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Children need communities

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Ms. Geeta Rao Gupta, UNICEF Deputy Executive Director, meets Zena Wondimgeza, 23, a mother who has brought her 9 months old baby boy, Abraham Yeshaw, for measles vaccination, Bassona Worena District, Amhara Region, Ethiopia © UNICEF/UN010923/Tesfaye

By Geeta Rao Gupta
25 February 2016

Editor’s note: _UNICEF‘_s Deputy Executive Director for Programmes, Ms. Geeta Rao Gupta, visited UNICEF-supported maternal and child health programmes in Ethiopia ahead of the Ministerial Conference on Immunization in Africa in Addis Ababa. At the conference, African leaders including health and finance ministers will come together to commit to expanding access to vaccines for children across the continent. 

My recent visit to a health post in Ethiopia’s Bassona Worena district allowed me to see routine immunization activities, community case management and child and newborn health care programmes. The visit also emphasized one crucial element that must underpin efforts for children: the importance of community engagement.

I spoke with several community health workers, including Ms. Demem Demeke, 29, who said, “We provide promotive, preventive and basic curative health services including immunization, community case management of diarrhoea, malaria, pneumonia and sepsis, antenatal care, post-natal care and other services to our community.” And Ms Etenesh Deksios, a leader in the Health Development Army, who said, “I am always inspired to teach communities about the importance of vaccination and other child health-related issues.” The Health Development Army volunteers educate and mobilize communities to use maternal, newborn and child health services.

I was very impressed by the high level of ownership and the contribution of female health workers in the community who deliver quality health services at the grassroots level. I truly admire their professionalism and strong sense of responsibility. Community engagement helps create a conducive environment to address traditional practices, cultural beliefs and social norms that create hesitancy or even resistance to vaccination.

It is rewarding to see that, in less than a generation, African countries such as Ethiopia have made significant gains in reducing child mortality by expanding access to and demand for essential health services like immunization with the help of community health workers. Ethiopia’s 38,000 health workers are mainly women selected from local communities and paid by the government as part of the country’s flagship health extension programme.

Thanks to these concerted efforts – particularly those leveraging community engagement for child health – Ethiopia reduced under-five mortality by two thirds between 1990 and 2012, meeting Millennium Development Goal (MDG) 4 ahead of schedule.

Community involvement is a common success factor among countries that are improving their control of childhood diseases, particularly those that can be prevented with vaccines. Communication with community health workers is among the most effective means of promoting immunization in rural or marginalized populations and also contributes to broader health goals.

Despite this evidence, consistent, nation-wide investments in the capacity of health workers to engage with communities and generate demand for routine immunization and other essential child health services are still the exception – not the rule – in far too many African countries today.

UNICEF partners with traditional and religious leaders, communities and Civil Society Organizations – including women’s groups and youth associations – to support government efforts to generate data and develop and implement evidence-based strategies to facilitate community involvement and enhance demand for vaccination services.

In Africa and elsewhere, polio eradication has been transformed by the involvement of community leaders and workers. This learning needs to be reflected in routine immunization programmes more consistently. Encouraging immunization demand and health-seeking behaviors requires comprehensive and continued actions that integrate immunization and other health promotion priorities.

To maximize the return on investment in immunization programmes, Ministries of Health should allocate adequate resources to support communication and demand creation efforts as a part of an overall health systems strengthening approach. Community-based health workers and community networks are essential in this effort.

To meet and sustain demand for routine immunization, responsive, high quality services are equally important. For this, communities must be engaged in planning for vaccination services and in monitoring the immunization status of children to boost ownership, acceptance and accountability.

During my visit to the health post in Bassona Worena, I personally witnessed UNICEF’s contribution to the immunization programme. By improving the capacity of health workers to engage with communities and identify community-led solutions, UNICEF supports efforts to reduce child mortality and allow children to reach their full potential. Programmes like these must become the norm across the African continent to make the right to health a reality for all children.

Geeta Rao Gupta is UNICEF‘s Deputy Executive Director for Programmes.