Every few minutes the universal sound of a startled baby crying draws sympathetic smiles from a dozen or so mothers waiting patiently on wooden benches to have their children immunized. At the Germame Gale health post in rural Ethiopia, health extension worker Batula Shemse pulls vaccines out of a square blue-and-white cold box and carefully prepares each syringe. Pentavalent–five crucial vaccines in one–goes in the left thigh, pneumococcal vaccine in the right thigh, polio drops in the mouth. Then she carefully records the vaccinations in a bright yellow family folder that tracks all of the health services the family receives, in the child’s personal immunization card, in the health post's immunization register and finally on a tally sheet. Two children are also there for measles vaccine.
This post, about a two-hour drive southwest of the capital of Addis Ababa, is connected to a nationwide labyrinth of more than 34,000 female front line workers dedicated to keeping their communities healthy. And for the past year or so, Ethiopia has been building up a system of volunteers called the Health Development Army to support them. Modeled after a similar approach for sharing best practices in agriculture, the female volunteers are responsible for monitoring five families each. They track pregnancies, making sure that mothers come to the clinic for prenatal care, learn about simple live-saving techniques like breastfeeding and clean cord care, and continue bringing their babies for health checks and vaccines. Immunization, offered twice a month in this community, was the cornerstone of what is now 16 packages of interventions.
I visited Ethiopia to learn about the challenges of increasing coverage rates of routine immunization. Bill and Melinda both passionately believe in the importance of reaching all children with the vaccines they need. We also focus on a handful of countries, funding an organization called JSI Research & Training Institute, Inc. in Ethiopia to pilot ways to create strong linkages between health workers and their communities with its Last Ten Kilometers project, for example.
But we are now also investing in areas we hope can benefit all countries. We are supporting ways to improve surveillance and data collection, so that health workers only have to track the most important information and governments can better allocate resources. We also invest in better ways to keep the supply chain moving. At Germame Gale, like in much of Ethiopia, the refrigerator is powered by kerosene and difficult to keep running.
Immunization data is notoriously hard to capture, and the estimates of coverage in Ethiopia have ranged from 40% to 80% (based on the third dose of the pentavalent vaccine). The government has just completed a robust national survey to provide a clearer picture, and will release it later this month. Whatever the rate, having more accurate data will be a huge step forward for a country committed to universal immunization. It will help health officials make better decisions and drive improvement. And that will make it easier for dedicated front line workers like Batula to do their jobs.