A partnership to help vaccinate children against measles in Pakistan

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Nishat with her 2-year-old son Rashid and his 'yellow card' record of vaccinations, outside their home in Damuanna, Sheikhupura district, Pakistan. © UNICEF/PAKA2015-00116/Zaidi

By A. Sami Malik

A measles vaccination campaign in Pakistan relies on the dedication of local health workers, coordination of government authorities and the support of international partners in order to provide life-saving immunizations to millions of children.

SHEIKHUPURA, Punjab province, Pakistan, 17 April 2015 – As the vaccinator fills the syringe from a vial of measles vaccine, Nishat, 30, watches carefully while she holds her 2-year-old son. She knows the needle will hurt, but she also knows the benefit that comes with the pain.

The mother of two young boys, Waheed, 5, and Rashid, 2, Nishat is conscious about her children being vaccinated. She knows that negligence in vaccinating a child can result in serious illness or even death.

The basic health unit (BHU) in Damuanna village, in Punjab province’s Sheikhupura district, is the closest medical facility to Nishat’s house. Having visited the BHU many times in the past for the same reason, she is at ease as she waits for her child to get his vaccination. “Every child falls sick once in a while,” says Nishat. “As a mother, I get a little worried when that happens. But I know that he has been vaccinated and is protected against diseases that can put his life in danger. I know that it is important, so I never postpone it.”

With a population of a little over 3 million, according to the last census data, the district is mostly rural and agrarian. During a recent measles campaign conducted by district health authorities, with support from UNICEF, more than 1 million children in the district were vaccinated against measles – nearly 100 per cent coverage of children under age 5. As the front-line force of the health service delivery system, the lady health supervisors (LHS), lady health workers (LHW), lady health visitors (LHV) and vaccinators have played a key role in the campaign.

Rehana Kausar, an LHW from Damuanna village, visited at least 10 houses each day during the campaign to collect health data about children and their vaccination status.

“Our efforts to vaccinate children continue whether it is a campaign or routine immunization,” says Rehana. “I belong to this village and know most of the women in the community. I know which household has how many children. On the day the vaccinator comes to the village, I ensure every child who is less than 5 years of age is present to receive the measles vaccine.”

Accurate records about children’s vaccination are essential in the effort to ensure that no child is missed. In order to do that, after a child is vaccinated, an entry is made into a ‘yellow card’ that stays with the family, and also in a register maintained at the BHU.

Reaching out

Fazal Abbas is the vaccinator at BHU Damuanna. In the morning, he is at the BHU to provide routine vaccination to mothers and children, and in the afternoon he goes from house to house in nearby villages to vaccinate children against measles.

“Women in the village have to work hard at home and in the fields,” Fazal says. “At times, this keeps them from bringing their children to the BHU, and their vaccination is delayed. Guided by the LHW, I reach out to these children at their doorstep. I do not hesitate knocking at any door to ask if the children in the house have been vaccinated. If they have been, I check their vaccination cards, and if not, I vaccinate then and there. I cannot risk to ignore a child, as it could put their life at risk.”

In late 2012, an outbreak of measles in southern Pakistan quickly spread to other parts of the country. The Government of Pakistan, along with partners including UNICEF and the World Health Organization (WHO), initiated a measles vaccination campaign targeting nearly 63.5 million children up to 10 years of age. The Global Alliance for Vaccines and Immunization (GAVI) stepped in to help and has since provided 37 million doses of measles vaccine, against the total requirement of 69.4 million doses – one of the biggest measles campaigns ever supported by GAVI.

Collective responsibility

UNICEF Pakistan Representative Angela Kearney recently travelled through some of the districts of Punjab to get a firsthand look at immunization services, visiting BHU Damuanna, the Rural Health Centre Kharianwala and a number of communities in Sheikhupura district.

“A thorough and vigilant system of monitoring is essential for compiling accurate data on vaccination coverage,” Ms. Kearney said, speaking to a group of health professionals and mothers at BHU Damuanna. “It is our collective responsibility to ensure that every child is vaccinated, properly and timely, with high quality vaccines.”

She also commended the work of mothers, vaccinators and LHWs in Sheikhupura in contributing to the low incidence of measles in the area.

“There is no room for complacency. Vaccination must go on,” she added. “And I assure you that GAVI and UNICEF will continue to support your good work. What could be more rewarding then to see a healthy child and a smiling mother?”