What happens when a community comes together and is involved in the implementation and design of health interventions?
The answer can be found in the remote, rural village of Jalasi, located in Mangochi District Malawi. Here, VillageReach and the Mangochi District Health Office (DHO) are working together to strengthen vaccine delivery by making not only HPV vaccines readily available, but also information on cervical cancer and immunization accessible and tailored to the needs of the community.
We spoke with Frank Ali, a Health Surveillance Assistant who works at the Jalasi Health Center in Mangochi and Mphatso Jussa, EPI Coordinator for the Mangochi District Health Office (DHO). They reflected on the impact of the HPV intervention and what they hope for the programs’ future in Mangochi.
What specific hardships/pain points did you endure prior to the HPV vaccination intervention? Who was impacted? How did these challenges affect their daily lives and well-being?
Frank Ali:
Before the HPV vaccination program in my area, the cervical cancer awareness and its potential progression created a substantial burden on individuals, families and the health care system.
The emotional toll of a cancer diagnosis, coupled with physical discomfort, represented significant hardships. Young women and adolescents in my area were particularly impacted by the social stigma and psychological distress associated with the diagnosis.
The psychological toll also extended to men. The social stigma associated with a spouse’s cervical cancer diagnosis also contributed to a climate of shame and reluctance to discuss sexual health openly, hindering prevention efforts and early diagnosis in my area and this was quite a challenge.
Mphatso Jussa:
The primary pain points revolved around the “last mile” delivery of vaccines, particularly in remote and hard-to-reach areas within the vast Mangochi District. This included issues such as limited transportation options (including bicycles) and difficulties in reaching the targeted but highly scattered communities and schools in the [Mangochi] district. The impact was widespread, affecting health care workers responsible for vaccine delivery, the DHO’s ability to meet vaccination targets and, most critically, the 9 to 14-year-old and adolescent girls who were the target population for HPV vaccination. These girls, often residing in rural areas, faced barriers to accessing the vaccine due to distance, lack of awareness and the logistical hurdles faced by health services in the district.
What is your role in the health system?
FA:
My role in the health system includes disease surveillance, health education, HPV and similar immunization campaigns and facilitating access to essential health services.
MJ:
My role as the EPI Coordinator involves public health management that directly contributes to reducing child mortality and morbidity, preventing epidemics and strengthening the primary health care infrastructure within the Mangochi District. I also work closely with the community, management and staff of the health centers in the district, providing immunization support services, supervision and mentorship.
What actions were taken by VillageReach to assist you? How was the assistance tailored to meet your specific needs?
FA:
VillageReach’s approach targeting 9–to-14-year-old girls to ensure HPV vaccination was specifically effective in my area [Jalasi Village]. I really liked the innovative model, which included HSA’s collaboration, community engagement and school-based vaccination campaigns. I also liked the idea of prioritizing community awareness and sensitization about HPV vaccination to overcome misinformation and build trust within the community.
A critical aspect of the awareness effort by VillageReach and the DHO was through the development and dissemination of culturally appropriate materials to educate the community about HPV, cervical cancer and the benefits of vaccination. Some of the specific resources utilized in my area included posters/charts, radio jingle messages and community theater (drama) performances designed to address common misconceptions and promote HPV vaccine uptake in my area.
MJ:
One key area of support was demand generation activities. VillageReach assisted in developing and implementing strategies to increase community awareness and acceptance of the HPV vaccine, addressing misinformation and promoting its benefits.
The assistance provided by VillageReach was tailored to meet the specific needs of the Mangochi DHO and its communities in a couple ways:
Community engagement strategies – Awareness campaigns and information, education and communication (IEC) materials were developed with cultural sensitivity and in local languages (Chichewa) to effectively resonate with the local communities in Mangochi.
Flexible implementation – The program allowed for real-time feedback on any challenges encountered during implementation, ensuring that solutions remained practical and effective in the local context of Mangochi.
What changes occurred in the lives of adolescents and other people in your community because of the HPV Vaccination solution intervention?
FA:
One thing I can point to is the increased uptake of the HPV vaccine among the target population of 9–to-14-year-old girls. This is important for a reduction in cervical cancer incidence in my area. Another thing to note is the issue of empowering these young girls and their families, fostering a sense of hope and control over their health futures.
The vaccination campaign, supported by VillageReach, helped to increase health awareness and education within the Jalasi community. Parents and guardians are now more informed about the benefits of HPV vaccination, helping with the program’s success in reaching a high vaccination coverage rate, through collaboration and engagement with local leaders and others.
A good example of how the program intervention is working in Mangochi is the integration of the HPV vaccination efforts into the existing school health program and community outreach initiatives. I appreciate how the collaboration is progressing, particularly between local community leaders and school leaders, who are conducting vaccination campaigns in schools. This makes it more convenient for girls to receive the vaccine, thereby helping to improve healthcare delivery in the Jalasi community and Mangochi district as a whole.
MJ:
VillageReach’s focus on last-mile delivery has ensured expanded vaccine coverage, even in the most remote areas of Mangochi. With higher vaccination rates, there is an expected reduction in the incidence of HPV-related cervical cancer in the long term. This provides a sense of security and improved health prospects for the young girls in our district.
The robust HPV vaccination and prevention awareness campaign, consistent availability of vaccines and the visible efforts to reach every child in the 9-to -14-year-old target group really help build trust between the communities in Mangochi and the broader health care system.
What would you like to see for the future of health care in your community and in terms of the program/HPV Vaccination solution intervention?
FA:
I feel that there is a need for deliberate effort aimed at sustaining partnerships and collaboration, including among VillageReach, DHO and others, and to instill confidence that the gains made in cervical cancer prevention can be maintained and expanded. The focus should also be on empowering HSAs through training and resources, as it builds long-term capacity for sustainable health interventions.
This speaks to the issue of sustained funding and the expansion of the HPV vaccination program beyond the Jalasi area and to ensure the target population of 9to-14 -year-old eligible girls receives the vaccine, including those who may have missed initial campaigns- This could further the long-term success of the national vaccination program.
MJ:
As someone deeply invested in Malawi’s health care, particularly in the realm of public health interventions, my primary aspiration for the HPV vaccination program is to witness the successful program interventions and outcomes observed in Mangochi not only sustained but also expanded to encompass the entire country. I would be very happy to see that every girl in Malawi, irrespective of her geographical location or socioeconomic status, has equitable access to this vital protection against cervical cancer. This comprehensive scaling would represent a significant stride towards eradicating cervical cancer as a public health threat in the country.
People-centered health systems are crucial in ensuring that health care reaches everyone, especially the hardest-to-reach. The success of the HPV intervention in Malawi demonstrates how incorporating community needs and preferences gives people a voice in the health programs that impact them. When we involve and empower the people who are at the heart of the work we do, anything becomes possible.
Read more about how VillageReach, together with the community and government, is working to increase vaccine uptake and protect girls from HPV.