The last mile: fighting MNT in Uganda

Rajesh Anandan is the Vice President for Corporate and Foundation Partnerships at the U.S. Fund.

“A wife has to be hard working, not quarrelsome, and pretty,” according to Michael, an 18-year old young man we met while visiting a weekly tetanus vaccination initiative at a church in Kotido District, Uganda.

Tetanus vaccinations at church? That’s what “health care delivery” can look like when you’re at the very last mile of eliminating a disease.

	A UNICEF motor-bike cold-chain in Uganda.

Michael is part of a pastoral community in Karamoja which features a worst-case scenario for development: no electricity or running water; the country’s highest under-5 mortality rate; malnutrition rates frequently in excess of the “emergency” threshold; less than a quarter of the population have access to basic health services; and primary school enrollment and literacy is extremely low.

But in addition to knowing what he was looking for in a wife, Michael also knew that it was important to sleep under a bed net and that the immunizations being given to the young women after Sunday church were going to protect them and their future babies.

This is because UNICEF and its partners have helped set up and train “Village health teams” (VHTs) consisting of members of local communities who conduct outreach and education. The VHTs serve as an invaluable link between the most remote villages in Karamoja and community health clinics where basic health services are available.

However, the VHTs pushing for young women of child bearing age to visit the nearest clinics were not having much success getting women to go to the health clinics get their Tetanus Toxide (TT) vaccines. The women said that even though they understood the importance of the free TT vaccine, they didn’t have time in their grueling day to get to the health center. In fact, the only free time they did have was when they went to Sunday church – which almost all of them did.

The VHTs and the local health officials went to UNICEF health officer Joanna Nikulin with an idea — what if they were able to extend the health center to Sunday church? Joanna immediately got to work to help the local health officials and church leaders pilot the idea in Kotido District.

Through the UNICEF team’s technical support and advice, UNICEF funding to help pay for transporting cold-chain vaccines on motor bikes and conducting immunizations at church, and TT vaccines provided through UNICEF’s partnership with Pampers and P&G, the initiative got under way.

The results speak for themselves – TT vaccination coverage in Kotido District has gone from 30 percent to 65 percent in just nine months! And, UNICEF is now working with local partners to scale up the initiative beyond Kotido, to the 5 other districts in Karamoja, reaching over 1 million people in the most marginalized communities in Uganda.

As a result of initiatives like this, UNICEF and its partners are on track to eliminate tetanus in Uganda by the end of the year!

This is how the last mile in the global efforts to eliminate tetanus is being run, and with UNICEF colleagues like Joanna and her team carrying the baton, I have absolutely no doubt that we will get there!