Polio Immunization in Yemen

A few months ago, I shared news through this blog about the approval of a new World Bank project for routine immunizations in Pakistan which included a component on polio.  Rotarian friends mentioned to me at the time that my blog post did not mention Rotary. The reason was that the project included partnerships with organizations such as the Bill and Melinda Gates Foundation, but not Rotary International. This was because the project did not focus solely on polio even though it included a component about polio, and Rotary (legitimately) targets its limited financial resources to projects focusing on polio only.  Beyond Pakistan, quite a bit is being done in developing countries on polio through routine immunizations. As Rotarians we should be aware of this.

Yemen 2016-Jul-6-feature-cover
Cover photo: Ashwak Althabibi holding her eight-month-old son Najran, who was vaccinated as part of the campaign. Photo credit: UNICEF.

Yesterday I came across a story about another World Bank project that included a polio component in Yemen.  As this may be of interest to some Rotarians, let me share this hopeful story below, which includes links to the project appraisal document (for those who like details, this document explains how the project works). A key message from the story is that by partnering with UNICEF and WHO, the World Bank was able to maintain disbursements for this project despite the conflict situation in the country.  As a result, the project has provided critical support for the national polio campaign which has managed to vaccinate 1.5 million Yemeni children despite the conflict.

 

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“This is so critical to us. We cannot afford to lose another child!” With these words, Ashwak Althabibi, a 36-year-old mother of six children, shared the story of losing her daughter Nora last year.

“We couldn’t get her to the hospital soon enough, and by the time we found a transportation and reached the hospital, Nora was gone,” Althabibi added with tearful eyes. She composed herself to say “I just want to thank the vaccination team for their perseverance. They come on a regular basis and vaccinate all my children. It’s a great consolation for us to feel such care.”

“No transportation can get there and it is the team’s responsibility to reach this population and to make sure all their children get vaccinated during this hard time,” commented Hana Ali Nagi, a 19-year-old health volunteer in the vaccination campaign.

Since the start of the current conflict, Yemen suffered massive damage to infrastructure, such as hospitals and clinics, and the interruption of medical supplies. Many foreign health personnel have left, and even the most basic needs for a healthy existence—access to water, sanitation, and food—have become, for most Yemenis, a daunting, daily task.

Gone too are the days when the victims of war were mostly soldiers: the Yemeni conflict has been unfair to women and children, which means the most vulnerable Yemenis are bearing the brunt of the conflict.

Thousands of Yemeni children have been killed and injured in the war, and hundreds of thousands put at more risk of death from disease or malnutrition. The UN’s Children’s Fund (UNICEF) estimates that 320,000 children now face severe malnutrition, while 2.2 million need humanitarian aid urgently to prevent their nutritional status from deteriorating.

The last two decades have been a prolonged period of political instability and economic fragility in Yemen, a country with both limited natural resources and an underdeveloped institutional capacity for project implementation.

But one lesson from previous World Bank Group experience in the health sector is that government ownership, simple project design, and donor coordination should come top of the list of the ways to make things work.

Yemen’s Health and Population Project (HPP) has a simple, evidence-based outreach delivery model for health services in coordination with UNICEF and the World Health Organization (WHO), in order to procure some of the essential medications and medical supplies needed for the outreach campaigns.

This has enabled the Bank to continue its support to the project, when the war escalated and the Bank’s whole portfolio in Yemen was suspended, through channeling grants from the International Development Association (IDA – the World Bank’s fund for the world’s poorest countries) directly to UNICEF and WHO to deliver vaccinations and basic health services such as nutrition and reproductive health to children and women, respectively.

Since the project’s activities resumed in January 2016, around 1.5 million Yemeni children under five years old were reached by the national polio campaigns supported by the project, which represents about 30 percent of the whole target population nationwide.

“Conflict can have devastating, multi-generational impacts, but by leveraging our partnerships in Yemen we are able to continue investing in children’s health, which is a vital investment in the country’s future,” said Asad Alam, World Bank country director for Egypt, Yemen and Djibouti.

The outreach model aims to reach children in the places where they are living, often in remote areas that are hard to get to. It will continue to operate like this until the foundations of the country’s public health system are back in place. Simple, ready-to-go interventions are what Yemenis want to see as a practical response to their desperate need for basic health care. Health workers use different ways to deliver those services in such remote areas where camels, donkeys, or mountain climbing are usual means of transportation.

More outreach rounds for basic health services are planned, although the security situation prevents access to children in some areas. But overall, because of the problems of damaged infrastructure, fuel shortages, displacement and increased poverty, the simple outreach model of delivering basic health services is best suited to Yemen’s present situation. A door-to-door health round gives children the chance of getting vaccinated at home, with health professionals and volunteers spreading out across the country, mobilizing communities and vaccinating children.

Hopefully, soon peace will mark a new chapter, both in rebuilding Yemen and its health system, and improving the lives of all Yemenis and particularly its future, the children.

Thanks go to UNICEF for sharing real stories and photos from the field.

This story is reproduced from the World Bank website.