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How Malawi’s health surveillance assistants advance childhood immunization

July 16, 2021 by Henry Nyaka

For Malawi’s health surveillance assistants, the job goes beyond administering vaccines.

A health worker prepares to screen children for vaccine eligibility at Malawi's Mitundu Community Hospital in rural Lilongwe. Photo: PATH

A health worker prepares to screen children for vaccine eligibility at Malawi's Mitundu Community Hospital in rural Lilongwe. Photo: PATH

By 7:30 a.m. on a typical weekday, health staff have already reported for work at Malawi’s Mitundu Community Hospital in rural Lilongwe. McEston Kachipapa is among them. He is one of many health surveillance assistants (HSAs) who serve as a vital link between rural communities and Malawi’s preventive health services.

“By the time I arrive at the hospital, I usually find a number of mothers and other caregivers already lined up to get their children vaccinated,” says Kachipapa. “They travel from surrounding villages, some traveling longer distances than others. They opt for care early in the morning so they have time to travel back home.”

Often serving the communities where they live, HSAs provide a range of preventive health services, including vaccinations that are part of Malawi’s routine childhood immunization schedule.

Staying up to date on vaccines

During each visit, HSAs are responsible for bringing children up to date on vaccine doses, providing other health services as needed, and sharing any necessary announcements, including reminders of subsequent vaccination visits.

At the Mitundu Community Hospital, routine vaccinations include the RTS,S/AS01 malaria vaccine, which is now part of the package of recommended malaria prevention measures in select parts of the country.

Children receive four doses of the RTS,S vaccine, with the first dose starting at 5 months old and the final dose given around 22 months old. However, most other vaccine doses in Malawi’s immunization schedule are administered in a child’s first year of life.

One of the major barriers to childhood immunization in the region has been a lack of access to information about childhood immunization services. For this reason, reminders about when to come back for subsequent vaccine doses are especially critical for new vaccines and for vaccines with novel dosing schedules.

“We leverage special strategies for immunization that require visits beyond the traditional time frame—such as the malaria vaccine and the measles-rubella vaccine,” Kachipapa says. “It’s really important that children receive the recommended doses at the right time. So, we remind parents when it’s time to bring children back for subsequent doses.”

Health education as part of routine care

Often, these reminders come during an HSA’s routine health talk—an important part of each vaccination visit. The health talks aim to provide guidance for staying healthy, up to date on vaccines, and well protected.

“Health promotion is a huge part of my job. Each health talk focuses on our facility’s topic of the day,” Kachipapa said. “I spend 10 to 15 minutes on the health talk—discussing health priorities, upcoming dates and doses, and answering any questions caregivers might have.”

In addition to health talks, HSAs work with village volunteers and other community groups to conduct door-to-door visits, village meetings, and other community-centered strategies to encourage caregivers to access immunization services.

HSAs also play a key role in documenting and tracing children who miss vaccine doses.

There is evidence that HSAs’ work is paying off. Since malaria vaccination began in Malawi two years ago, more than 230,000 children have received a first dose of RTS,S. These promising numbers indicate strong community demand for the vaccine.

Meanwhile, HSAs will continue issuing reminders to keep children coming back until they are fully vaccinated.

Fanny, a 27-year-old mother of two who has attended the vaccination sessions with each of her children, says her 2-year-old son, Evison, has already received all four malaria vaccine doses. She credits the health workers for keeping her on track with the vaccination visits.

“I was eager to get my son all four doses,” she says, adding that Evison received his final dose of RTS,S in November 2020.

Working alongside clinical and nursing staff within health care facilities, HSAs help foster the integration of immunization with other health services.

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