In Mozambique, vaccination programme gets off to a roaring start

There is a blazing bonfire just off the main road in Xipimanine on the outskirts of Maputo. But what is being cast on to the flames is not the traditional Mozambican spiced chicken but the used syringes from hundreds of vaccinations.

The bonfire, however basic it may seem as a medical incinerator, represents something of a triumph.

Few countries in the world are in greater need of immunisation against disease than Mozambique. Life expectancy is 38 years and malnourishment and poverty make Mozambican children particularly vulnerable to illness. So the project by the Global Alliance for Vaccines and Immunisation (Gavi) to try to reach 80% of the population by the end of 2005 has a particular urgency.

Inside the clinic, scores of women, many pregnant and many with babies and small children, are waiting patiently for their vaccinations, which today will consist of DPT-Hep B, measles and BCG. The nurse, Ricardina Graca, brings in a batch of four or five women at a time and they prepare their unsuspecting children for the jabs.

The manager of the clinic's vaccination unit, Andrew Sibinde, writes the names of the women and the vaccination they have received in a vast ledger. "On average, there are 100 children and 80 women coming in daily," said Mr Sibinde. One of the main problems is that of record-keeping in a country where even many health organisations do not have access to computers, so each person is given a yellow vaccination card which they are asked to keep safely. The ledger acts as a back-up.

Dr Manuel Novela, the national manager for the Extended Programme for Immunisation, said that the large attendance of mothers was the result of a long information process.

"People know about the importance of immunisation in a big city like Maputo, but elsewhere in the country there are still many difficulties," he said. "We use the radio to publicise campaigns and in the very rural areas we use activists to let people know. We still have a big lack of human resources, a shortage of people who are trained to carry out the programme. We still don't have enough nurses who specialise in preventive health."

Bertrand Jacquet of Unicef, one of the partners of the Gavi programme, said: "There are three main challenges here in Mozambique: firstly, the safety issue - making sure that the injection itself is safe and that the syringes are properly disposed of; secondly, reaching the rural areas, which is very hard; and thirdly, stopping the drop-out rate when there is a course of three injections.

"At the moment, about 8% of the mothers do not come back for their second injections."