Community Health Nurses Innovate To Reach Children With Essential Services

A BACKPACK containing simple but essential medical tools is all Antoinette Segla, Principal Community Health Nurse, (CHN) needs to embark on a health outreach at Supresu, a community situated in the outskirts of the Suhum municipality of the Eastern Region.

“All I need is in this bag,” she says. “I have my face mask, sanitiser, gloves, cotton, medication box and also my vaccine carrier.”

Antoinette and her team of three other nurses have been organising child welfare and immunisation clinic at a local church premises in the community serving over 50 mothers and their children on clinic days.

But, caregivers in the community hardly patronise their services since the incident of COVID-19.

“When they heard about COVID-19, they refused to come for the clinic and we were also a bit scared initially because we didn’t have proper Personal Protective Equipment (PPE) to work with; no hand washing basin to wash our hands and fewer chairs to ensure proper physical distancing,” she adds.

The fear of getting infected with the virus, among both health workers and caregivers, have not only reduced the demand but also the supply of immunisation services.

The Expanded Programme on Immunisation (EPI) in the early days of the pandemic halted several immunisation campaigns including the Yellow Fever but after it was restored, care givers remained home with their children.

Also, community outreaches, which accounts for about 45% of the means of all immunisations, have been interrupted.

However, Antoinette and her team continue to offer routine immunisation services in the Supresu community, using innovative approaches.

Holding smaller but frequent clinics, making phone calls to caregivers who have missed the vaccination of their children and arranging an appropriate time for the vaccination, as well as going to the homes of caregivers, in some instances, are some of the innovative ways CHNs are using to reach children with essential services within the COVID-19 pandemic.

“Ours is preventive healthcare, so if they are not coming, we have to go to them. That is the nature of our work, and that is what we have signed up for and we are committed to doing it,” Antoinette says, as the team moved from one home to another, providing child welfare and immunisation services.

Good health and well-being

“We have made great progress against several leading causes of death and disease. Life expectancy has increased dramatically; infant and maternal mortality rates have declined, we’ve turned the tide on HIV and malaria deaths have halved,” she noted.

The United Nations (UN) Sustainable Development Goal (SDG) 3 highlights the interconnectedness of good health to sustainable development.

It indicates that Universal Health Coverage (UHC) including immuniaation will be integral to achieving SDG 3, ending poverty and reducing inequalities.

Immunisation has contributed to the reduction in neonatal, infant and under five mortality rates in Ghana and has demonstrated that in low resource settings, vaccination against Vaccine Preventable Diseases (VPDs) presents one of children’s best chances of survival.

Data from the World Health Organisation (WHO) Ghana, shows that through immunisation, cases of measles have reduced from over 23,068 in the year 2000 to 34 in 2018, while neonatal tetanus has been eliminated in the country since 2011. Ghana has also not reported any wild polio case since 2008 because of routine immunisation and special polio campaigns.

“Making my child available for vaccination is the best I can do to protect him and that is why I welcome the nurses into my home,” says Aboagyewaa Osei, a mother of three year-old, Kojo Osei.

For her, allowing the nurses to do their job is her way of showing gratitude for the risk they are taking to provide essential services to children.

“They come in their nose masks and gloves so there is no cause for alarm,” she adds.

The WHO has supported the Ghana EPI team to develop a guideline for the delivery of immunisation services in the context of COVID-19.

The guideline, a composite guide for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH), focuses on essential services which must be delivered in all facilities and outlines measures health workers should take in order to prevent the spread of the pandemic.

Fred Osei Sarpong, WHO EPI Focal Person, says the guideline also summarises the basic protective equipment that must be made available at all vaccination sessions.

Mr Sarpong says constant monitoring is being done to identify facilities, districts and regions, which have been hard hit by the pandemic so as to provide feedback to the EPI programme for follow-up.

“Direct support, in terms of PPEs, has also been provided to regions to enable the sustainability of EPI services in the context of COVID-19,” he adds.

Mr. Sarpong says such collaborations and innovations are needed to maintain essential services especially in a COVID-19 hotspot like Accra because, “the impact of such outbreaks may even be more damaging than COVID-19 especially, to children who would otherwise have been vaccinated.”

Dr. Kwame Amponsah-Achiano, Programme Manager of the Ghana Health Service (GHS) Expanded Programme on Immunisation (EPI), says it is through such innovation that the country can bounce back from the dip in its immunisation coverage and reach the children who were missed.

According to the World Health Organisation (WHO) County Report for 2020, the Ghana Health Service (GHS) did not achieve the targeted coverage of 95% for any of the vaccines for children under 5 years.

Specifically, there was a drop of 4,629 in the number of children vaccinated Penta-3 in 2020 compared to 2019.

A total of 167 (64.2%) districts achieved Penta-3 coverage of 95% and above compared to 178 (68.4%) in 2019. Sevenbdistricts had coverage rates of less than 50% in 2020 compared to three in 2020.

“We have not halted routine immunisation because of COVID-19,” Dr. Amponsah-Achiano explains adding “We are doing it in line with COVID-19 measures and WHO guidelines and it is gradually picking up.”

The guidelines outlines the procedure for the delivery of routine immunisation activities which focuses on the implementation of the reaching every district/child approach.

Dr. Amponsah-Achiano says regions like Bono, Bono East, North East and Northern have all been able to vaccinate more children within the same period using similar innovative practices.

BY Jamila Akweley Okertchiri