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Quthing Struggles with Childhood Vaccination Amidst Cross Border Dynamics

10 May 2024 by Limpho Sello

 Est Read Time: 7 min(s) 42 sec(s)

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Health Minister Selibe Mochoboroane administers an antigen to a child during the African Vaccination Week official launch on May 2, 2024 in Quthing. Photo Credit: Limpho Sello.

Quthing’s Government Public Health Nurse, ‘Mateboho Khoarai-Mothupi, is keenly aware of the porous nature of the Dili-Dili River that serves as a border between Lesotho and South Africa.

Situated along the banks of the Dili-Dili River in Quthing, Lesotho nationals freely traverse to and from South Africa daily, whether it is to purchase a loaf of bread, other essential items or just meeting friends and family.

For instance, just across the Dili-Dili River lies Herschel in the Eastern Cape province of South Africa. The local chief of the Dili-Dili area Mpiti, Sekhobe Letsie, notes that intermarriage between the communities of Dili-Dili and Herschel is a prevalent and customary practice.

Moreover, Lesotho nationals frequently cross the border in search of job opportunities in grape and maize fields, or wool and mohair mills in Sterkspruit, South Africa.

However, this unrestricted and illicit movement between Lesotho and South Africa has negatively impacted childhood vaccination rates in the Dili-Dili area of Quthing district, one of the four districts situated north of the capital, Maseru, in Lesotho.

Mothupi knows this well. She says meeting childhood vaccination targets for Dili-Dili Health Centre has been difficult. This is because mothers cross the border and hardly come back to take their children for their routine childhood shots.

According to Mothupi, some mothers opt to reside on the South African side to access child grants provided by the government there, prioritising financial support over ensuring their children receive life-saving vaccination shots.

“In all the health facilities in the district, the lowest-performing one regarding immunisation is the Dili-Dili Health Centre. If I were to quantify it in terms of percentage, I would estimate it to be at least 80 percent or more,” Mothupi remarked.

Mothupi explained that in Dili-Dilli a child may have only been vaccinated once or twice before disappearing from the vaccination schedule altogether.

Despite the porous border crossings between Quthing and South Africa, which hinder health facilities in the district from reaching their childhood vaccination targets and leaving no one behind, Mothupi emphasized that Dili-Dili bears the brunt of this challenge. This is primarily because other health facilities are not situated as close to the border as Dili-Dili.

“It becomes evident during the festive season when many individuals return home from areas such as Tsatsane, Ha-Makoae, Maqokho, and Mphaki,” she explained.

Taking vaccines to the people

On May 2, 2024, Health Minister Selibe Mochoboroane inaugurated African Vaccination Week at Anywls Kop in Quthing. This annual event, earmarked by the World Health Organization (WHO), takes place during the last week of April, aiming to locate children who have missed immunisations and reach out to new ones.

It was at this launch that Mochoboroane emphasised that no child should be left behind when it comes to vaccination, as it is crucial for protecting them from diseases throughout their infancy and as they grow.

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Mochoboroane underscored that every child must receive vaccinations against diseases such as measles, rubella, polio, tuberculosis, strep throat, and numerous others to prevent illness and promote overall health.

He further emphasised that the Ministry ensures vaccines are readily accessible in all health facilities, schools, and at the community level for children to receive vaccination.

“Therefore, our greatest appeal as the Ministry is to remind all parents of their responsibility to safeguard their children’s lives by ensuring they are vaccinated,” he stated.

Four days after the launch, Mothupi informed Uncensored News that between April 29 and May 5, 2024, a total of 1,017 babies, ranging from six weeks to 59 months old, were successfully vaccinated. Additionally, eleven pregnant women received diphtheria toxoids (TD) vaccinations, with 143 first doses and 30 second doses of the Covid-19 vaccine administered. In total, 184 Covid-19 vaccines were administered during this period as part of the African Vaccination Week initiative.

Mothupi noted that besides occasional stockouts, the proximity of Quthing to South Africa poses additional challenges. Most mothers who migrated to South Africa send remittances back home.

“What often happens is that mothers simply send money without following up on their children’s routine immunisations, and sometimes grandparents forget or lose interest in taking the children to the clinic for their monthly immunisations,” she explained.

To address this gap, Mothupi explained that when some children miss their routine immunisations, health professionals in Quthing organize frequent outreach programs.

“We have only one vehicle for conducting outreach programs, which leads to significant inconsistency both on our side and within the community. This vehicle is shared among all the health facilities,” she explained.

“This situation is disheartening for us as service providers and for our clients because our irregularity in conducting outreach programs means that sometimes the message of our visits does not reach everyone in time, resulting in some individuals missing out on vaccination opportunities.”

When questioned about whether they have requested support for vehicles to ensure consistency in their outreach programs, Mothupi responded, “I would be dishonest if I said we have; we have not.”

Mothupi suggested that with both government and development partner vehicles available in the district, they could convene monthly meetings to assess the availability of these vehicles and the number of activities requiring transportation. This would enable collaborative planning to allocate vehicles efficiently for essential services within the district.

“I believe there are sufficient vehicles to provide assistance where needed, without them being specifically designated,” Mothupi remarked, based on her understanding of the situation.

She added: “At times, we receive assistance from our partners, but since we are unable to coordinate with their vehicle schedules, we often receive support when they are already on their missions.”

Mothupi proposed another solution to this problem: intensifying school vaccination campaigns. She noted that their harmonious working relationship with the Ministry of Education typically facilitates smooth access to all schools, enabling them to administer vaccines effectively.

“Even in situations where some schools are initially hesitant, the Ministry of Education intervenes. We receive official letters of authorisation which we present upon arrival at the school.

“It becomes easier because when we communicate effectively with the schools, they inform both learners and parents. Learners then bring their booklets to receive vaccinations or drops,” Mothupi explained.

More good news is that not all hope is lost in Quthing. Facilities like Quthing Government Hospital and St. Matthews Health Centre are shining examples of top-performing health facilities within the district. Their easy accessibility and presence in numerous villages make them pillars of healthcare in the region.

Teachers speak out

Learners in Quthing pose for a photo after taking their vaccine shots during the African Vaccination Week in Lesotho. Photo credit: Limpho Sello.

Uncensored News interviewed Pholohong Pre-School teacher, Makhanya Mokonyane, during the African Vaccination Week on May 2, 2024. Mokonyane, who was present with her young learners to receive vaccine shots and drops, emphasised the significance of vaccinations.

She highlighted that as teachers, they comprehend the importance of immunisations, making it effortless to collaborate with parents and health facilities to ensure that children receive their vaccinations.

Mokonyane explained that during each campaign, the Ministry of Health notifies them through the appropriate channels, after which they relay the message to parents to send their children’s vaccination booklets to school.

The health facility then visits the school to identify children in need of vaccine shots and drops, as well as those who missed previous vaccinations, while also assessing their general health conditions.

“However, a challenge we face is that some parents forget to send the booklets, while others send new booklets for their children without any vaccination history, claiming that the old ones were lost,” she explained.

“Sometimes, you will find that original booklets were left elsewhere, such as in Kapa, resulting in their vaccination records being left behind there, prompting parents to purchase new booklets.”

Contrarily, Maretsepile Mabetha, a teacher at Alwyns Kop Primary, highlighted the communication breakdown between schools and health facilities as a major challenge on their end. She noted that nurses often arrive unannounced at the school without making prior arrangements with parents and learners to bring their vaccination booklets.

“Nurses arrive unexpectedly without any communication, leaving us unprepared to facilitate the vaccination process,” Mabetha remarked.

Community collaborations

Mothupi further elaborated that Quthing health professionals have been actively collaborating with the Child Health Officer in the district. This collaboration aims to foster close coordination among health professionals, area chiefs, community councillors, and village health workers. Their collective goal is to enhance the district’s performance by ensuring consistent vaccine administration on a monthly basis throughout the year.

“These statistics should categorise babies who are younger than one year, those aged one to five years, and those older than five. By aligning ourselves with these head counts, it will aid us in evaluating our performance and conducting targeted campaigns,” she emphasised.

“Having this data will enable us to provide a solid explanation for any missed individuals, as we can locate them during campaigns even if they are part of the community. Additionally, we will be able to identify whom to trace and from which village.”

Meanwhile, Health Minister Selibe Mochoboroane highlighted the crucial role played by village health workers in vaccine administration.

“It is the responsibility of village health workers to ensure that children in their catchment areas are vaccinated by regularly checking whether they have received their shots,” he emphasised.

“Village health workers serve as the first line of defense for the Ministry of Health in disease prevention in Lesotho.”

Mochoboroane stressed that a nation leads a healthy life when diseases are prevented. He emphasised the importance of health professionals educating communities on how to protect and care for their health.

Vaccination as a fundamental human right

Representing the World Health Organization (WHO) at the African Vaccination Week launch in Quthing, Dr. Mesfin Zbelo reminded attendees that vaccination is a fundamental human right.

“Vaccination is not merely a medical intervention; it is a fundamental human right,” Dr Zbelo added.

Reflecting on this year’s theme for African Vaccination Week, titled ‘Vaccinated Communities, Healthy Communities,’ Dr. Zbelo emphasized the collective responsibility that everyone holds in ensuring that every individual has access to life-saving vaccines.

“I commend the government for joining the rest of the countries in the Africa Region to celebrate the 2024 African Vaccination Week. This shows the country’s willpower and resilience in ensuring the health systems remain responsive, particularly to children, even in adversity.

“We call on all parents to ensure their children’s routine vaccinations are up to date. It is the best thing we can do for ourselves, our families and our communities.”            

He stated that WHO remains committed to providing the government of Lesotho with the necessary support to ensure that supply chain mechanisms are responsive to the needs of the people.

Dr. Zbelo further emphasised their commitment to integrating and innovating for better responses, particularly in the context of primary health care, and to sustaining the gains made for future generations.

“It is time for us to renew our commitment to this ambition and work together to restore and strengthen essential vaccination services to save the lives of children, Dr Zbelo said.

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