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Great story worth telling of strides in childhood vaccination in Tanzania

LEMUANI Naengop looks satisfied with a job well done on his client's head. He had just finished weaving her hair into thin, Rasta-like dreadlocks, the Maasai braided hairstyle.

The traditional Maasai braiding of hair has become a popular style amongst women in urban areas and attracted some Maasai warriors to become hairdressers in towns and cities of East Africa.

The prospects of earning money in beauty salons has lured the Maasai morans, revered as brave lion hunters, to do hair plaiting, a kind of job not meant for warriors.

However, it is not hair salons only that offer the young Maasai men refuge in towns. You will also find them with their distinctive red robes, beaded jewelry, a club and a light short sword popular known as `sime,’ eking out a living as tour guides, or security guards.  Some are selling traditional herbs, bragging about their curing and strength-enhancing potential.  

But, while the young Maasai pastoralists leave their cattle behind to look for greener pastures in urban areas, their wives back home are no longer worried of the likelihood of their children to die before reaching five years of age.  That has been made possible by a digital technology revolution that has helped to expand access to routine immunisation.

Children among Maasai nomadic pastoralists are protected against preventable childhood diseases, after the Ministry of Health, Community Development, Gender, Elderly and Children with support from international health organisations, reached them out with life-saving vaccinations.

Like other children in the country, they stand a better chance of surviving past their fifth birthday than ever before after Tanzania made great strides in children vaccination.  The East African country is regarded as one of the best performing in Africa with over 90 percent of children covered for major vaccine-preventable childhood diseases.

According to Demographic and Health Survey of 2015/16, three-quarters (75 percent) of children age 12-23 months in Tanzania received all basic vaccination-one dose each of BCG, or bacille Calmette-Guerin, a vaccine for tuberculosis (TB), disease; and measles and three doses each of DPT/pentavalent and polio.

Basic vaccination coverage increased from 71 percent in 1991-92 to 75 percent in 2015-16 and coverage is lowest in Katavi Region and highest in Kilimanjaro Region (54 percent versus 93 percent), the survey said.

The government undertook a five year campaign to improve quality of immunisation data which led to a roll out of an electronic immunisation registries, data-use campaigns, and barcodes or QR codes on child health cards.

Information from the ministry of health show that by 2017 more than 600 health facilities in Tanzania were using data interventions, and more than 320,000 children were entered into the electronic immunisation registries.

In 2018, electronic systems were interlinked to create a truly digitised immunisation supply chain information system that allows healthcare workers to match vaccine doses to children, thereby increasing efficiencies and reducing wastage.

According to information obtained from Better Immunisation Data initiative, in 2018, local medical officers began using wireless digital tablets to track which children received which immunisations in a pilot scheme covering more than 1,300 health facilities across four regions.

The benefits of using electronic methods of record-keeping quickly became apparent, especially in the most remote places, for example, within the dry highland plains of the Ngorongoro plains that is home to the Maasai.

"We had challenges of knowing where the children were. But the system is helping us in data collection and tracking children from Nomadic families which keep on moving from one place to another like the Maasai," says the Immunisation and Vaccination Development Manager, Dr Dafrosa Lyimo.

Dr Lyimo told the `Daily News’ that it was earlier difficult to ensure Maasai children receive all their vaccination at the appropriate time because they were not always brought to clinics as their parents were always on the move looking for good green pasture for their animals.


The electronic system where health workers use tablets has had big implications for immunisation coverage because it made it easy to identify, record, and track children’s vaccinations, she says. Dr Lyimo says further that the electronic system has dramatically reduced time for filling paperwork, tracking down patient records, and determining which patients have not shown up for their vaccines.

"It has eased the work load of health workers as pen and papers were replaced by tablets and smartphones...just a finger tap you get medical records of mothers and infants and the vaccinations their children need," she says.

The old paperwork system was prone to challenges as coverage estimates were not sufficient, data quality often raised doubts affecting coverage estimates and data produced by aggregate reporting systems always come late and are often incomplete.

On the potential of quality data and use interventions, Dr Lyimo says she envisions a national system in which all children are recorded at birth and tracked throughout childhood.

The data which are now more relevant are used by the national-level decision-makers to drive resource allocation and other strategic decisions, she says.

The system has covered 10 regions and projections are to reach all regions by the end of the year, she says but notes that floods in some parts of the country due to heavy rainfall and Covid-19 pandemic may delay the work.

"We are proceeding but floods in some areas and Covid-19 disrupted our work. We have enough vaccine stock and the vehicles but poor infrastructure in some areas posed risks," she says. But as the old adage says necessity is a mother of invention, the floods encouraged creativity. Some districts affected by the problem in Morogoro Region opted for trains to distribute the supplies.

"We have planned to reach all the regions by the end of the year. We are going to meet the target provided the travel restrictions due to Covid-19 will not affect availability of important equipment such as the tablets," she said.

These interventions that have brought impressive success in vaccination to children are not without challenges. According to Dr Lyimo funding constraints, human resource factors, and poor or lack of network coverage in some remote are the main impediments.


Unvaccinated or under vaccinated children

Dr Lyimo says despite the success in immunisation coverage, about two per cent of children in Tanzania are unvaccinated or under vaccinated which presents quite a big challenge to the whole programme.

"We still have two per cent of children who are unvaccinated or under vaccinated. Those are so many children. So, the main challenge in our programme is that we still have so many children who have not received vaccination.

The number of unvaccinated children in Tanzania has been going down with an exception of 2013 when it rose from 123,342 in 2012 to 145,013 before going down to 47,013 in 2014 and reached 30,662 in 2017, according to Ministry of Health statistics.

Demographic and Health Survey shows the proportion of unvaccinated children has been decreasing from four per cent in 2004 to two per cent in 2010.

She said although immunisation coverage rates are usually higher in urban areas than in rural areas, evidence shows the largest number of un and under immunised children often reside in urban communities.

Lower immunisation coverage is found in poorer urban dwellers, she says.

"That may surprise many people but it is the truth. Some parents may be too much occupied with petty businesses or those activities to earn a living and neglect to take their children to clinics,"

Other challenges include shortage of staff mainly at district and lower levels although the government is making efforts to fill in the gap by employing health workers.








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Mwandishi: HENRY LYIMO

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