How a locally-led initiative brought vaccines to remote villages in Ethiopia’s Amhara
In Chagni district, women’s groups, sub-district leaders and district health workers banded together to institute regular monthly vaccine outreach days, helping solve a persistent problem right at the grassroots.
- 23 January 2024
- 6 min read
- by Abinet Bihonegn
The temperatures in Chagni district, part of Ethiopia's Amhara region, run oppressively high. The district's more than 20 scattered, rural villages, each between one and five hours' walk from Chagni town, lack roads, electricity and potable drinking water. Until recently, they were short on vaccines, too.
"Delivering vaccines and other necessary equipment to remote villages by foot was not an easy task. There was a time when vaccine drugs became dysfunctional, due to a lack of sufficient portable refrigerators, and once opened, the vaccine might be useless before vaccinating the expected number of children," said Nibret Alem, deputy head of the Chagni Health District Health Office.
Each child’s visit to the vaccination outreach point was a vital contact point with the health system – an opportunity not only to deliver immunisations, but also to inquire about children’s health and well-being.
According to Nibret, back then, health workers often returned to the district headquarters without delivering, and mothers and children in rural kebeles – small, sub-district administrative units – had to travel for hours across difficult terrain to the closest health centre for access to vaccines.
Credit Deneki Berihun
But in 2022, the local government implemented a vaccination outreach programme, in partnership with local women's organisations and kebele leaders.
Since then, three times a month, for three days at a time, the district sets up three temporary vaccination sites in three kebeles: Semine Gedeba, Birzakan and Sigad Maryam. Villagers from the surrounding area say the initiative has brought about a profound change.
At the outreach session
One Sunday in December, VaccinesWork travelled to an outreach session that was being staged in the compound of an elementary school in Semine Gedeba kebele.
At around 16:00, Ayehush Atinafu, a health extension worker, arrived at the station with her colleague and set up all the necessary equipment. Ahead of each outreach date, say local authorities, the Chagni District Health Centre gathers data on the children who are due vaccines, and the children from the nearest kebeles had been assigned to the Semine Gedeba vaccination point. Those children's charts were stacked and ready.
"Accessing vaccines on specific days in the village through outreach programmes is very convenient for us. The selected vaccine days were not farming days. This gives us a good opportunity since our livelihood depends on farming."
- Atitegeb Abera, mother of three
Not just children, but also women's organisation leaders had begun to gather. Now the health workers started to call up each child up by name.
Each child's visit to the vaccination outreach point was a vital contact point with the health system – an opportunity not only to deliver immunisations, but also to inquire about children's health and well-being. Each child was weighed, and health extension workers asked mothers about the food they were providing, meting out nutritional advice based on the child's age. According to Atinafu, mothers of underweight children were counselled to visit the District Health Centre for further assistance.
Grassroots care
Atitegeb Abera, 39, a mother of three, explained how difficult it was to get her children vaccinated before the outreach programme began.
"I used to travel more than two hours on foot through rugged terrain to access the closest health centre. Because of its difficult landscape, I was unable to go alone; my eldest son had [to] miss school. There was a time I was told to come back another day," Atitegeb said.
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When the outreach programme launched, the District Health Office began to regularly set up a vaccination station at the midway point between Atitegeb's kebele and the neighbouring kebeles.
Atitegeb explained, "Accessing vaccines on specific days in the village through outreach programmes is very convenient for us. The selected vaccine days were not farming days. This gives us a good opportunity since our livelihood depends on farming."
The success of the outreaches relies on a network of collaborators at grassroots level. Beyenech Worku, a member of the women's organisation of Semine Gedeba kebele, said, "I know all mothers who gave birth recently in my specific village. The village health extension worker informed me about the vaccines [the children would need] and their vaccination dates. Accordingly, I always deliver the message to those mothers in my specific village."
And it isn't only in Semine Gedeba kebele, but across this remote region that women's organisations have been instrumental in getting the vaccination message out. Typically, organisation members will also accompany mothers to the vaccination sites. But that depends: "Sometimes, when we are busy, the mothers will go alone," Worku conceded.
A child who is not present at the temporary vaccination centre due to personal or social problems will be given an appointment at the health centre in the district capital.
Atitegeb explained that making those replacement appointments can be difficult. "If we left vaccine day due to different reasons, we were forced to go to the district another day, probably farming day," she said. "Once you missed a programme, it's not easy to get a vaccine in the district."
Belayneh Aligaz, chairman of Semine Gedeba kebele, said, "The vaccination site is [fixed] – it is known that there are three days on which vaccination is given in the kebele. However, every Sunday after the church service, we always remind the next vaccination dates. Through this, we shared the responsibility for the whole household family".
"A member of the local kebele [leadership] has been assigned and facilitates the outreach programme," the chairman added.
Involvement from diverse local figures has also improved villagers' confidence in vaccination, Atinafu, the health worker said. In years past, a large number of mothers dodged vaccinating their children due to their own prejudices against immunisation. That problem has been all but solved through active community participation in the outreach service, Atinafu attested.
Cracking the logistics puzzle
Atinafu, the health extension worker, explained that grouping together vaccinations for children from multiple villages during the outreach days provided an opportunity for more efficiently managing logistics and limited supplies.
"The vaccination site is [fixed] – it is known that there are three days on which vaccination is given in the kebele. However, every Sunday after the church service, we always remind the next vaccination dates."
- Belayneh Aligaz, chairman of Semine Gedeba kebele
"In one temporary vaccination site, 30 to 35 children have been getting vaccines," Atinafu said.
Access may have improved, but Nibret Alam, the deputy head of the Chagni District Health Office, says other challenges remain. A scarcity of syringes, vaccines, and other necessary supplies continues to trouble the district, he says.
Still, he adds, the outreach initiative has made it possible to get vaccines to the children of every isolated settlement. Since the outreach effort has been in place, the district's vaccination rate has increased, he confirmed.
