From Declaration to Action: Improving Immunization in Africa


By Joyce Nganga

Joyce Nganga is policy advisor with WACI Health, an African regional health advocacy NGO headquartered in Kenya.

Inviolate Akinyi, a 46-year-old grandmother, got her granddaughter immunized using a mix of private and public clinics. Credit: Veronique Magnin – Habari Kibra Volunteer

NAIROBI, Kenya, Apr 25 2018 (IPS) – Inviolate Akinyi, a 46-year-old grandmother, is certain that her grand-daughter needs to get all her vaccines for her to grow up healthy and strong. She uses a mix of private and public clinics in Kibera, one of the largest informal settlement in Nairobi, to get the 15-month-old the shots she needs.

Mary Awour, mother to two-year-old Vilance Amondi, also believes immunization is important to protect her child against infectious diseases. She got all the required vaccines for him at the public Kibera South Hospital.

But many children in Africa are not as fortunate as these two children. Instead, they are faced with health threats like diphtheria, measles, mumps, whooping cough, rubella, tetanus, diarrhea, pneumonia and other childhood disease.

While immunization is a critical intervention for preventing these diseases, millions of children do not have access to them because of state fragility or conflict, lack of parental education, religious practices–and too often—inability to access the vaccines because of cost or geographic location. Children in remote rural or mountainous areas face greater barriers to vaccine access.

As recently as 2000, slightly under 10 million children died globally from vaccine preventable deaths before their fifth birthday. The numbers declined to 6.3 million by 2013 but sub -Saharan Africa accounted for 50 percent of the under-five deaths worldwide.

Mary Awour mother to two-year-old Vilance Amondi said she got all the required vaccines for him at the Kibera South Hospital which is government facility. Credit: Veronique Magnin – Habari Kibra Volunteer

While Africa has made significant gains in immunization in the last 15 years, one in five children still do not have access to life-saving vaccines. Of the more than 19 million children worldwide who did not get the three doses of Diphtheria, pertussis and tetanus (DPT) in 2013, 40 percent or 7.6 million were from sub-Saharan Africa.

According to a UNICEF report, in 2016, more than half of all children unvaccinated for DTP3 lived in just six countries, three of them in Africa: Nigeria, Ethiopia, and Democratic Republic of the Congo.

That same year, African leaders signed the Addis Declaration of Immunization (ADI), pledging to ensure that everyone receives the full benefits of available vaccines to inoculate them against infectious diseases like measles, mumps, rubella, hepatitis B, polio, tetanus, diphtheria, and pertussis.

The Declaration, which was ratified in January 2017, contains ten commitments including: increasing vaccine-related funding, strengthening supply chains and delivery systems, attaining and maintaining high quality surveillance for targeted vaccine preventable diseases, developing an African research sector to enhance immunization implementation, and making universal access to vaccines a cornerstone of health and development effort in Africa.

These steps to scale up immunization rates on the content in line with the rest of the world and achieving the targeted Global Vaccine Action Plan (GVAP) rate of 90 percent national coverage, and 80 percent coverage in every district or administrative by 2020. To date, representatives from 50 African countries have signed, and three statements of support were signed by civil society organizationsreligious leaders and parliamentarians to support implementation of the ADI.

At only 80 percent coverage in Africa, routine immunization is the lowest of any region in the world. This is unsatisfactory since immunizations have long been proven as a cost-effective way to improve global health—and in the current age, a critical pathway to attaining the sustainable development goals.

Worldwide, more than three million deaths are prevented annually as a result of vaccinations. In the case of debilitating diseases like polio and meningitis, vaccines prevent permanent disabilities as well. Effective immunization programs are being heralded now for the impending eradication of the polio virus. One of the most lethal childhood infections, only eight cases were recorded in the world last year—in Afghanistan and Pakistan.

For Africa and elsewhere in the developing world, universal access to immunization is central to enabling individuals lead productive lives and for the continent to reach its full potential. Increasingly, we recognize that good health is a major driver of economic growth and must be at the center of all development plans. The cornerstone of this is strong immunization programs and sustainable systems.

As the world and Africa commemorates this year’s immunization week, in the full glare of GAVI transition, a challenge to universal access to immunization for poor and middle-income countries, our call to government is to re-examine their commitments and contributions towards domestic resources to ensure all children access immunization and that the gains made, will be sustained and even surpassed.

Women like Inviolate and Mary demonstrate the commitment of mothers to protect their children. It is up to government to remove the barriers, create the policy environment and make the resources available to fund routine immunization for every child.


Engaging Southern Africa Development Community (SADC) leadership on HIV and Sexual and Reproductive Health and Rights (SRHR) in East and Southern Africa (ESA) region

Despite progress in development and delivery of efficacious HIV prevention interventions, more than one million HIV incident cases are recorded annually. There is global momentum to fast track HIV prevention when evidence from countries that have reached treatment targets demonstrates that the world will not end AIDS without stemming new HIV infections.

Eastern and Southern Africa (ESA) Region has made good progress in addressing the HIV epidemic. Between 2010 and 2016, the number of new HIV infections declined by 29%; among children was a 56% drop whereas in adults a 24% decrease was noted. Declines in new infections were greatest in Mozambique, Uganda and Zimbabwe but in Ethiopia and Madagascar HIV incident rates increased – South Africa constitutes a third of all new infections in ESA region! In spite of these remarkable decline in new HIV infections, it’s not sufficient to reach targets of ending AIDS by 2030.

In 2016, the UN political declaration on ending AIDS by 2030 was preceded by establishment of a Global Coalition on HIV prevention with set targets and commitments. Achieving these targets, one may argue that it largely depends on a holistic approach in prevention which appreciates the structural barriers to access services. In recognition of this challenge, under the leadership of AIDS Rights Alliance for Southern Africa (ARASA) and UNAIDS, WACI Health among other civil society convened in Johannesburg ahead of the Southern Africa Development Committee (SADC) ministers of health meeting. It is from this consultation that civil society mobilized to discuss strategies on a national and regional level that have worked to address structural barriers to HIV prevention and where scale up is needed; explore available evidence; determine gaps in data and programming to inform future work and agreed on key advocacy steps that are needed to increase attention to prevention.

A panel discussion with key populations represented by Amsher, SWEAT, Tanzania IDUs and Gender DynamiX on HIV prevention

Photo credit: Jaque, UNAIDS


WACI Health participated in this meeting in her capacity as the secretariat to AfNHi. AfNHi is an African led network of HIV prevention research advocates based in Africa borne out of a joint vision by African Advocates seeking to fast track the biomedical HIV Prevention research agenda on the continent through local ownership.

Outcomes from this events included civil society reviewed progress of HIV prevention efforts in the region and implementation of the 100-day plans developed by SADC Member States following the launch of the Global HIV Prevention Coalition Roadmap in October 2017. There is need for continued political will and leadership at the national level to ensure that HIV prevention efforts gain momentum, are person-centred and no one is left behind – this among others is explicitly laid out in the Southern Africa Civil Society Statement  developed.

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Enhancing Social Accountability in Kenya’s health sector: A UHC perspective

In recent years, the term “Universal Health Coverage” (UHC) has become increasingly visible and prominent on global and national agendas of numerous countries. What is UHC and why is this concept so attractive for countries and development partners?

Apart from having a well-designed health system, UHC equally depends on a health financing system which assures adequate financial resources for health and their equitable use. It exists when all people receive quality health services they need without suffering financial hardship. According to the World Health Organization (WHO), there are about 1 billion people around the globe without any access to health care. While access to quality health care is a constitutional right, millions of Kenyans still struggle to afford payment of health services at either public or private clinics even citizens with public health insurance. Such barriers to accessing health services does not only impact the health status of people but contributes to societal inequities and undermine sustainability of social and economic gains. Nearly 1 million Kenyans fall below the poverty line because of health care related expenditures every year and expanding health care access will reduce this burden – about 20% of Kenyans have access to some sort of medical coverage.

Moving toward UHC is a political process that involve negotiations between different interest groups such as government, private sector and community. Civil society organizations (CSOs) frequently hold critical roles in representing communities, the disease-laden and key populations/vulnerable pushing for a more equitable distribution of health resources and services.


Stimulating dialogue on Enhancing Social Accountability among health stakeholders in Kenya
Photo credit: AMREF Health Africa

March 14th and 15th, under the leadership of Health Rights Forum (HERAF), WACI Health and many CSOs herald the first ever conference on Enhancing Social Accountability in Kenya’s health sector. It provided a platform for key stakeholders to share experiences, challenges, lessons learnt including progress towards UHC. Social accountability is a key element in the Kenya Community Health Strategy and it accentuates the need for strengthening communities in realizing their rights for accessible and quality health care. In order to improve quality, access and demand for health services; public participation is crucial in that it offers citizens the opportunity to engage with government in decision-making processes, community feedback, health sector investments planning and budgeting. This also ensures that government adopts a people-centred approach in their programs and social accountability mechanisms in planning and delivery of healthcare services as highlighted in the Kenya Health Policy 2014 – 2030.

With the devolved system of health, Kenya has seen an increase in use of social accountability tools including community or county score cards, public hearings and civic education to mobilize and empower citizens to participate effectively and ensure accountability is integral in management of both national and county government resources – much still needs to be done.

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