A simple vaccine can prevent a child from contracting polio and a host of other deadly diseases, but some children in Malawi hardly recieve all six shots.
Some 30 women in Nthunduwala, Kasungu, are going door-to-door, walking up to 30km, to ensure every child gets vaccinated.
“We are foot soldiers. We came together in 2013 because many families were shunning vaccines. We help women to understand the importance of vaccines and encourage men to get involved,” says Eliza Banda, 32, chairperson of the mother care group formed and trained by Malawi Health Equity Network (Mhen).
By getting men involved, the mothers are breaking old stereotypes that leave care-giving to women.
Armed with cards detailing dates a child got the last vaccine and when the next is due, the volunteer visits pregnant and breastfeeding women in their neighbourhood to keep them reminded. Once a month, they meet to share numbers of children getting vaccinated and dropouts. They also save their money and share low-interest business loans to enhance their livelihoods.
“We are marching to break myths and barriers to immunisation,” says Banda. “We don’t get any pay, but this is our area and the children are ours. If we stop, children will suffer and deadly diseases currently dying out due to vaccines will resurface.”
Men getting involved
In rural settings like Nthunduwala, some children grow up without recieving any vaccine because health centres and workers are few and far apart.
“Previously, a health centre with a refrigerator for cooling vaccines was faraway and vaccines were usually out of stock,” says Gertrude Tembo, a mother of three.
In the past, her community was going to Kawamba Health Centre for immunisation as the nearby facility at Kamboni had no refrigerator. To get her two children vaccinated, she often woke up around 4am to get to Kawamba by 10am. Cyclists charge K5 000 for the trip, an equivalent of the fare for a 330-kilometre bus ride from Blantyre to Lilongwe.
The long travels, out-of-pocket payments, frequent stock-outs and myths about vaccines conspired to deny children in the tobacco-growing setting a healthy start in life.
“Some went two years without being vaccinated as many parents didn’t appreciate the benefits of vaccines to a child’s health. With increased awareness, they leave other chores to get children immunised,” says Misozi Patrick.
She is happy that “even men who once paid more attention to their tobacco fields than children’s health” are joining the queue for vaccines.
“Most men are realising that parenting goes beyond siring a child. They now take children to hospital for vaccination and treatment. Women are no longer suffering alone,” she says.
Even community health workers are adjusting the way they work.
“When a man brings a child for vaccination, it’s a good example. We help them first to encourage women to bring their partners as well,” says Vincent Kakwera, a health surveillance assistant (HSA) at Kamboni Health Centre.
He salutes the care group for improving the uptake of vaccines in hard-to-reach localities by raising mass awareness, registering children requiring immunisation and tracking defaulters.
“We cannot do it alone. There are babies we cannot follow up on our own. Since we started working with these volunteers, immunisation coverage has gone up from around 45 to 90 percent,” he says.
HSA Chimwemwe Mwale says many parents now appreciate why vaccines matter.
“These mothers are dedicated. We need more of these groups. They have contributed tremendously towards addressing social, cultural and religious barriers that prevent people in their community from accessing health services, including immunisation” he says.
Mhen formed and trained the community-based care groups with funding from Gavi, the global vaccines alliance, through the Catholic Relief Services to increase civil society involvement in strengthening the country’s expanded programme on immunisation.
The initiative was trialled in Kasungu, Mzimba South, Karonga, Neno and Zomba from 2013 to 2018. It has since expanded to hard-to-reach parts of Lilongwe, Blantyre, Kasungu, Mzimba, Chitipa, Ntchisi, and Mchinji. It is also underway in urban slums in Lilongwe, Blantyre, Mzimba and Kasungu Municipality.
Florence Khonyongwa, monitoring and evaluation officer at Mhen, says: “It is easy for the mother care groups to mobilise, convince and sensitise their communities. They live together and understand each other’s perceptions and cultural beliefs. They are making HSAs’ work simpler by reaching people the community health workers could not be able to mobilise on their own.
‘We need support’
The mother groups also advocate quality immunisation and child healthcare services.
Moses Nkhoma, one of “converted men”, commends them for “creating a fortress” against vaccine-preventable public health crisis, including the possible return of polio.
He says, “Men are joining the queue because even traditional leaders support what these volunteers are doing. Vaccines are a reliable preventive measure for diseases likely to occur later in life.
“When a child falls sick, the family spends a lot of time and money seeking medical help instead of generating income. Besides, unvaccinated persons are particularly at risk of contracting and transmitting preventable diseases that may affect the entire community. We don’t want the return of strange diseases that haunted our ancestors.”
For Banda and her group, the future looks bright.
“We just need support,” she says. “When men and women work together, children are safe.”