Vaccination and other health drives to continue

Health workers in seven remote northwestern mountain districts of Nepal are gearing up for the final phase of an ambitious national measles vaccination campaign. Five of the districts form the western half of the Himalayan border with China where the major peaks are over 6,000 m. There are no roads in these areas, so the vaccines have to be flown in to the district headquarters. From there, they are carried on mules and by porters to each village. Health workers and community health volunteers hope to reach over 120,000 children who are between nine months and 15 years of age and who live in some of the highest and most remote villages in the country. Many of these villages are also in Maoist-controlled areas. With this last phase, starting on 21 April, the number of children receiving the life-saving vaccine will reach nearly 9.5 million since the campaign began in September 2004. Every year, about 150,000 children suffer from measles in Nepal and the campaign aims to cut in half the annual death toll of about 5,000 children, as well as reduce the number of children who suffer complications such as blindness, deafness and mental disability. The campaign, through the Ministry of Health (MoH), is supported by the Nepal Family Health Programme, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). The National Human Rights Commission and other human rights organisations have been instrumental in promoting the concept of vaccination as a child right, and the campaign to date has been supported by both sides in the conflict. However, there had been serious concerns that a two-week transport blockade imposed by Maoist forces in February, which ended last Saturday, could have impeded the campaign. “It is vital that these supplies reach remote areas as soon as possible,” Carol Bellamy, executive director of UNICEF, said in a press statement on 4 March. She was also referring to the ‘National Vitamin A Programme’ that is scheduled to be held on 18 and 19 April. UNICEF has called on all parties in the conflict to help facilitate the transport of vaccines, vitamin A and de-worming drugs. However, there are now reports that the Maoists may call another nationwide blockade on 14 March. As one of Nepal’s most successful health campaigns, the vitamin programme is organised twice a year in April and October. “The biannual vitamin A supplementation reduces the under-fives mortality rate by 30 percent, it is estimated that the programme is averting the death of some 12,000 children each year,” UNICEF representative in Nepal, Suomi Sakai, told IRIN. Around every second Nepali child is stunted and malnourished. Intestinal worm infections are also a chronic problem that further reduce the amount of iron they absorb, making them weak and anaemic. The vitamin programme is aiming to reach 3.3 million children around the country in April. It is implemented by the MoH with the support of AusAID, USAID, the Nepali Technical Assistance Group, and UNICEF. Already, the supply of drugs and vaccines has reached over 46 district headquarters around the country. There is still a big logistical challenge to carry the supplies to the primary healthcare centres in the villages. Once that happens, the rest will be easy, health workers say. The distribution is then done by female community health volunteers working closely with rural communities who have no access to health centres. Each distribution takes about two days. On the first day, each volunteer calls all the mothers with children at a common destination. The second day, she makes home visits to supplement children who failed to come and collect capsules. UNICEF is optimistic that, as with measles, that the vitamin and de-worming programmed can proceed smoothly. “In spite of the escalating armed conflict, the coverage of the programme has remained high. The main reason for this is that the female community health volunteers operate in their own communities, where they are recognised and appreciated by people in general and by both the conflicting parties,” explained Sakai. The Nepal Vitamin A Programme started initially in just eight districts in 1993. By 2002, it had expanded to all 75 districts in the country.