- Report -

Ukraine

Making every school a health-promoting school: global standards and indicators

Credits

author

Outcome

Improved access to essential medicines, vaccines, diagnostics and devices for primary health care

[COUNTRY STORY]

Access to vaccines for indigenous populations in Paraguay: a joint effort

Paraguay

Photo: PAHO/WHO Paraguay Vaccination teams going out in the Caaguazú region

Improved coverage of COVID-19 and routine vaccination

Indigenous communities are often marked by health inequalities. These populations are regularly marginalized with limited access to mainstream public services. In Paraguay, the COVID-19 pandemic created additional challenges to provide public health services to these, often remote, communities who are at disproportionate risk during public health emergencies. Between March 2020 and September 2021, the case fatality rate was 12.5% among this population, almost four times higher than the national rate of 3.5% [1]. To address this, between September 2021 and October 2022, the Ministry of Public Health and Social Welfare (MSPyBS) and PAHO/WHO Paraguay devised and implemented a holistic plan of vaccination across six departments out of 18 in the country, covering roughly 60% of the indigenous population. As a result, by December 2022, the case fatality decreased to 8.3%, and only 2.5% for the period between September 2021 to December 2022 for COVID-19 [2]. The plan also included the delivery of routine vaccines to increase coverage among these populations.

Key WHO Contributions

Provision of technical expertise to contextualize vaccination plan
Procurement of transportation equipment for teams and vaccines
Procurement of IT equipment to strengthen local immunization information systems
Implementation of trainings to sensitize indigenous populations on vaccine safety
Administration of vaccines in collaboration with local and national counterparts.

How did Paraguay, with the support of the PAHO/WHO Secretariat, achieve this?

The COVID-19 pandemic is a grave health threat to indigenous people around the world. Indigenous communities already experience poor access to healthcare, significantly higher rates of communicable and non-communicable diseases, lack of access to essential services, sanitation, and other key preventive measures, such as clean water and disinfectants [3]. Likewise, most nearby local medical facilities, if and when there are any, are often under-equipped and under-staffed. Even when indigenous people are able to access healthcare services, they can face stigma and discrimination, along with cultural barriers. According to the Federation for the Self-determination of Indigenous Peoples (FAPI) in Paraguay, there are approximately 115,944 indigenous people, categorized across 19 ethnic groups.

^{Administration of vaccine.}Photo credit: PAHO/WHO Paraguay.

Between March 2020 and September 2021, a total of 589 cases were identified across 14 indigenous populations in 22 municipalities of the country, with 75 deaths reported resulting in a case fatality of 12.5%. As this was substantially higher than the national rate of 3.5%, MSPyBS and PAHO/WHO Paraguay together leveraged their strong partnership to increase vaccine coverage among indigenous populations for both COVID-19 and routine vaccinations such as measles, mumps, rubella, polio, pneumococcus, rotavirus, HPV, influenza and other vaccines from the national immunization programme. The vaccination plan for indigenous communities was developed by the MSPyBS, through its expanded immunization programme and with technical inputs from PAHO/WHO Paraguay, specifically the inclusion of explicit approaches to reach and engage these populations. Vaccination teams were established by MSPyBS at the local level to cover the key areas across six departments in the country: Boquerón, Presidente Hayes, Alto Paraguay, Canindeyú, Amambay and Caaguazú. These covered roughly 60% of the total indigenous population.

PAHO/WHO Paraguay provided transportation for the vaccines and vaccination teams and procured a total of 66 computers to improve the registration and monitoring of the programme using the immunization information system. Technical support was also provided to develop a social communication strategy, emphasizing an intercultural approach through the development of audiovisual materials in nine native languages. A total of 342 indigenous health promotors and community leaders were trained on the benefits of vaccines and their safety by MSPyBS and PAHO/WHO Paraguay.

“PAHO's accompaniment came at an excellent time, because we did not have the means to reach those communities”

Lic. Marcia Gonzales, In charge of immunisation programme, XV health region, Canindeyú.

During the vaccination administration, it was observed that some doubt still persisted about the safety and effectiveness of the vaccine against COVID-19, generated by false news or inaccurate information. These doubts were effectively addressed by the trained health promotors and community leaders providing contextualized information in the native languages, such as Guarani. Subsequently, these individuals were empowered and were able to propagate the messages to other members of their communities. Furthermore, a series of workshops were organised by PAHO/WHO Paraguay using the knowledge dialogues methodology to better understand the perception of vaccination in indigenous populations. This was critical given the ongoing concerns among the population and the need to build intercultural understanding on health.

‘Knowing that, with the support of PAHO, we were able to fulfil our duty to guarantee that all people can live a dignified life and to provide protection through vaccination to indigenous peoples, is very gratifying for all the Paraguayan people’

Hector Castro – Director, National Expanded Programme on Immunization

As a result of these efforts, between July 2021 and September 2022, the vaccination teams accessed 334 indigenous communities and were able to administer a total of 101,642 vaccine doses (37,839 doses of the COVID-19 vaccine and 63,803 of regularly scheduled vaccines [4]. While cases of COVID-19 continued to increase amongst indigenous populations between September 2021 and December 2022, only 13 new deaths were reported in the same period (among 474 cases), with the general fatality rate decreasing to 8.3%, and being 2.5% over that specific period [2]. In some health districts of the Western region, such as the department of Boquerón, it was reported that, thanks to this strategy, it had been possible to vaccinate 40% of the indigenous population for COVID-19 just in 2021, increasing vaccine acceptance in the process [5].

These outcomes were possible thanks to the strong partnership between PAHO/WHO Paraguay and the MSPyBS, including members from the national immunization programme as well as the local health administrations through which much of the implementation was conducted.