Zombo reaches 94% immunisation success — District health officials

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ZOMBO - Under overwhelming obstacles, a beacon of hope is emerging in Zombo district as Village Health Teams (VHTs) members are spearheading a tireless effort to bring essential health services to their doorsteps, mobilising residents with unwavering dedication.

On a sweltering day, Patrick Kasamba, 31, a VHT member in Athuma village, Athuma sub-county proves that health is wealth, rallying his community residents to prioritise wellness and benefit from services at their monthly integrated health outreach.

Kasamba whose sub-county has no single health facility is mobilising locals to overwhelmingly turn up and take advantage of services, especially immunisation of children, treatment of common childhood illnesses, antenatal, neonatal and postnatal care, and family planning, among others.

The monthly outreach organised by Amref Health Africa Uganda in partnership with the Ministry of Health with support from the Pfizer Foundation brings together medical experts from different facilities in the district to offer medical services to locals right in their localities.

Albert Okwaimungu a health worker at Ayaka Health Centre II administers a measles vaccine to 9-month-old Maxwell Pimungu as his mother Juliet Ayiorwoth looks on. This was during a health outreach at Athuma sub-county offices in Zombo district. (Credit: Lawrence Mulondo)

"The health outreaches help us get children to get their vaccines especially those whose parents stay far away from health facilities and often find transport challenging," he said.

"I use the outreach to rally pregnant mothers especially those that live far away from health facilities to move and stay at the health facilities three weeks to their dates of delivery to reduce delays that would lead to maternal mortalities."

In a remarkable testament to community-driven healthcare, Zombo has leapfrogged from category four to the top-tier category one in children's immunization rates, thanks to the tireless efforts of Village Health Teams and targeted monthly medical outreaches around the district.

Achieving 94% success

According to the district health team, last financial year the district was lagging at 83% in the Expanded Program on Immunisation (EPI), however, following VHTs mobilisation of community members, the EPI services uptake has gone up to 94% nearly the national target of 95%.

District statistics have it that in the financial year 2021-2022, the district was in category four in regards to EPI, however, in the financial year 2023-2024, it has achieved category one.

Category one (green) means the district has good access to EPI services and their utilisation while category four (red) means poor access and poor utilisation. 

Jenaro Amathu, the Village Health Team Member for Ameri Village uses a Mid-Upper Arm Circumference (MUAC) measuring tap to detect severe malnutrition in one of the children in his community as the child’s parents Michael Oryem and Brenda Ayiorwoth look on.(Credit: Lawrence Mulondo)

The district attributes the success to the involvement of VHT members in community mobilisation and integrated community outreaches under the Strengthening Community Health Workforce program, implemented by Amref Health Africa Uganda with funding from the Pfizer Foundation.

Tadius Tumwesige, the project manager at Amref Health Africa Uganda said the project is derived from government's National Health Strategy running from 2021 to 2026, with a focus on accelerating progress towards universal health coverage through provision of quality, evidence-based based and integrated community health services.

Tumwesige said the project is anchored on the strategic direction two of the national community health strategy which he said is to ensure that the country has an equipped, competent, committed and compensated community health workforce.

"The project is being implemented in five districts of West Nile including Arua, Adjumani, Zombo, Moyo and Terego," he outlined.

Tumwesige said one of their objectives is to strengthen the contribution of community health workers towards the reduction of vaccine-preventable diseases like measles, polio, and tuberculosis, among others.

He said under this, they are supporting monthly proper pre-planned integrated health outreaches in all the five target districts on top of supporting the effective mobilization of community health workers through door-to-door home visits to ensure that all people get time to benefit from services.

He added that they also motivate the VHTs with some facilitation for the voluntary essential noble work that they do, pushing them to work even harder.

"At health facilities, line listing was introduced where VHTs sit together with the facility-based workers to identify children that are defaulting immunization," Tumwesige explained.

Tumwesige said one of their objectives is to strengthen the contribution of community health workers towards the reduction of vaccine-preventable diseases like measles, polio, and tuberculosis, among others. (New Vision/Files)

"Here VHTs go to the homes of these particular children to mobilise parents to take them for immunization, especially during the monthly outreaches in their areas."

With these interventions, three districts where the project is being implemented including Zombo, Terego and Adjumani have moved to EPI category one while two districts including Arua and Moyo have moved to category three from category four.

Tumwesige said they have also partnered with the health ministry to build the capacity of the district health teams to deliver Integrated EPI services more effectively.

"After receiving the training, members of the health teams were facilitated to cascade the same knowledge and skills to health workers who are based at health facilities, to ensure that each health work is well updated on the modalities of administration of the different vaccines, the tools which are used, the reporting and the data management.

He said under the project they have been able to support the ministry of health to guide the districts in preparation of their annual EPI improvement plans.

According to Tumwesige, by August, the project had provided essential health services to 40,422 beneficiaries.

Teopista Omyer, a child health specialist and quality control officer in Zombo district said the district's performance in terms of immunization was not good, especially for most antigens that she said were below the required targets.

Currently, the district has suppursed targets for antigens like measles and PCV and is striving hard to achieve better in giving the rest like measles and rubella two catch up.

Omyer said the district was also performing poorly when it came to administering hepatitis B doses at birth and polio zero doses at birth even though antigens were at health facilities.

She said after VHTs were sensitized and empowered they were able to mobilise the children that had missed out to get the vaccines changing the trends.

A health worker collects blood samples from a boy to test for malaria as other residents patiently wait on. This was during a health outreach at Athuma sub-county offices in Zomzo district. (Credit: Lawrence Mulondo)

"Initially, the district would rely on one parish mobilise for an outreach which would yield fewer results however after bringing VHTs on board they have been realizing high turn up for the service at times leaving workers overwhelmed," she said.

Omyer added that VHTs were sensitized on their roles including identification of health-related issues and reports, ensuring that homes are ideal with good sanitation and referring health cases to the health facilities.

Omyer noted that VHTs have mapped families that often resist government vaccination programs and that when one is organised, they inform the district leadership, especially the resident district commissioners and other stakeholders to take the lead in ensuring children are vaccinated.

Christine Acirocan, the Zombo district Assistant District Health Officer in Charge of Maternal and Child Health, said due to limited resources, the district would give VHTs sh5000 for transport during only outreaches however this would yield fewer results as VHTs would not reach far.

She however said after partners motivated them with about sh30000 whenever they mobilise communities for an activity for three days, attendance at outreaches and health facilities went up.

She said of late the district has been advocating for ANC in the first trimester however mothers would stay in villages and not come for the services even when the VHTs are in the know.

"Now that they are motivated, they mobilise mothers well to attend ANC and some offer to escort mothers to the health facilities," she said.

Proper data entry is key

Nelly Rubanga, the EPI focal person for Jangokoro Health Centre III, said they were given refresher training on immunisation, especially data entry of vaccines in the new registers and follow-up of mothers to ensure all children conclude getting their vaccines.

Tumwesige said they have also partnered with the health ministry to build the capacity of the district health teams to deliver Integrated EPI services more effectively. (New Vision/Files)

"Proper data entry has helped us follow up on the areas that are not doing well and immediately find ways on how to improve their uptake of vaccines," she said.

She said the community outreaches have helped in the improvement of the uptake of family planning as mothers would give long distances as a reason for missing out on the methods.

Tom Orwodhi the secretary for social services in Zombo district said the relationship between VHTs and the health facility workers has always been poor since they were not properly facilitated yet they are responsible for feeding facilities with health information from villages.

He said as the district leaders they are to continue mobilising health workers to continue practising what they have learnt under the project to ensure sustainability of the positive outcomes.

"We are to sit in council as leaders to see that we plan during budgetary allocations to see that within our minimal resources, we set a fee for the health sector to continue with outreaches for a healthy population," Orwodhi said.

Ephraem Alias Kumakech, the assistant principal Chief Administrative Officer Zombo district said they still have a sub-county called Athuma which has no single health centre adding that the medical outreaches help government take health services to all locals in such places.

What residents say

Juliet Ayiorwoth 22 a mother living in Athunna Athuma village Zombo district would find it difficult to get transport to Jangokoro Health Centre III, 8km away from her home to take her now nine months baby for immunisation.

"My child would have missed out on the immunisation because all the vaccines given to a baby apart from those given at birth at the health facility have been accessed by my boy during the health outreaches," she said.

Nancy Akello, a 23-year-old mother of two in Avogira village noted that having services brought to her community saves her sh14,000 that she would have spent on transport to Langi health centre three, channelling it to buying supplementary food for her children.