Ensuring routine health services, such as immunisation, continue during COVID-19
Rose Foley and Sammy Nyaberi
A baby smiles and wriggles in his mother’s arms at a health clinic in Mathare informal settlement in Nairobi, while a nurse prepares in the corner. Health information posters line the walls. “Today I came to the clinic for the ten weeks’ immunisation,” explains the baby’s mother, Sarah Adhiambo. She looks down at her son, a black and white mask covering her nose and mouth.
Moments later the nurse holds cotton wool to the site of the injection on her baby’s thigh, while Sarah cuddles him closely. “He’s been given the rota vaccine first which prevents diarrhoea, then the polio vaccine, then the two injections that are being given at ten weeks,” she says.
Outside the clinic, a spaced queue of mothers in face masks holding small babies, wait to have their temperature taken as part of screening, before they enter the building for the same routine immunisations. A washing station has been specially installed to allow them to keep their hands clean.
These measures were introduced after COVID-19 was detected in Kenya in March 2020, to help keep everyone safe. The Ministry of Health is stressing the importance of parents continuing to take their children for their vaccinations, despite the pandemic. “Mothers like me, they should not be afraid to bring their babies to the clinic to get the immunisations due to COVID-19,” Sarah Adhiambo reassures others.
The pandemic has had a dangerous secondary impact across the globe: a decline in the use of health services, especially in lower income countries. UNICEF and WHO estimate that over 94 million children around the world have missed out on measles vaccination alone, because of disrupted immunisation services, leaving them at risk of catching a highly infectious and dangerous childhood illness.
In Kenya, between March and June 2020, the use of outpatient services for children under-five declined by almost half. Over the same period, uptake of the diphtheria, tetanus and pertussis vaccine declined by nine percent, antenatal care appointments by 10 percent, and skilled birth deliveries by four percent. Disrupted supply chains for medical supplies and limited staffing played a role. However, travel restrictions, curfews and fear of getting infected also led to a significant drop in attendance at health facilities. The situation is now improving but is not yet back to normal.
“It is very important to have vaccines during a pandemic, simply because there are other diseases that are still going on amidst the COVID-19 pandemic,” says Dr Fathiya Hamumy from the Ministry of Health’s National Vaccine and Immunisation Programme.
To help drive home this message, health workers have stepped up their work in the community. With masks over their nose and mouth, they walk through markets and residential areas in the catchment area of local health centres. Through megaphones, they broadcast the importance of immunisation. Women working behind tables laden with fruit and vegetables look up. Others come to their doors. Health workers stop to speak to mothers with young children.
“Because of the COVID-19 pandemic we have increased the outreach to the mothers so that we can reach each and every mother for the immunisation,” says Lucy Naivasha, a nurse from Mathare North Health Centre. “We do this weekly, because the mothers are not coming to the clinic the way they used.”
UNICEF plays a triple role in making sure routine health services like immunisation contiunue during COVID-19. Internationally, the organisation is working to ensure that countries continue receiving the vital vaccines they need to administer to children. At the national level, UNICEF Kenya is supporting the Ministry of Health to ensure that guidelines are developed on the safe delivery of vaccines. And at the local level, it is working with communities to encourage them to access vaccination services during the pandemic.
“Continuity of essential health services is a matter of life or death, of wellness or illness and disability,” says Peter Okoth, Health Specialist at UNICEF Kenya. “Children are at much higher risk of getting very sick from other causes than COVID-19. We must not let this become yet another child rights crisis in Kenya.”
Back at Mathare health clinic, mothers wait patiently outside for their child’s immunisation slot. Nurses administer drops in the babies’ mouths and quick injections at the top of their legs, providing vital protection against major childhood diseases.
“What I would advise other mothers is that it’s very important to have your children vaccinated,” says Leonida Nyanchama, another mother holding her baby after her appointment. “Even though there is COVID-19, let’s follow the guidance given to prevent infection by wearing masks and sanitising. And let’s bring our children for vaccination. This is crucial for their health.”