Halima Aso (left) with fellow Women’s Federation member, Aysha Hodale in Berhale, Kebele 01. Photo: Therese Bjorn Mason, PATH.
Emily Loud, Gavi.
“There are so many sad stories,” says Halima Aso, 48 year old mother of 8 from Berhale – a rural area of Afar, Ethiopia. “There were many lives claimed from measles outbreaks, even my own child died from measles. Most families have lost at least one child like this. My relatives, my neighbours, they all lost children. Sometimes, even 5-6 children at one time. This was normal life.”
Halima’s loss may have been seen as typical, but her response was not. She is now a member of the local Women’s Federation, and has been trained to talk to her community about the benefits of vaccination – including clearing away misunderstandings that can put protection out of reach.
“One of the misperceptions was that vaccines will bring infertility to women, or that if the child receives a vaccine, that child will become paralysed. These were the beliefs. Now there is a huge improvement – almost all children are getting immunised.”
Halima’s region faces a variety of challenges to vaccinating children. Between the sweltering heat, that makes vaccine vials harder to transport, and the nomadic lifestyle maintained by many communities, key vaccines had been reaching just 12% of children in some areas. More generally, DTP3 (diphtheria, tetanus, pertussis) vaccines protect only around half as many children as they do in Ethiopia’s urban areas. In response, Halima and her colleagues have been part of broader efforts to engage rural communities in routine immunisation across Afar, as part of a pilot project that has been going since 2015. Supported by international organisations PATH and Gavi, as well as by the government of Ethiopia, the project has focussed on so-called “demand generation” activities. This means equipping parents in Yalo and Behale with the knowledge and the confidence to bring their children to be vaccinated.
Alongside women’s community leaders like Halima, other advocates such as teachers, marketplace speakers and religious leaders are involved. These influencers can ensure that parents repeatedly hear positive immunisation messages from trusted sources, and over time are engaged to protect their children from preventable diseases. Together, they have so far reached and informed around 21,000 people.
And it’s not just immunisation. Across the project’s two districts, health workers and mobilisers make the most of outreach sessions, using the opportunity to speak to the community about other aspects of 16 health packages, including family planning and hygiene.
Hasan Aliyu (left), Walie Kebele Administrator in Yalo District, with imam, Yahya Ibraham also from Walie. Photo: Therese Bjorn Mason, PATH.
Building bridges with religious leaders has been a particularly important step, as local government administrator Hassan Aliyu explains. “You always have to think of the community, their cultural and religious beliefs and lifestyle, when designing a project and trying to reach these people. The bad perceptions around vaccines are usually linked to religion, and therefore the Imam is the best placed person to answer these concerns. I, as the Kebele administrator represent the government, and the government is often seen as an outside force. But the Imam is regarded as part of Afar society and his views are respected.”
Working with Imams as well as other influencers is starting to pay off already. “The work of the Social Mobilisation Committee has really transformed immunisation in our kebele – now people come to claim the vaccines for their children. They now see it as their right,” says Hassan.
But even beyond this vital success, the Afar project is exciting for another reason – its sustainability. Training community influencers and giving them the right materials is a low cost intervention, working through existing structures. More than that, it means that those who are trained remain in the community and can take ownership of the initiative, allowing it to flourish and be passed on to others. Cumulatively, this can help entire communities adopt immunisation as their right, and a key part of creating healthier prospects for generations to come.
The project will not stop here: there are already plans to expand influencing activities to traditional marriage ceremonies and birth attendants, helping immunisation messages to reach the most remote and hardest to reach families. Gavi funding will allow this work to continue over the coming years. Outside of Afar, these methods are also gaining momentum, with PATH planning on bringing the project’s approach to similarly disadvantaged communities in different countries across Africa.
In the end, this approach is a victory for both health programmes and communities, engaging local people to effectively and sustainably change their own lives for the better. Halima expresses it best: “I feel pain when remembering the past, but it makes me happy to be part of creating a different future.”
To follow the project’s journey from the start, read blog posts from 2015 and earlier this year.