Ghana measles campaign gives chance to tackle malaria too

Published: 14 March 2003 0:00 CET

iA recent meeting of Measles Initiative partners in Washington heard that they were on track to meet their target of immunising 200 million African children by 2006, thus saving 1.2 million lives. One of the shining lights has been Ghana, where vaccination coverage was not only 100 per cent, but it was also combined with attempts to tackle malaria.

The Measles Initiative was created in 2001 at the instigation of the American Red Cross. It brought on board key players in global public health such as the World Health Organisation, the UN Children’s Fund, the Centers for Disease Control and Prevention, the United Nations Foundation, African ministries of health and national Red Cross and Red Crescent Societies, supported by the International Federation.

The initiative was born out of the realisation that nearly half the 1.7 million vaccine-preventable deaths among children in the world are caused by measles, and well over half of these are in Africa.

Ghana was one of 12 countries that had conducted mass measles vaccination campaigns in the first 18 months of the partnership. A total of 8.76 million children under the age of 15 were vaccinated in the West African state – which translates to nearly 13,000 lives saved.

“Measles accounted for 90 percent of all vaccine preventable deaths among Ghana’s children,” Theresa Babero Nobiya, acting secretary general of the Ghana Red Cross Society (GRCS), told the meeting in Washington.

A key to the campaign’s success in Ghana was the way the GRCS succeeded in mobilizing some 14,000 volunteers – including the president and members of the governing board. Their main role was social mobilisation and communicating with the population at grassroots level. This house-to-house mobilisation was combined with mass media campaigns and “recruitment” of influential sections of the community, like churches and women’s groups to ensure that coverage was as high as possible.

“During the campaign, we were able to mobilize volunteers who would go door to door to each home, even in the more rural regions, to raise awareness about the initiative,” Nobiya said. “This way, people didn’t have to travel to other places - we came to their communities.”

Schools were targeted first, with Red Cross volunteers assisting Ministry of Health vaccination teams. In the first three days of the campaign, 80 per cent of children being vaccinated. After the school-based campaign, the GRCS took part in the "mopping-up" phase, again going house to house or even through markets to reach those children who had not yet been immunized.

In those regions where there were no Red Cross volunteers, village leaders and opinion formers were approached and new volunteers recruited from the local community, making it easier to sell the message about vaccination and counter the misinformation and rumour that inevitably surrounds such campaigns.

“Some people though that vaccination helped to spread HIV/AIDS,” Nobiya said. Recognition of and sympathy for the Red Cross emblem were powerful factors in overcoming the public’s resistance and fears.

One of the more positive aspects of the campaign for the GRCS was that it was now being regarded as a valued partner in public health campaigns both by the Ghanaian authorities and by international agencies like UNICEF and the WHO.

“The mass measles campaign opened a gateway to collaborating with the Ministry of Health and other stakeholders in other health activities,” Nobiya said. “We are now seen as true partners.”

In the case of Ghana, the Measles Initiative has proven the importance of in-country partnerships and the key grassroots role a Red Cross or Red Crescent society can play within them, because it has the power to mobilise people for the benefit of the community.

“Getting to the table early and being part of the process from the start was crucial in Ghana, as was the ability to mobilise 14,000 volunteers,” says Nick Farrell, coordinator of the International Federation’s African Health Initiative, ARCHI 2010.

One region was especially in the spotlight during the Ghana campaign – the rural north-western district of Lawra. Here, a pilot project was carried out that sought to combat another disease that claims the lives of thousands of African children every year: malaria.

In Lawra, every parent that brought a child under the age of five to be vaccinated against measles, also received an insecticide-treated bed net to protect the child against the mosquitoes that carry the disease.

Lawra, one of the poorest districts of Ghana, was chosen because bed net distribution was being carried out by UNICEF in other, less inaccessible regions. “It is very rural and very close-knit, making distribution and monitoring easy,” Nobiya said.

Prior to distribution, GRCS volunteers educated families about malaria, the importance of the nets and how to use them properly. They also made follow-up visits to homes to ensure they were being properly used.

There are those that question the wisdom of this “piggy-backing” – using the measles campaign to try to tackle other scourges, be it malaria, polio, rubella or yellow fever.

Mark Grabowsky, senior technical advisor for the American Red Cross and a proponent of such an integrated approach, is unrepentant. He believes that full advantage much be taken of gaining precious access to remote communities. In the long run, such an integrated approach saves money and provides an add-on service to recipients.

“Routine measles coverage is high, so we know that the population is being accessed. You do it and then identify the constraints,” he says. “There are different levels of complexity. Focusing on quality and measuring it allows us to improve.”

A number of problems have already been identified: there was a logistical mismatch with bed nets and vaccines sometimes arriving at different times; there was a seasonal mismatch, with measles being a dry season disease and malaria generally coming in the rainy season; and working more closely with malaria partners.

This month, surveys are being conducted to check that the nets were retained and used by recipient families. The nets will also be retreated with insecticide free of charge.

Following the experience of Ghana, there are now proposals to conduct a larger scale integrated measles-malaria pilot project in Zambia.

Related links:

Measles Initiative
Ghana: appeals, updates and reports
Profile of Ghana Red Cross Society
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