Nestled in the hills of Mangochi District, Malawi, is the rural village of Jalasi. To the east is the neighboring country of Mozambique, to the west is Lake Malawi. The community is a vibrant one – its market bustling with vendors, its streets alive with children playing games, and its health center full of people ready to receive their essential health services and vaccines, including the HPV vaccine.
Young girls and adolescents across Mangochi like Mayamiko Ali, have recently been the recipients of this lifesaving vaccine that protects against cervical cancer. As a 14-year-old living in Jalasi, Mayamiko fell within the target age range to receive the HPV vaccine.
At first, for Mayamiko and many other young girls in her community, accessing the vaccine was a challenge, given the remote nature of Jalasi, the limited options for transportation and delivery of both health products and health services and the lack of awareness on the importance of HPV vaccination. Stigmatization and misinformation surrounding the vaccine also contributed to community hesitancy and low uptake.
To overcome these obstacles, it is crucial that health programs routinely integrate community needs and preferences into their design and implementation, creating responsive health systems. Addressing vaccine availability, alongside stigmatization and lack of awareness about vaccination, enables communities such as Jalasi to access better care. Keeping the community in mind improves health care availability and access, leading to reduced inequities and improved outcomes.
As Mayamiko put it: “The constant threat of cervical cancer instilled fear and uncertainty in the lives of young girls like me. For young girls like me, this also meant a potential future burdened by the inability to attend school, play and associate with friends.”
Through the work of VillageReach and the Mangochi District Health Office (DHO), specifically its Expanded Programme on Immunization (EPI) Unit, to strengthen the delivery and reach of vaccines to girls aged 9 to 14 in the district, more girls and adolescents have received the HPV vaccine, leading to higher vaccination rates and better protection against cervical cancer in Mangochi.
Making immunization services, as well as information on cervical cancer and HPV vaccination, readily available within the community has given Mayamiko and her community hope for a future that is cervical cancer-free. By strengthening health supply chains and supporting communities to improve their access and availability of life-saving health products, VillageReach, in collaboration with the MoH, is assisting communities to meet health challenges head-on.
Partnering with the Mangochi District of Health
VillageReach worked with the Mangochi DHO to identify areas of support, including demand generation activities, developing strategies to increase community awareness and acceptance of the HPV vaccine and its benefits, as well as address misinformation.
This came in the form of various information, education and communication (IEC) materials, such as posters, radio jingles, drama group sessions and community sensitization messages that were tailored to the communities served by the Mangochi DHO.
These strategies incorporated the use of the local language, Chichewa, and took into account the cultural sensitivities surrounding the vaccine. The awareness campaigns were also conducted at Mayamiko’s school, leading her to become curious about the HPV vaccination program and how the vaccine could prevent cervical cancer.
“I really liked VillageReach’s focus on comprehensive community engagement related to HPV vaccination programs that also targeted young girls like myself. This really helped young people trust in the system as opposed to relying on inaccurate information from friends or other community members,” she said.
She highlighted the increase in health literacy and awareness when these campaigns were conducted in her school.
“Within a few months of the initial vaccination campaigns, including at our school at Jalasi, I feel like there was a noticeable increase in the number of girls mentioning that they too received the HPV vaccine and a growing understanding within our community about its importance.”
Incorporating Real-Time Implementation Feedback
The intervention was flexible, allowing for real-time feedback on any context-specific challenges encountered during implementation, ensuring the intervention’s effectiveness in Mangochi. DHO stewarded the HPV solution throughout, retaining local ownership and supervision.
“[The DHO has] been supervising and going there [to the community], checking how vaccination is done, checking that it is the right procedure to vaccinate the child against HPV, how many children have been vaccinated against HPV, and what’s the gap?” said Mphatso Jussa, EPI Coordinator of Mangochi DHO. “It is because of VillageReach that we go into the community and see these gaps,” he added.
Local ownership is a recipe for improved vaccine availability and uptake and can set up governments and the MoH for long-term, sustained success when a solution is in their hands. What starts as an increase in vaccination in one community can be scaled up to even more communities when the government helms these campaigns.
Mphatso now hopes to expand this program to other communities in Mangochi. “I want to see a future where all of Mangochi District is vaccinated,” he said.
Community Leaders Championing Vaccination
Jalasi Village Headman Nyson being interviewed at the Jalasi Health Center in Mangochi Distict Malawi. Photo Credit: Raisa Santos
Community leaders also played a big role in championing HPV vaccination in Jalasi. Nyson Elias Kikah, Village Headman and volunteer community health advocate, initially had reservations about the HPV vaccine.
Like many others in his community, Nyson had believed the vaccine to be a form of family planning imposed by the government and that it might play a role in infertility in women. But his perspective changed when his own wife was diagnosed with cervical cancer. After attending several sensitization meetings with HSAs, he became aware of the importance and benefits of the HPV vaccine.
“This personal experience transformed me into a passionate advocate for the program, actively supporting initiatives for community health awareness, particularly regarding HPV vaccination for women and young girls in my community,” he said.
Nyson now champions the vaccine within Jalasi and has noted how the VillageReach-led intervention has significantly contributed to destigmatizing cervical cancer and vaccination more broadly within the community.
“I’ve seen a definite increase in the number of school-aged girls and women getting vaccinated in my area. This increased uptake is encouraging, and I believe it’s contributing to a reduction in the negative impact on marriages that was previously associated with HPV-related health concerns.”
He also calls for even more extensive efforts to enhance the program’s impact, such as the use of phone messages.
“This additional channel could provide a more direct and consistent means of communication, reinforcing the messages delivered through other platforms and reaching a broader audience within the age group and community,” Nyson said. “By strategically expanding the program and fully leveraging the capabilities of mobile technology, we can significantly enhance HPV vaccination rates and contribute to a healthier community in this country.”
As with any responsive health system, it is important to incorporate the needs of the under-reached, such as women, adolescents and children. Leaders such as Nyson are trusted members of the community and are crucial for strengthening HPV vaccine acceptance, highlighting gaps that may have otherwise been overlooked.
Empowering the Community
The HPV program has not only increased awareness about the importance of vaccination against cervical cancer and increased vaccination rates, but it has also made women in Mayamiko’s community more confident to seek health care for themselves.
“The increased awareness about the HPV vaccine and cervical cancer prevention has also empowered women and girls of my age to seek early screening and understand the importance of preventive measures. Girls of my age, our parents and community leaders are all now better informed,” said Mayamiko.
Now, Mayamiko and many other girls her age in Jalasi can access both readily available information and health care services. In addition to providing protection against cervical cancer, making vaccines more available and increasing awareness about vaccination has destigmatized HPV in the community.
“The program offered quite a sense of protection and hope, alleviating the fear and misconceptions about cervical cancer that had long affected our community here at Jalasi,” Mayamiko added.
Ensuring that health care services are available when and where they are needed leads to improved health outcomes and moves us one step closer to a future where everyone, including girls like Mayamiko, has the health care they need to thrive.
“I feel immense gratitude and relief about VillageReach and the Ministry of Health’s intervention regarding the HPV vaccine program in my community, where access to health care can be challenging. The relief I feel is from how this program brings a life-saving vaccine directly to us and how this represents a significant positive change in my community.”
Mayamiko’s story is one of hope, showing how we can protect women and girls from deadly diseases and the stigma that stops us from taking necessary actions to safeguard our health. Through collaboration between the government and the community, we can make critical health care products and services more available to the hardest-to-reach.