Vaccinating children in Haiti’s hardest-to-reach communities

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By Benjamin Steinlechner

CAP HAITIAN, Haiti, 23 January 2012 – It doesn’t take an earthquake to kill a child. More often, children are killed by something much less dramatic, and much more insidious: disease.

This is why Marie Lucie Osias waits patiently at the Centre Médico-Social de Lafossette in Cap Haitien for her 6-month-old daughter Miana to be vaccinated. Miana wriggles as a nurse immunizes her against diphtheria and tetanus.

When it is done, Ms. Osias is relieved. She lost two of her five children in the January 2010 earthquake, a disaster that swallowed thousands of lives. Guarding her other children from preventable diseases has become a priority.

Fortunately, she lives within easy reach of a UNICEF-supported clinic – one of hundreds across Haiti. There, Miana receives routine immunizations, a simple and highly effective way to protect her from polio, diphtheria, tetanus and measles-rubella.

But not all of Miana’s peers are getting vaccinated.

Reaching every district

According to 2009 statistics, 30 per cent of newborns are not protected against tetanus, and only 59 per cent of 5-year-old children are immunized against polio or measles. Immunization rates for diptheris, tetanus and pertussis linger between 59 and 83 per cent.

To remedy this, UNICEF is embarking on RED, the Reach Every District approach to ensuring every child in Haiti is immunized. This innovative project is also being implemented across Africa, in communities that have frequently missed out on routine immunizations.

RED helps plan and manage resources, reach target populations, and link services with communities. RED also provides supportive supervision and monitoring for action. This approach has improved communication between rural communities and health workers, increasing vaccination coverage in Africa.

It’s also working in Haiti.

“The results have been excellent,” said UNICEF Haiti Health Chief Jean-Claude Mubalama. “In some of the 36 communes we have chosen to focus on, there has been a change in coverage from about 10 per cent to about 80 per cent.”

Worth the expense

The government, with support from UNICEF, the World Health Organization and other partners, conducts supplementary vaccination days. During these days, vaccinators go out into the community to immunize children who have not made it to the clinics for routine vaccinations.

“But we found out that there were communities that were never being reached, either by these supplementary days or by the routine immunizations,” said Dr. Mubalama. “These are the communities in very hard-to-reach areas, up mountains or on the other side of rivers.”

RED is changing this, providing assistance to the 36 communes with the lowest vaccine coverage. With support from UNICEF and WHO, the government has been sending small teams to far-flung communities once a week or month.

But it comes at a cost.

“It costs about US$7–20 to vaccinate a child in a normal place, but in these hard-to-reach areas, because of fuel and the time it takes to get there, it’s closer to US$30–40 a child,” said Dr. Mubalama.

Still, every immunized child helps protect communities against disease and preventable death.

And other efforts are further increasing children’s protection from illness. UNICEF and WHO have helped the Government of Haiti successfully apply for assistance from the Global Alliance on Vaccination and Immunization (GAVI), an international public-private partnership focused on saving lives by increasing access to immunization. This assistance will allow UNICEF and WHO to introduce three new vaccines to Haiti over the next two years.

For Ms. Osias, these efforts are well worth the expense. “Vaccinations prevent my baby from getting sick,” she said. “There's typhoid fever that can provoke disability. There's a throat disease that can prevent her from inhaling, so the vaccinations are good for all of these.”

Simply put, “It's protecting my child’s life.”