Update from Afar: Islamic leaders champion immunisation

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Imams in one of Ethiopia’s remotest regions are helping break cultural and geographical barriers to increasing immunisation rates

HMD

Health extension workers in the Afar region of Ethiopia out on the "last mile" of reaching children with vaccines.
Credit: PATH / 2013 / Jiro Ose.

In most doctors’ waiting rooms, it’s the nurse who calls the mother and child for vaccination. In Ethiopia’s vast Afar region, where families are constantly on the move searching for water and fresh pasture for their cattle, health workers have to go out and look for their patients.

Geography is only the first barrier to increasing immunisation coverage rates in a region where less than quarter of all children receive the basic package of vaccines. Even when health workers find Afar’s shifting communities, they must overcome deeply entrenched fears and suspicions of vaccines. One nurse has described being threatend by an angry father after approaching his child for a routine immunisation check.

Yet the children of Afar cannot afford to miss out on the protective powers of vaccines. When a child falls sick here, they must travel vast distances to receive basic medical treatment.

Ethiopia’s immunisation coverage rates: no half-measures

While 94% of children in Addis Ababa are reached with three doses of the basic DTP (diphtheria-tetanus-and pertussis) vaccine, the rate plummets outside the capital. In some areas, immunisation coverage rates are as low as 12%.

Ethiopia’s Government, the second largest recipient of Gavi funding, has developed a coverage improvement plan which addresses geographical inequities through, for example, routine immunisation outreach programmes, and data and supply chain improvements.

In Afar region, which has an average immunisation coverage rate of 25%, the Regional Health Bureau is targeting geographical inequity by working closely with religious leaders to help overcome local fears and raise awareness of the power of vaccines.

Community outreach

Recognising the need for a fundamental shift in the community’s beliefs, Afar’s Regional Health Bureau turned to influential religious leaders such as Sheik Mussa Mohammed, a highly respected Islamic scholar and deputy head of the regional Islamic Affairs office. “You have the messages and we have the people. Together we can reach the community with messages that will protect our children from illness and death,” said Sheik Mussa.

With support from PATH and Gavi, the Bureau and the Islamic Affairs office invited more than 40 imams to attend an advocacy workshop on immunisation and plan how to spread the word about the importance of vaccinating children. Sheik Mussa cited a passage from a ‘Reflection of Islam in the Quran on Child Care and Protection’ which tells Muslims that it is their religious duty to protect children from any illness, including vaccine-preventable diseases.

Subsequent workshops involving more than 100 imams from across Afar have resulted in widespread dissemination of immunisation messages in mosques during Friday prayers and at religious events. During Nika - the marriage vows ceremony - imams often call upon couples to vaccinate their future children.

Increasing immunisation rates

One year after first reaching out to the Islamic community, Ibrahim Gudelle, Head of the Maternal and Child health unit at Afar’s Regional Health Bureau has already noticed an increase in immunisation coverage rates.

Following the success of its initial pilot project in Afar, the Regional Health Bureau is expanding the partnership with PATH and Gavi and reviving social mobilisation committees across the region. First established several years ago, the committees are composed of respected members of the community including administrators, clan and religious leaders, womens’ groups and health and education authorities.

“I am happy to inform you that we have seen a lot of successes, particularly in increasing our region’s coverage with the basic package of childhood vaccines. It’s a result of the involvement of Islamic leaders,” says Mr. Gudelle.

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