka, a health surveillance assistant (HSA) for the area, hails the women for their efforts to fight infant morbidity and mortality in the area. He mans a health post that serves under-five children.
He says: “These women through the MCGs have also mobilised resources and constructed a house where I stay, allowing me to operate from within.
“I used to stay far away from the health post and this posed a challenge in that when it rains, for example, it was difficult for me to come and administer vaccines on scheduled dates.”
Saka adds that through MCGs’ efforts, health authorities are able to have correct numbers of pregnant women and children.
“With MCGs’ efforts, at least all children needing vaccines and pregnant women that are there come here for our services,” he says.
Saka adds that, initially, it was not common for men to take part in immunisation activities, as is the case is now, due to cultural beliefs that these roles are for women.
“It is now common to see men bringing their children for vaccination, a clear sign that MCGs’ efforts are paying off. We just hope this will be sustained after the project phases out,” he says.
According to Mhen monitoring and evaluation officer Florence Khonyongwa, the project specifically seeks to contribute to strengthening the capacity of integrated health systems to deliver immunisation by resolving health constraints, increasing the level of equity in access to services and strengthening civil society engagement in the health sector.
“We want to improve access, quality and utilisation of Essential Health Package (EHP) services, including immunisation, with a focus on populations systematically missed due to geographical, socio-economic and cultural barriers,” says Khonyongwa.
“Mhen, together with EPI under the Ministry of Health, established and trained MCGs in hard-to-reach areas with low immunisation coverage to accelerate immunisation uptake,” adds Khonyongwa.
Apart from Kasungu, the project is also being implemented in Blantyre, Lilongwe, Mchinji, Dowa, Ntchisi, Kasungu, Mzimba South, Mzimba North and Chitipa.
Khonyongwa says MCGs have been established in localities that are characterised by geographical barriers, inaccessible road networks and bridges, and isolated and scattered settlements.
“They are also in communities with economic activities hindering people from accessing healthcare services and religious beliefs prohibiting its members from accessing immunisation services,” she says.
Each MCG comprises 30 members and a group village head. Specifically, these groups are responsible for tracing those that default on antenatal and neonatal visits, conducting sensitisation and advocacy meetings on maternal and neonatal healthcare services and registering newly-born babies and pregnant women.
At Manjondo, the MCG has also constructed modern toilets for the health post and is mobilising to have the facility upgraded to a dispensary.
The current Malawian expanded programme on immunisation prescribes basic vaccination to include whooping cough, tetanus, measles, poliomyelitis rotavirus, and pneumococcal vaccine.
According to WHO, immunisation is an effective tool for controlling and eradicating life-threatening infectious diseases and reduce and eliminate many diseases that would otherwise kill or severely disable people.
To benefit from direct and indirect impact of immunisation, WHO, through its global vaccine action plan, set country targets of 90 percent coverage for all antigens by year 2020.
Kasungu District health promotion officer Catherine Yoweli says the Hsis programme has helped to reduce vaccination default rates in areas where MCGs are working.
“We used to have high default rate on immunisation; but with the effort of these women who are tracing defaulters, the default rate has drastically gone down, meaning more children are being immunised.
“In areas where MCGs are in place and functional, the default rate should be around two percent compared to other areas without MCGs, where it is around 10 percent,” Yoweli notes.
While at least 14.5 million children did not get any vaccination globally, Malawi’s vaccination coverage is said to be high with over 80 percent of the population to have accessed the six basic jabs.
Infant mortality rate has also significantly gone down to 31.9 deaths per 1 000 live births in 2024 compared to 37.8 deaths per 1 000 live births in 2020.
