As a health volunteer in Majuni village, Mangochi District, in southern Malawi, Mathews Augustino provides communities with information on the lifesaving benefits of vaccines while addressing myths and misinformation.
This is one of several essential roles of these health volunteers, who support childhood immunization services, among other things, in villages across the country.
“I was elected secretary of the village health committee, which put me in constant touch with the health facility and health workers who provide vaccination. When I realized the challenges that health workers face in our community, I became a volunteer,” said Mathews, who has been an active volunteer since 2016.
In 2019, Malawi became one of three African countries that provide the new RTS,S malaria vaccine to children living in areas with moderate to high malaria transmission.
The pilot program, coordinated by the World Health Organization in collaboration with PATH, vaccine developer GlaxoSmithKline, and other partners, has reached more than 1 million children across Ghana, Kenya, and Malawi so far.
Village volunteers like Mathews play an essential role in ensuring this lifesaving vaccine reaches as many children as possible.
Health volunteers collaborate to reach every child
Although most parents in Mathews’ community welcomed RTS,S, he recalls addressing rumors following the 2019 subnational rollout.
“At the outset of malaria vaccination in our area, there were conflicting stories about the vaccine, so I was approached by a health worker to lead a community awareness campaign. We shared accurate information about the new prevention tool and what to expect,” Mathews said. “I had to work with caregivers, chiefs, and health workers to ensure uptake of the malaria vaccine increased.”
Recognizing the health volunteers’ importance as trusted, local sources of health information, PATH partnered with the World Health Organization and the Malawi Ministry of Health to give volunteers the tools they need to educate their communities about the malaria vaccine.
Together, PATH and partners hosted malaria vaccine orientations for peer educators and mothers groups.
In a recent two-day orientation, PATH and partners trained roughly 350 peer educators, each of whom serve five to seven villages. The attendees learned about the malaria vaccine’s four-dose schedule—children receive the vaccine from 5 months old, with the final dose given at around 22 months.
The training sought to prepare volunteers to help all eligible children receive all four doses of RTS,S. Volunteers learned key information, good practices, and common misconceptions that they can share with their communities.
For instance, volunteers can encourage parents to bring children in even if they are late for their doses. Volunteers can also emphasize that RTS,S is one part of the malaria prevention package, so vaccinated children should continue to sleep under a mosquito net every night.
With any new intervention, collaboration between health facilities and village elders is essential. In the event of new Ministry of Health guidance or a new intervention, health workers brief volunteers, who then work with local leadership to get out the message.
“We need collaboration to achieve this,” Mathews said. “All important stakeholders at the community level are involved. If everything goes as planned, there is almost zero room to miss vaccine defaulters.”
To track vaccine-eligible children, Mathews relies on an improvised record book, where he keeps a list of children under the age of 2 and their vaccine doses.
“I make a copy and share it with the health worker for our area so that during the next outreach clinic, these children aren’t missed,” said Mathews. “At the end of a clinic session, I ascertain whether health workers have understood and responded to caregivers’ questions and fears and whether all eligible children received their scheduled doses.”
Going door-to-door
At Mlomba Health Center in neighboring Machinga District, 37-year-old Veronica Major followed in her sister’s footsteps when she began volunteering.
“A normal day at the facility involves us organizing the waiting area for the caregivers,” she said. “It is usually in shade, so that children are not exposed to the rains or heat from the sun. We collect all the child health passports and arrange them according to the scheduled vaccines recorded.”
Volunteers visit each house in the villages served by their assigned health facility—this is often one of their biggest challenges, especially for those who serve large communities or multiple villages.
On Mondays, Wednesdays, and Fridays, Veronica visits caregivers in the four villages within her catchment area. She calls on 15 to 20 households per day, checking immunization records, reminding caregivers of the next vaccine visit, and referring children to the health facility if they missed doses.
“The communities know my schedule, and I usually find caregivers at their homes. We have a small chat with the mothers, and they ask any questions they couldn’t ask at the clinic,” she says.
As Malawi continues to roll out the RTS,S vaccine, PATH will continue working with partners to provide volunteers with additional training, including orientation with immunization messages and other tools such as reminder cards.
All trainings will provide the information needed so volunteers can educate their communities and help to increase vaccine uptake.
