Rapid improvements in immunization exercises across Rwanda over the past decade have led to a large number of infants being immunised. The endeavors target a healthy future generation.

"We have immunised 94% of the infants. We now have 8 vaccines to immunise against tuberculosis, diphtheria, tetanus, whooping cough, hepatitis, influenza, measles, polio,” explains Fidel Ngabo, the coordinator of the immunsation department in the ministry of Health.

Anicet Rwasangabo, a logistics officer with the immunisation department said that immunisation supplies for this year’s exercise had already been purchased.

"We have enough logistics like vaccines and syringes and have a distribution plan. The target population is those between 0-12 months. This year we are targeting 395,328 infants,” he said.

Rwasangabo said that, "with the push system”, once logistics are dispatched to the 40 district hospitals, they are then distributed to the other 340 health units. 

Talking about the purchase route, Rwasangana said, "We receive [logistics] twice a year from different manufacturers around the world through WHO recommendations and purchase them through UNICEF.”

Ngabo said that they expect the pneumonia vaccine by 2009 and rotavirus in 2010.

With more vaccines expected in the near future the life expectancy is expected to rise despite an underlying issue of overpopulation.

Previously, all has not been well with the immunisation sector, particularly in the aftermath of the 1994 genocide.

After the genocide, Rwanda’s health sector had been gravely devastated in urgent need of rehabilitation as many lives were at risk surviving below the poverty line. 

The exercise started long ago in 1978 as an initiative led by the ministry of health to reach out to a population beset with numerous preventable diseases and abject poverty compounded by lack of access to adequate health services.

Ngabo said that before the immunisation exercise was put in place; "Every year measles was killing 7000 out of 800, 000 infants in the country.”

Ngabo said that at the start, the immunisation team had few vaccines compared to the numerous killer diseases that children could be immunised against.

But later, the health ministry got the measles vaccine and before the genocide period registering a considerably successful immunisation trend.

A joint 2006 Demographic Health Survey by the World Health Organisation [WHO] and United Nations Children Emergency Fund [UNICEF] on Rwanda shows that the vaccination exercise sharply declined during the genocide period.

Immunisation against measles dropped from 90% to 21%. It also shows a dip in the trend of children immunised with 3 doses of DPT.

Dr. Veronique Mugisha, Director of Epidemiology and Public Hygiene with the ministry of health, in her 2002 report titled; ‘Progress and Changes in Revitalizing Routine Immunisation: Linking with communities’, describes the impact of the 1994 genocide on the health system that had began celebrating its first fruits.

"The health system was destroyed by the war and genocide of 1994, human resource base rendered insufficient,” reads the report.

In the report, she outlines; "Health education, community mobilisation, search for dropouts, organization of outreach sessions, notification of diseases, service delivery; Oral Rehydration Salts [ORS], Vitamin A,” as requirements that were needed to hastily revive the health sector.

The WHO and UNICEF report shows that after the genocide period, there was a successful recovery and  that by the end of 1995, the immunisation exercises had shot up to 80%.

The graph also shows that by 2006, 99% of children had received 3 doses of Hib vaccine.   

Ngabo said that upon implementation of Rwanda’s Millennium Development Goals 1990- 2015, the immunisation campaign moved to full throttle.

The government targets infant mortality rate drop from 107 to 50 per 1000 and increase the life span from 45 to 55 years.

The ministry of health put in place the Expanded Programme of Immunisation [EPI], a separate department to ensure an effective immunisation exercise.

Ngabo said that a combination of government and donor organisations has helped possible immunization services trickle to the grass root level. 

"Last year [2007], we used $6 million for immunisation. The government provided 32%, Global Alliance for Vaccine and Immunisation [GAVI] gave us 64%, WHO [World Health Organisation] provided 3% and UNICEF United Nations Children Emergency Fund] gave us 1% of the money,” he said.

Rwanda has three levels of health centres, said Ngabo.
"The health centers which include preventive care like immunisation, family planning and consultation. Then the second level is at district level, it includes district hospitals, there are doctors in four sections; pediatrics, surgery, gynecologists.

The third level we have referral hospitals and here are the specialists,” Ngabo detailed the present strength of the health system.

He added that the health units are evenly spread throughout the country allowing easy access to health services in rural areas.

Ngabo said that the immunisation exercise’s fast pace was due to the government’s intention to meet the MDG’s target.

Ngabo said that the present trend of the immunisation exercise was on course to achieve the government’s targets. He said that the exercise also caters for pregnant women.

"A pregnant woman should be injected against tetanus when the pregnancy is at 3 and 6 months old,” said Ngabo.
He explained that for complete dosage of all vaccines a child is supposed to receive four doses by 9 months.

"At birth the child receives BCG and polio vaccines. After 6 weeks he receives the second dose of diphtheria, tetanus, whooping cough, hepatitis B and influenza vaccines. The third dose is in 10 weeks and is a repeat of the previous vaccines.

Then the fourth is at the ninth month with the measles vaccine.”

However, Ngabo mentioned that there are some infants who miss dosages because of forgetful parents.

"The women who don’t return with children between 6 to 14 weeks are 3%. Then those between 6 to 9 months are 9%,” he said.

He said that the parents’ forgetfulness has prompted the door to door strategy.

"We send health teams into the communities and they reach out to families reminding them to take the children for immunisation. We also carry community campaigns teaching the masses the importance of immunisation,” said Ngabo.

But despite forgetful parents, the immunisation process is largely a success.

Ngabo said that the fast pace of the immunisation exercise was due to efficient funding and political stability thus making Rwanda on track to meeting government targets by 2015.
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