wiki ya kuanzia tarehe 15 april asasi yetu ilikuwa katika maeneo ya Iringa vijijini katika vijiji vya tarafa ya Isimani vya, kinywang'anga, mkungugu, na kising'a. katika kampeni ya kupiga vita matumizi ya pombe.

siku hizo zilikuwa katika siku za maandalizi ya mwisho ya chanjo. japo haikuwa rasmi tuliizungumzia kwa kuendesha majadiliano ya dakika kumi hadi kumi na tano.

Pomoja na hilo jambo hili halikuwa rasmi kwetu, hali iliyopelekea kupata nafasi ndogo kulizungumzia.

katika uhalisia wake tatizo bado lipo, idadi ya watoto ambao wanahitaji kupata chanjo bado ni wengi, hii inatokana na uvumi na uzushi mwingi miongoni mwa jamii kuwa chanjo zina malengo maalum ikiwemo kupunguza idadi nya watu.

njia zinazotumiwa na serikali katika kufanya uhamasishaji ukweli zimekuwa za kulazimisha zaidi kuliko kuhamasisha haswa katika maeneo ya vijijini. maofisa maendeleo, watendaji wa vijiji na kata na kamati zao ndio wamekuwa wapelekaji ujumbe katika jamii kupitia mikutano mbalimbali ya vijiji.

maelezo ya kutosha kutoka kwa viongozi na watawala hayapatikani, nia na maelengo sahihi ya chanjo bado havijawa wimbo kwa jamii (havijulikani).

sioni sababu kwanini serikali isitumie mashirika ya kiraia katika kuhamasisha vema malengo,umuhimu wa watoto kupata chanjo kwa ustawi wa afya ya jamii.

meneo mengi ya vijiji ni maeneo yaliyosahaulika, ni jukumu la serikali kuhamasisha kwanza mashirika ya kiraia ili yawezeshe upashanaji habari njema za afya haswa hili la chanjo katika maeneo ya vijiji.

Toka tarehe 13 hadi tarehe 28 mwezi wa 4 tulikuwa na kazi ya kufuatilia matokeo ya utekelezaji wa mradi wetu wa kuijengea jamii uwezo wa kina kuhusu kupambana na biashara za ngono na matumizi ya dwa za kulevya katika maeneo ya machimbo, ziara iliyoweza kutufikisha kwenye vijiji vya Amani makolo, Ngemba mbili, Tingi, Mkako, Kigonsera, Mpepo, na Dar pori.Pia tuliweza kukutana CBOs zipatazo 50 ambazo ni matokeo ya mradi wetu, katika wilaya ya Mbinga mkoa wa Ruvuma. kote tulikopita hakuna taarifa wala maadalizi ya chanjo hii, na wala hakuna ushirikishwaji wowote wa taasisi za kiraia katika kampeni hizi, hii inanipa wasiwasi wa kutokuwepo kwa matokeo mazuri tarajiwa na mpango huu.
Tatizo kubwa la kutofanikiwa kwa mradi huu ni kutokuwa na mpango mzuri wa uhamasishaji jamii na elimu ndogo kwa jamii kuhusu umuhimu wa chanjo hii, jamii inaamini kuwa serekali ina mpango wa kupunguza idadi ya watu kwa kuua kizazi cha watoto kupitia chanjo hii.
Nini kifanyike sasa: kuna kila sababu ya serekali kuhusisha taasisi za kiraia katika kutoa elimu hii na kufanya kampeni, kwani taasisi hizi ziko karibu zaidi na jamii na ni rahisi kueleweka kwa jamii , kuliko hii njia inayotumika ya kutoa matangazo kwenye vyombo vya habari. wananchi wa vijijini hawana hata huo muda wa kufuatilia vyombo vya habari.

The Vaccination Week in Tanzania which was took place on 23rd April – 28th April, 2012 has contributed a lot for the positive child immunization and polio campaign sensitization towards community awareness in Iringa region and its seven (7) districts as such Iringa district, Kilolo, Iringa Urban, Mufindi. (and Njombe new Region and its districts - Makete, Ludewa, Njombe Urban, Wanging’ombe) districts observe April 23rd April – 28th April, 2012 as Infant Immunization Week, as occasion for raising awareness about the importance of immunization and polio control, in some places, intensifying vaccination activities.

Following the above, Iringa Regional Government Hospital recognizes National Infant Immunization Week because is dedicated to ensuring that every infant and woman of childbearing age in the Tanzania is fully immunized. To achieve this goal, Tanzania Ministry of Health and Social Welfare is working with global, regional, and national partners to strengthen health systems by building local capacity to offer effective and sustainable vaccination services. Immunization is encouraged during routinely provided service as part of maternal, newborn and child healthcare packages at the community health center level.

The Ministry of Health and Social Welfare of the United Republic of Tanzania (URT) strengthens the capacity of Ministries of Health to fully vaccinate all infants in a timely way with good quality services. In addition, the Ministry of Health and Social Welfare promotes infant immunization during counseling with pregnant women and mothers, including TT (tetanus toxoid) immunization for all pregnant women through focused antenatal care (FANC), and recommending Polio birth dose, (OPV0) hepatitis B birth dose, and BCG (TB) vaccines for newborns. Around the 126 districts of Tanzania, immunization prevents three million child deaths each year, and the World Health Organization (WHO) estimates that 20 percent of the remaining under-five mortality—approximately 1.6 million deaths annually—could be prevented with existing vaccines.

Based on the big contribution of Iringa Government Hospital in Tanzania towards child vaccination, immunization and polio campaign awareness, yet the Children Care Development Organization (CCDO) through its investigation team of CCDO - International Children Health and AIDS Research Center which is located within Iringa district of Iringa region has discovered several weakness within this Vaccination Week in Tanzania strategies of community awareness and polio promotion campaign.

In our observation it was seen that, in traditional Tanzania culture, families and children are the core of society. Becoming a mother is central to the life of every woman. Raising healthy children to continue your family is of unquestionable importance and joy. However, in Tanzania today, the lives of women and children are jeopardized by extremely poor health conditions. While, maternal and neonatal mortality as we all know is now a global issue, this is considering the fact that concerned stakeholders on health are now involved in the fight to ensure universal access to improved maternal and child health. Even though the developed world has a remarkably low level of maternal mortality rate (0-11/100,000 live birth), developing nations like Tanzania has one of the worst maternal mortality data in the world.

It is worthy of note that the causes of this maternal death are largely preventable if appropriate interventions are taken towards reducing the three forms of delays in accessing health care and ensuring skilled attendance at birth. As the deadline for achieving the Millennium Development Goals (MDGs) draw nearer. Tanzania seems to be moving further away from achieving MDGs 4 and 5 which is aimed at improving maternal, neonatal and child health by ensuring universal access to quality maternal health services.
Mothers' knowledge about vaccine preventable diseases is said to be correlated with immunization coverage in a population (Rahman, 1995, Quaiyam, 1997). Rahman showed that the knowledge of vaccine preventable diseases did not directly correlate with the literacy. Therefore, the mobilization of vaccine knowledge was the cost benefit way to increase the coverage without expensive education. On the other hand, it was reported that positive attitudes about vaccinations were always low regardless of the education level. This study was done at a high vaccination area in Iringa rural districts which was famous for "good health at low cost" and high literacy and low mortality (Kutty, 1989). Another report from Makete rural district showed that less than 10% of the population received the appropriate vaccination even after the successful Government Health Policy (Nichter, 1995).

These investigations demonstrate that knowledge is necessary for high immunization coverage. However, the increased knowledge about vaccine preventable diseases is not necessarily correlated with the demand and the health-seeking behavior resulting in high coverage. CCDO – International Children Health and AIDS Research Center team proposed two dimension of demand “active demand” and “passive acceptance of vaccinations”. They described in his paper that the force for immunization is mostly comes from the supply side (Government and donors) but the community demand is not so strong. Without the efficient communication with the people, it is difficult to make people understand the meaning of immunization and polio. Community demand is very weak, anyway. They concluded that health education only was not good enough to raise the community demand but social marketing was required as Coca-Cola seems to have done quite well.

CCDO is expected to promote the social mobilization and strengthen the mothers' knowledge about vaccinations because the social mobilization is one of the tactics employed in the campaigns. The CCDO Hospital strategy will be used for community education about cholera control, polio promotion immunization and for promoting oral rehydration solutions (Diets, 1997). To avoid giving inappropriate preparation the CCDO will work to disseminate correct information to mothers and communities because in this Vaccination Week in Tanzania particularly in Iringa region we didn’t hear any positive Government campaign awareness from our available local radios within Iringa Municipality rather than political scandals and Bongo Flavor music.

During our research within the Region it was seen that, misunderstandings and rumor were prevailed in some districts. It was reported that mothers had wrong knowledge about the vaccine, that it caused their children to be infertile. Inappropriate and short preparation for Iringa Government Hospital leads to inappropriate information. Oral polio vaccines were already given in routine services but repeatedly they were delivered to children in PHCs. It is reasonable for mothers to question “Why my child has to be vaccinated more than three or four times?” Rather long periods of education and preparation preceding PHCs will be needed to avoid these rumors.

In terms of social mobilization, CCDO experience in Tanzania showed that sophisticated communication method did not work for the most targeted people who were difficult to reach. The simplest messages disseminated by local leaders were sometimes the most efficient (Olive, 1997). Involving local leaders is crucial for not only the current mobilization but also the sustainability of immunization program, which means long preparation is dispensable.

Another concern over polio eradication initiative is so-called “missed opportunities”, that is, a child who is eligible for immunization and who has no contraindication to immunization fails to receive a needed vaccination (Hutchins, 1993). It is reported that if all missed opportunities were eliminated, immunization coverage would increase by a median of 17 percent of community-wide (range, 3-67 percent) and by 44 percent for clients of health services (range, 0-80 percent) (Diets, 1997). Four main reasons of missed opportunities are; 1) failure to administer immunization simultaneously; 2) false contraindications; 3) negative health workers attitudes; and 4) logistic problems.

Example in Iringa region, logistic problems was recorded during the Vaccination Week in Tanzania. In addition, it is common to keep infants away from the public for the first weeks for fear of the evil eye “jicho baya”. It is one reason for mothers having their children vaccinated late (TADREG Research Report, 1992).

A report showed the major reasons for incomplete immunization in routine vaccinations (TADREG Research Report, 1992). They randomly sampled 210 children from two districts each whose population was 20,000. Vaccine deficiency and time constraints are the major issues in these districts. However, in addition to these interviews, they conducted group discussion with the same mothers which revealed that “negative staff attitudes” was an important factor whether they came to posts to have your children vaccinated. Relationship between mothers and health workers is very important to promote vaccinations.

However, the Ministry provided more convenient vaccination compared with routine vaccination by dispatching many vaccination teams into remote areas. The next question is whether the Ministry of Health and Social Welfare discourage mothers' motivation to take their children to existing health facilities as the result of out these reach services. In fact, Diets reported that after the Ministry of Health (MoH), a coverage survey showed that 56% of children in Iringa were not fully immunized and that 16% of mothers waited for the out reach services (Dietz, 1997). The assumption is that mothers no longer want to walk miles to get to a facility only for a vaccination. The theory is that once people get accustomed to an easy condition, one no longer makes the same effort as in the past. Coercive implementation may hamper the mothers’ motivation to take children to vaccine posts. Further research is needed to know the impact.

Example, a report made by the CCDO hospital team showed the reason for incomplete immunization from the Vaccination Week in Tanzania implementation stages, it said that there were no vaccine at services centers, no time, child sick, clinic too far, lost card, relative refused, side effects, negative staff attitudes and others. There fore, one can declare that “We are all poor here, because we have no school and no health center. If a woman has a difficult delivery, a traditional cloth is tied between two sticks and we carry her for seven kilometers to the health center. You know how long it takes to walk like that? There is nobody who can help here, that’s why we are all poor here. Why this? Because poverty creates ill- health, it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. Poverty creates hunger, which in turn leaves people vulnerable to disease. Poverty denies people access to reliable health services and affordable medicines, and causes children to miss out on routine vaccinations. Poverty creates illiteracy, leaving people poorly informed about health risks and forced into dangerous jobs that harm their health.

A Vaccination Week in Tanzania especially in Iringa region where we work it was observed that this campaign were facing several constraints like lack of intervention to prevent child deaths from measles, polio, malaria and worms, limited availability of vaccines to prevent measles and polio, mebendazole to treat parasitic, worm infections and insecticide treated nets to prevent malaria, inadequate funds for funding all planned activities, delay in disbursement of funds from both government and Development partners, receiving fewer funds as compared to pledges from different sources, delays in the procurement process, and lack of adequate and qualified staffs especially at the facility level despite its good EPI Strategies 2007-2015 which aimed at to strengthen the delivery of safe and effective vaccine, to have adequate monitoring system supplies and performance, to support hard to reach/low coverage districts, to strengthen outreach services, to involve local governments in planning, to ensure availability of CFC free cold chain equipments by 2010, to ensure proper coordination between EPI and other partners, to strengthen managerial capacity at national level, to strengthen reporting system at all level, to strengthen active surveillance for polio & measles at all levels, to ensure implementation of mass campaign for measles control and polio eradication, to ensure polio free status is maintained, to strengthen community surveillance, and to establish hib/pneumococci/rota disease burden.

The way forward to remedy the constraints above, the CCDO proposed the needy of partnership in this campaign through the provision of medical material aid to its new constructed international children health and AIDS Research Center which have no medical equipment since we have no existing partner. The needed medical material aid partner is for reciprocal exchange information, experience, training our medical doctors’ staffs on the given medical material equipment, maintenance and how to operate it in ethical manners.

Through this partnership we expect to promote the vaccination week in Tanzania for the coming years in positive manner through the creation of informed demand, support and action at the household and community level of the campaign, in which the main vaccination communication campaign will tell us to closely plan, coordinate and monitor the communication and social mobilization initiative with the service components of the vaccination programme particularly if there is a measles outbreak, ensure that caregivers receive timely and accurate information about vaccination – the venue, date and time; the warning signs of measles and where to seek treatment, address possible inequalities in access to vaccines by employing social mobilisation efforts and health education specifically for the most vulnerable and ‘hard-to-reach’ groups, involve caregivers, community leaders, children and youth groups and other critical groups to garner understanding, participation and support for the emergency vaccination campaign, pro-actively address possible myths and doubts.

Many cultures in Tanzania may believe that it is necessary to withhold food and fluid when a child is ill or is known to have measles – a belief which can prove fatal for a sick and dehydrated child, be prepared for possible adverse events following immunization (AEFI). During a vaccination campaign, a clustering effect of AEFI might occur and, with it, a heightened public and media interest in vaccine and related issues and mobilise partners and the community to use all available means of communication (radio, loudspeakers, community meetings, etc.) and organisational structures (government bodies, NGOs, CBOs, FBOs, and community based groups) to quickly reach the affected population.

Finally, the CCDO believes that working in partnership is the solution all those seen weakness during the conducted vaccination Week in Tanzania so as to create behavioral communication change to the Government, political leaders and social movement activist for actors /change, health policy practitioners, health researchers, donors, and health policy law enforcers in remedying the vaccination and immunization common barriers like the major reasons which makes many caregivers to refuse to bring their children for vaccination due to their fever, diarrhoea or some other illness on the way day of the vaccination as was observed in our conducted investigation in Iringa.

However, it is our duty and other Tanzanian Civil Societies role to influence health workers and other local opinion leaders to proactively communicate to mothers that it is safe to vaccinate a child who has minor symptoms of illness. We must make health workers understand that this advice can yield negative consequences. A measles vaccination can save a malnourished child from death as the infection can be extremely dangerous to children in this fragile state. Not only is the vaccination safe, but it is key to boosting the immune system of a malnourished child – especially if the malnutrition is severe. Thus, the CCDO will continue to voice up for the needy to use formative research that will help us to determine these barriers, to define why does my baby need the polio vaccine? Why should I be a part of the Pulse Polio programme? and enable us to develop communication strategies, messages and materials to quickly supply children in emergencies with the vaccine and vitamin A supplements.

Looking for further connection based on our needy partnership for our the provision of medical material aid to our new constructed hospital –International Children Health and AIDS Research Center for the well being of Tanzanian children and pregnancy women. By Majaliwa Mbogella email mmayova@yahoo.co.uk

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