Lesotho’s village health workers are doing everything in their power to ensure Basotho children are vaccinated.

9 September 2022 by Monyane Khau

Some of the northern region Village Health Workers attending a function in Berea. Credit: Lesotho Times

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Immunisation is one of the most impactful and cost-effective public health interventions available, averting more than four million deaths every year. And with support from Gavi, countries such as Lesotho have been able to reduce child mortality by preventing illness and death.

In addition to Gavi support, Lesotho’s Ministry of Health says it has enlisted the help of female volunteers, known as Village Health Workers (VHW), to address challenges of possible dropouts due to problems such as caregiver complacency, forgetfulness and lack of awareness about how many vaccine doses are needed by young children and when.

“Some mothers are very stubborn; some are anti-vaccine, while, in some cases, you come across those who do not want to walk long distances to have their children vaccinated. Our work is to regularly and patiently encourage mothers to take those children for vaccinations.“

According to the United Nations Development Programme, Lesotho’s VWH unit has existed since its inception in 1978, and is now a permanent active unit within the Ministry of Health.

According to Susan Ramakhunoane, a public health nurse for the Ministry, VWHs played a critical role in the attainment of more than 100% of childhood immunisation coverage for most of the country’s ten districts last year.

She says these women are recruited and trained to undertake door-to-door campaigns that encourage expectant and nursing mothers to use antenatal care (ANC) and childhood immunisation services countrywide.

“In 2021, we aimed to have 80% of the children aged under five vaccinated at district level, which would equate to 90% at national level. But our uncleaned data indicates that most districts have over 100% coverage. That is huge,” Ramakhunoane says, adding that VHWs helped the country exceed its targets.

“VHWs know every single nursing mother in their respective villages and they visit their homes, inspect children’s health booklets and continuously encourage mothers to take their children for vaccination. This has worked in the past and continues to deliver results even now,” Ramakhunoane adds.

This is a huge improvement for the country which, according to its latest Demographic Health Survey published in 2014, had only 68% of its children aged between 12 and 23 months receiving all basic vaccinations. These consist of one dose each of BCG and measles vaccines, three doses of diphtheria, pertussis and tetanus-containing vaccine and three doses of polio vaccine.

“Basic vaccination coverage increased slightly from 62% in 2009 to 68% in 2014. Just 48% of children in Mokhotlong have received all basic vaccinations, compared to 80% of children in Mafeteng. Vaccination coverage increases with mother’s level of education,” reads the report.

In the urban Peka Health Centre in Leribe, 52-year-old VHW ’Majoale Lesupi says that the plan is to leave no expectant woman or child aged under five behind, however small the percentage may be. 

Once a month, Lesupi wakes up before 06:00 to bathe and prepare breakfast for her family ahead of a busy day. She uses one of her family rooms to measure body weights for children aged five and under. 

“I organise chairs outside the room for nursing mothers to sit while waiting for their turn to enter the room, and have their children’s weight measured. I then write a note for each mother taking their children for vaccinations at the health centre to present to my supervisor,” Lesupi says.

On some occasions, Lesupi is forced to donate food to the nursing mothers in exchange for bringing children for vaccination.

“Some mothers are on life-saving medication and they need to eat before taking such medication. Some will tell you that they are going for a ‘piece job’ on the day of vaccination and that providing food for their family is more important than child vaccination. We either give them food if we have it or allow them to bring the children on the next vaccination date as a way of cooperating with them; we just cannot leave them behind because they missed the last appointment day. We must be patient with them,” Lesupi explains.

In the rural Botha-Bothe district, 48-year-old ’Mamohale Chitja supervises VHWs from six villages that include Sephokong, Ha Mohlanka and Ha Mokhejane. Both Leribe and Bothe-Bothe are located in the northern part of the country.

“I became a VHW in 2014. My responsibilities include making sure that children aged five and under are vaccinated and regularly have their body weight measured in all the six villages that I am supervising,” Chitja says.

She adds that some mothers lack understanding about the importance of childhood immunisation and, if not monitored regularly, their children miss life-saving vaccines.

“Some mothers are very stubborn; some are anti-vaccine, while, in some cases, you come across those who do not want to walk long distances to have their children vaccinated. Our work is to regularly and patiently encourage mothers to take those children for vaccinations. To maximise impact, we also encourage expectant mothers to visit clinics because, in some cases, children aren’t vaccinated because of home deliveries,” Chitja says.

She adds that they also work together with public health nurses to bring the vaccination programme closer to the nursing mothers through community outreach programmes.

“Some cases are very special. You come across a family that literally has no food and having their children vaccinated is the least of their problems. To ensure that these children get vaccinated under these difficult circumstances, we are forced to provide food for those families even though ours is just a volunteer job. I can say we are going beyond the call of our volunteer programme to meet our targets,” Chitja says.

She warns that this work is not for the faint-hearted and that only sympathetic people can achieve results. In June alone, 17 children were vaccinated in her area of supervision.

It is difficult for mothers to admit on record that they are having a hard time prioritising their children’s lives over other needs, such as securing a piece job (work paid at a fixed rate according to the amount done, rather than the time spent doing it) to make enough money just to last their families a day.

A ward counsellor in Peka, ’Mantebaleng Maleshoetla, says that the country’s health system would have collapsed a long time ago had it not been for the dedicated work done by these volunteer women.

“There are some children who would have missed even the BCG vaccine [which tackles tuberculosis] if VHWs did not step in and help. Some women in the rural villages give birth at home and many times I have seen a VHW step in by providing home deliveries and immediately taking the mother and baby to a clinic or hospital,” Maleshoetla says, urging the Lesotho government to consider paying these women monthly stipends.

In 2019, the Ministry of Health finalised a Village Health Programme Policy aimed at addressing challenges in meeting the welfare needs of VHWs, including paying their allowance. But there continue to be challenges in effective implementation of the policy.

This story was produced and first published by the VaccinesWork.