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Leaving no one behind: Reaching every child in humanitarian settings in the Horn of Africa

By Shiferaw Dechasa & Mihiret Fekadu

Even during difficult circumstances, we all want the best for our children no matter what age they are and what situation they are in. As a parent, the first thing I wish for my son is for him to be healthy and happy, and I can assure you that every parentfeels the same way.  

Routine immunization is a crucial factor in enhancing child health and survival. It safeguards children and the whole community from devastating vaccine-preventable disease outbreaks. Yet children residing in humanitarian settings such as conflict-affected areas, remote regions, and cross-border communities still face significant barriers to accessing this fundamental health care service.  

According to the World Health Organization (WHO), in 2021, an estimated 18.2 million children worldwide did not receive a single dose ofvaccine during their childhood, with 91% of them living in lower-incomecountries. These children, primarily residing in conflict-affected, remote, and cross-border communities, are beyond the reach of government services.

The International Rescue Committee (IRC)-led REACH (Reaching Every Child in Humanitarian Settings) consortium project, created and funded by Gavi, the Vaccine Alliancewas established to help tackle this challenge. Leveraging the strengths of a broad set of partners with extensive expertise, it is well-positioned to serve fragile, poor, and remote communities living in humanitarian settingsby adopting an innovativeapproach.

In the Horn of Africa, the IRC and partners estimate that among a total of 2.71 million children under five identified within the region, 1.23 million (54.9 percent) qualify as zero-dose. Another 420,000 children (18.6 percent) qualify as under-immunized, meaning they have not received their full schedule of vaccinations and remain vulnerable to preventable infectious diseases. Based on the population data and the reach of existing government vaccination efforts, 156 districts in Ethiopia, Somalia, South Sudan, and Sudan were selected for implementation. 

In Ethiopia, the Gavi REACH project targets 179,639 affected children in six regions, namely Oromia, Tigray, Amhara, Afar, SNNP, and Gambella regional states.  These regions have experienced devastating conflicts, particularly in Tigray, Amhara, and Afar, and interruptions in primary healthcare services, resulting in children not receiving essential vaccines for three to five years. 

The project delivers immunization services to these children through innovative approaches such as geospatial mapping to precisely locate populations and optimize where vaccines are deliveredtomaximize immunization coverage; ethnographic approaches to better understandcultural norms, preferences, and barriers which helpinform the design of how best to engage communities; as well as the implementation of a hub and spoke model where service delivery points are linked to newly mapped supply chain hubs thereby reducing delivery times and, in turn, stock-outs.

Despite operating in challenging and uncertain contexts, often in remote areas with security and infrastructure challenges, the Gavi-funded REACH consortium team remains dedicated and committed to Gavi’s Vision of “leaving no one behind” in immunization.

They go to great lengths, including transporting vaccines via camels and donkeys due to the lack of road infrastructure. Additionally, the team works tirelessly to negotiate access to conflict-affected areas controlled by different armed groups. This unique approach allows the project to reach “communities living beyond the reach of traditional health systems.”

The project team coordinates with community members especially women to implement community-based activities and to ensure community participation in every step of the project. The integrated government-led women’s developmental agents mobilize community volunteers and networks through the health extension workers to create awareness of vaccination and other health-related issues.   

Besides the challenges, the strong partnership across stakeholders such as the Ministry of Health, regional health bureaus, zonal and district health offices, local and international Non-GovernmentOrganizations (NGOs), and the willingness and devotion of the health professionals on the ground are the biggest support for the work we do and the success we have had so far. Through this strong partnership, we hope to do much more and to achieve our target of reaching thousands of children with life-saving vaccines. 

The commitment of the Federal Democratic Republic of Ethiopia and, the Ministry of Health in recognizing the crucial role of immunization in reducing child morbidity is also something we recognize and appreciate. The government affirmed its responsibility to ensure that every child is protected from vaccine-preventable diseases and developed a catch-up vaccination guideline, which also supports the vision of Gavi’s REACH project. 

Today, we reaffirm our commitment to ensureevery child’s right to be healthy becomes a reality and to make immunization accessible to every child in a humanitarian setting. We equally would like to celebrate those who are working with us to save millions of children from dying from diseases that are preventable through immunization.  

(ShiferawDechasa is the Gavi REACH project director in Nairobi, Kenya, and MihiretFekadu is the communications manager for the International Rescue Committee in Ethiopia. MenaseAbrham, GaviREACH Project Coordinator, IRC Ethiopia, Sirage Mohammed, Health Manager, IRC Ethiopia, AdoniasAdugna, Humanitarian Access Officer, IRC Ethiopia, also contributed to this article.)

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