New immunization approach in Ethiopia reaches more children

October 2012

A new approach to routine immunization in the rural Afar region in north-eastern Ethiopia nearly quadrupled the numbers of children vaccinated against measles, diphtheria, pertussis, tetanus, polio and other diseases in 2010 (from as low as 22% to nearly 80% coverage in the target area). The immunization activity used “community champions” to encourage nomadic, pastoral families to have their children vaccinated and introduced new approaches such as task shifting to improve service delivery to these hard-to-reach populations.

The Enhanced Routine Immunization Activity (ERIA) had already generated strong results among nomadic, pastoral families on a small scale in the neighbouring Somali region. With support from WHO and partners, health officials replicated the approach on a larger scale in Afar to reach more children.

Mekeya, here sitting with her child, is a community champion in the Afar region, Ethiopia.
WHO/W. Belay
Mekeya, here sitting with her child, is a community champion in the Afar region, Ethiopia.

Mekeya is a mother of four from a large rural settlement called Anderkalo. Her children have been able to complete their immunization schedules with the new services. For her, the public health value of vaccination is clear: “Immunization benefits children and mothers. It protects children from deadly diseases. Children who are immunized are healthier than others.”

The need for enhanced immunization services

Very low child immunization coverage in Afar had been troubling health officials for some time. Not only is the region remote, but much of its population is nomadic, moving regularly in search of water and grass to sustain the animals on which its livelihood depends.

This makes it hard to get children immunized. Child immunizations were mostly available at health posts in urban centres, leaving many children in rural areas at risk of infectious diseases, according to Amin Arba, head of a district health office in the region.

Amin Arba, head of a district health office in the Afar region, Ethiopia.
WHO/W. Belay
Amin Arba, head of a district health office in the Afar region, Ethiopia.

Then a deadly measles outbreak killed many children in Afar.

“Seeing the high death rates among unimmunized children during the epidemic and knowing those who survived had been immunized, local community leaders were prompted to demand better access to immunization services,” he explained.

Health partners work together to replicate success

WHO responded by working with health officials and partners to replicate the ERIA approach.

“WHO saw the potential of what had worked in one setting and then led the community advocacy to expand its reach and results,” said Dr Khaled Bessaoud, Acting WHO Representative for Ethiopia.

“We were able to boost immunization coverage in a short time, with relatively low costs, by investing in measures that had shown success, and filling in the gaps with technical assistance where it was needed,” he added.

The activity focussed on bringing together community champions to support the effort and motivate parents to get their children vaccinated.

WHO facilitated a partnership among political and religious leaders, government health offices, non-governmental organizations, UNICEF and other partners – by, for example, organizing a regional interagency coordinating committee - to win local support, expand the health workforce and plan and implement a vaccine delivery plan to meet local conditions.

The three-month operation took immunization services to children where they lived. Health workers were trained to administer vaccines; health extension workers registered children for immunizations and followed up their progress through home visits, and rural health posts were set up and equipped with vaccine cold-chain supplies to increase access to services.

Better capacity for immunization services

There were health capacity benefits to the experience as well.

“The activity changed our ways of working to get children vaccinated. It improved our planning skills and built local capacity to mobilize and coordinate whole communities,” explained Taher Juhar, a primary health worker at one of the Afar health posts.

Immunization is a one of the most cost-effective public health tools to prevent serious infectious diseases. WHO estimates that immunization averts anything between 2 and 3 million deaths each year globally.