Nepal launched its biggest ever vaccination campaign to immunise 1 million children between 9 months and 15 years against measles and rubella on 26 February and is conducting over three phases across the country.
The government had organised support from WHO, UNICEF, Rotary International and the Lions Club to immunise children against measles, one of the world's deadliest and most contagious vaccine-preventable disease, which kills thousands of Nepali children under five every year. All the logistics required to get the vaccinations and volunteers to remote areas had been arranged. Minister of Health and Population, Rajendra Mahato, proclaimed: "Immunisation is a weapon of mass protection."
However, on the day the campaign was set to kick off here in western Nepal on 26 February, two teacher's unions affiliated to two political parties declared a nationwide closure of schools because their demands for benefits and salaries were not met by the government.
Even though some of the schools agreed to let their premises be used as vaccination centres, the two day shutdown resulted in a much lower turnout. Instead of administering the shots, district public health officials in the far and mid western regions were busy rearranging new dates and venues.
"Although we went ahead with the vaccination, due to the banda we could not reach all the children and 100 per cent coverage was impossible," said public health officer, Achyut Lamichane. The children who missed their shots are now in serious danger of being infected with measles.
Female Community Health Volunteers (FCHVs) who had worked tirelessly to prepare for the day, spread awareness about measles-rubella and remind families of dates and centres were disheartened by the poor attendance. Raj Kumari Tharu, a volunteer at the Somnath Janata Primary School in Vakhari VDC said, "We could not vaccinate a lot of children and we are worried whether they will show up on the rescheduled date."
"This just proves once again how irresponsible our politicians are," said Tara Sharma, a primary teacher at Shiva Higher Secondary School in Satakhani, Surkhet. Health experts compare this to Sri Lanka where even during the separatist war, there would be ceasefires on vaccination days.
Health officials are now trying to salvage as much of the vaccination as possible in western Nepal and moving on to the next phases in the central and eastern regions. But even there, there are strikes and bandas, and officials are keeping the dates open so as not to have the same disruption as in the west.
The last anti-measles and rubella vaccination campaign was carried out in 2005 at a time when there was a war going on. Yet, despite the conflict and lack of resources, Nepal's anti-measles vaccination campaign has been credited with reducing the burden of the disease by 95 per cent. If this year's anti-measles campaign is successful, health officials say, it can be the last. Nepal can deal with this major childhood killer with booster shots and routine immunisation.
Women volunteers to the rescue
"The programs done by the female volunteers in our village have made me more aware about my family's health. I ask questions and try to keep myself well informed," she explained.
Over the past 10 years, Satakhani has made dramatic progress in early childhood development, thanks to female health volunteers. Indeed, Nepal's dramatic decline in maternal mortality and infant mortality has been credited to the work of the nearly 65,000 female community health volunteers across the country.
Kamala Khatiwada, a teacher at Shiva Higher Secondary School says: "The volunteers work very hard alongside mothers groups to keep the women informed about sanitation, safe delivery practices, and pre-natal care."
Each ward in the VDC also has a child care centre where parents who are busy working in the fields or outside their homes can drop off their children. Moreover, the enrolment rates in primary schools have increased significantly due to the efforts of the dedicated mothers groups.
The involvement of local communities in places like Satakhani has not only led to greater awareness and better access to health services but is also helping the country meet the Millennium Development Goals (MDGs). According to the MDGs Progress Report for 2010, the ratio of girls to boys in primary education has experienced such incredible growth in the past 20 years that we have already met the 2015 target.
Similarly, the maternal mortality rate which was 415 in 2000 declined to 229 in 2010 and the under-five mortality rate dropped from 84 in 2000 to 50 in 2010. Nepal is likely to fulfil most of the UN's requirements in the next three years, if we continue to progress at the same speed.
Cities are worse off
While most people assume that children living in poor rural communities face greater hardships, findings from UNICEF's annual report show that children in cities from poor families are the most vulnerable to disease and exploitation and are denied clean water, education and healthcare.
The State of World's Children 2012: Children in an Urban World which was launched in Kathmandu on 5 March, highlights the effects of rapid urbanisation on the billion plus children who now live in urban areas. While cities provide better health and education facilities and offer greater economic opportunities, growing population and the wide gap between the urban rich and urban poor means that access to services is increasingly difficult.
Despite their proximity to maternity and obstetric emergency services, the report says, the poor in cities are deprived of such services which in turn leads to high urban child mortality rates.
The situation is worse in slum areas where one-third of children are unregistered at birth. Low levels of hygiene and sanitation in overcrowded slums put children at higher risk of disease and disasters. Most slum dwellers fare worse than their rural counterparts in health, sanitation and nutrition indicators.
Similarly, children of migrants, refugees and internally displaced people who make up a large part of the urban poor are at a huge disadvantage because they don't have birth certificates. Without papers, children and their families are virtually non-existent in official accounts, are unable to access government support and live in constant fear of eviction.
Even when education is provided free of charge, many children are not able to attend schools because of soaring costs of uniforms, books and supplies. But when children stay out of schools, they are in danger of being trafficked or exploited by their employees in dangerous jobs.
UNICEF recommends urgent changes in urban planning, and infrastructure development, so that the needs and priorities of urban children are fulfilled.
Read UNICEF's report summary: