Head nurse Nguyen Thi Vuong points to the right arm of a girl playing and asks ‘Co Tiem Chung Khong?’, Vietnamese for have you been vaccinated. The child nods and a few moments later her mother proudly shows the head nurse a Measles-Rubella vaccination certificate.
Nguyen Thi Vuong is the head nurse of A Ngo commune health centre in the remote and mountainous Da Krong district in Quang Tri province. The district borders Lao PDR, is one of 63 poorest districts in Viet Nam and home to a large group of Pa Co and Van Kieu ethic minority groups.
Overcoming linguistic and cultural barriers
Vaccinating all children in a remote, mountainous district where 80% of the people belongs to a minority group is a challenge explains Dr Chau Van Hien, Director of Da Krong district health centre: “We need to overcome not only geographical barriers, but also linguistic, cultural and planning barriers.
Vaccinating all children in a remote, mountainous district is a challenge
The Measles-Rubella immunization campaign in Viet Nam targets all children aged 1-14, equalling a total of 23 million children. Da Krong district aims to vaccinate 14 500 hard-to-reach children as part of the campaign.
Earlier this year, Viet Nam was confronted with a big outbreak leading to more than 30,000 reported infected children and the death of 150 children. Of the cases reported nationally, most were either unimmunized or their vaccination status was unknown.
To ensure all children will be vaccinated the national campaign runs in three phases. In phase one all children aged 1-5 will be vaccinated, in phase two all children aged 6-10, and in the last phase all children aged 11-14. Viet Nam has committed to eliminate Measles and Rubella and reaching every single child is critical to obtain the goal of elimination and to stop outbreaks such as the one of April 2014.
In A Ngo commune the phased approach poses a challenge. When asking parents how old their children are they cannot always remember their sons or daughters age. Most children also do not have a birth certificate. The central registry is also incomplete because not all mothers give birth in the commune health centre.
To overcome this challenge we decided to vaccinate all children all together regardless of their age and not follow a phased approach” says Dr Hien.
This was only the first hurdle A Ngo commune had to overcome. Make all parents aware of the vaccination campaign and ensure they will bring their children to the commune health centre on the day of the vaccination campaign is another one.
To reach all parents and children a hand-drawn was developed by the village health volunteer and local commune health care workers to map out every single household. With the help of the map the village health volunteer and commune health care workers mobilized all households to come to the commune health centre to vaccinate their children.
Mop-up
Local health volunteers play a very important role in mobilizing all children and parents. They know the village, the parents’ concerns and are able to speak Pa Co, the language of the Pa Co minority, as well as Vietnamese.
In spite of sound planning, a small number of children fail to receive the vaccine on the day of the vaccination campaign for various reasons. Some families are not around; some children are postponed due to fever; some show contraindications or others simply forget about it. To still reach those children it is important to conduct a so-called Mop-Up.
Makiko IIjima, immunization officer at the World Health Organization in Viet Nam, explains the mop-up activity traces the missed children to vaccinate them: In some communes across the country 1 child out of 5 still needs to be vaccinated during the mop-up activity.
The mob-up of the Measles Rubella Immunization campaign usually takes place only a few days after the actual MR Immunization campaign. In Xa Gio Hai commune, a small and remote coastal commune in Quang Tri province, 14 children are targeted during the mop-up activity.
If we wait too long to mop-up we risk forgetting about those that have not yet been vaccinated. With support of the People Committee we also engage a local health authority to visit families to address their concerns. Those extra efforts results in very high immunization coverage says Dr Loc, head of Xa Gio Hai commune health centre.