Faced by a series of public health emergencies, Wild Polio Virus Outbreak, the protracted Cholera Outbreak, COVID-19 and Post Flood Recovery, Malawi’s health care delivery including immunization was gravely impacted in 2022. Coverage of the Third dose of the DPT vaccine was at 86% the lowest since 2018. The burden of zero- dosed and under immunized populations also increased rising to from 3% in 2019 to 6% in 2022 with widened equity gaps.
In line with the Immunisation Agenda 2030 goal of leaving no one behind, the Ministry of Health (MOH) with support from the World Health Organisation (WHO) conducted a rapid gender, equity and human rights analysis and barrier assessment to assess the differential impact gender related domains have on Immunisation and document strategies to address the identified gaps. The findings revealed that gender related inequalities and unfavorable socio- cultural practices were key barriers to healthcare services access including immunization, High illiteracy especially amongst women, limited decision-making power among women, adolescent marriages, and pregnancies were found to influence distally ability to seek health care services including immunisation. With regards immunization, whilst most women were more willing to have their children immunized, most of them needed authorization from men to access services for themselves and for their children, Men were however less targeted with immunisation information and often failed to provide the appropriate informed consent.
Programmatic interventions including health education and information materials often had little consideration for the needs of persons living with disability such as visually impaired and the hearing impaired thereby limiting their ability to make informed decisions.
To address these issues, WHO- Malawi with funding from GAVI, The Vaccine Alliance and in collaboration with Ministry of Health and Ministry of Gender, Community Development and Social Welfare in Malawi, is working to address the highlighted barriers. Technical and financial support was provided to implement key recommendations from the assessment to bridge equity gaps and ensure a Gender, Equity and Human Rights inclusive Immunisation programme that ensures access for all. Initial efforts have been focused on three pilot districts namely Mangochi, Thyolo and Blantyre.
“It is vital for men to understand the benefits of immunization, without their involvement and support, women and children will always be hindered. This starts with creating awareness on the importance of vaccines, the required routine process and addressing of myths and misconceptions at family level, where all parties can understand the benefits and consequences to create a sense of responsibility. Men can be reached in spaces where they socialize- places they play games, business spots or hang out joints to promote understanding and encouragement on peer-to-peer level. Deliberate strategies need to be put in place to reach out to women in complex work environments like women working in tea plantations in Thyolo. Women should not have to choose between engaging in economic activities and accessing vaccines”.
She added that improving access to immunization requires addressing these dependencies and breaking cultural barriers that limit gender equality in health decisions.
“Strategies should be tailored to incorporate approaches that work for all. People with disabilities are sidelined, health facilities are far, and it is sometimes difficult to walk long distances, we are looked down upon and are often exploited and humiliated in cases of sexual and reproductive health both at community and health facility level”. He further explained that health information material should also be inclusive and meet the needs of all including the visually impaired and hearing impaired.
“Misconceptions such as claims that vaccines reduce sexual desires and cause barrenness must be tackled with sensitivity and provision of timely accurate information for all to understand. If these are not debunked, some women will always be left behind for fear of divorce when they take vaccines. Male involvement in health advocacy should be strengthened. Issues such as frequency of visits to hospital for activities such as child welfare clinics should be strengthened. Issues such as frequency of visits to hospital for activities such as child welfare clinics should be explained to all to avoid accusations of promiscuity by partners. Religious leaders who discourage congregation members from seeking vaccines and health services should be engaged and be made champions to drive change”
Janet says peer to peer conversations have proved efficient in her advocacy for change. Women have respected her views as she is the pillar of hope for women in remote areas in cases when they cannot reach to health facilities during labour. This work makes her a credible source of information and women confidently confide in her and take her advice which helps her work effectively with them and act as their referral link to health workers and hospitals within her district.
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