Vaccination is one of the most effective public health interventions to prevent and control the spread of infectious diseases. However, vaccinating nomadic populations can be difficult due to their constant mobility. In the Zinder region, implementing effective vaccination strategies for nomadic populations is a major challenge for health authorities.
Health and mobility of nomadic populations
The nomadic populations of the Zinder region are mainly pastoralists who are constantly on the move with their herds in search of pasture. This mobility makes it difficult to access health care, including vaccination. However, vaccinating these populations is crucial to prevent the spread of diseases such as polio, measles, yellow fever, and other vaccine-preventable diseases.
Indeed, Zinder, located in east-central Niger, covering an area of 155,778 km2 with an estimated population of 5,268,039 in 2023, stands out from the other regions of Niger because of the nomadic nature of its population, which affects 5 of its 11 departments.
This situation makes it difficult to provide equitable access to health services to these populations, particularly routine immunization. Despite satisfactory administrative vaccination coverage, cases of vaccine-preventable diseases continue to be recorded. According to the 2017 ECV, the region's coverage was 89% for Penta 1, 82%, for Penta 3 , 17% for the dropout rate and 5% for the proportion of Zero dose.
In December 2022, Penta 3 vaccine coverage was 104% for a specific Penta 1/Penta 3 dropout rate of 5% with extremes in Tesker 17% and Belbeji 9%, located in nomadic areas, which increases the risk of vaccine preventable diseases (VPD).
In 2023, VPD was observed in the region, particularly in the nomadic districts (NDs). The first cases of diphtheria were reported in the nomadic districts of the region (Tesker and Gouré).
The graph below provides a summary of the epidemiologic situation as of week 14 2023 with a focus on nomadic SDs.
Mobile medical teams to address vulnerability
In order to improve immunization indicators and epidemiological surveillance, a strategy for immunization in nomadic areas has been defined in a guide developed and validated by the Niger Immunization Directorate. In order to reach nomadic populations, medical teams must adapt to their way of life and in turn be mobile. Thus, mobile medical teams have been set up to reach out to nomadic populations wherever they may be.
The first step in ensuring the smooth movement of mobile medical teams was to map nomadic routes through the target HDs. To carry out this mapping, many parameters were considered, such as the different seasons synonymous with different movements, the usual grazing and resting areas, the herders' home areas, pastoral water points, pastoral structures, markets, nomadic schools, gathering sites and socio-cultural events that constitute passage corridors. Health facilities located on the seasonal nomadic route, which are good opportunities for associating a vaccination activity with the population, were also inventoried. Data from Supplementary Immunization Activities (SIAs) are also used to locate nomadic populations for routine immunization programming.
Mobile vaccinators are equipped to provide medical services independently and on the move. They travel to target populations with vaccines, carefully stored in dedicated refrigerated boxes. They are equipped with all the medical and hygienic devices required to administer the vaccines safely. The waste is then stored in a safety box before being returned to the specific waste garbage cans of the health facilities. An immunization registry is used to keep track of people who have been vaccinated and to access data useful for monitoring and evaluating the strategy implemented.
Holistic communication for successful collaboration
During their interventions, the medical teams can rely on an image box to raise awareness among the population. However, it is thanks to the involvement and support of all community actors that the vaccination of children aged 0 to 11 months is most successful.
Thus, communication strategies are implemented in order to facilitate access by nomadic populations to strategic information concerning immunization in general and the importance of respecting the immunization schedule. Consultation meetings between the various community actors are organized monthly and quarterly to share information and pool interventions, particularly with the "One Health" committee also working in the Zinder region. Collaboration with the livestock services is also essential for raising awareness and organizing vaccination sessions.
In order to ensure that as many people as possible are involved, all stakeholders are called upon: civil society organizations, community leaders and traditional chiefs. They participate in raising awareness among nomadic populations, reminding them of the importance of vaccination and encouraging them to participate in vaccination activities. Socio-cultural events, listed in each of the target zones, are also an opportunity to mobilize the communities as a whole in favor of vaccination.
This innovative immunization strategy, combining action, communication, and community engagement, overcomes barriers to routine immunization among vulnerable populations, such as nomadic populations in the Zinder region of Niger. This multi-faceted approach can be adapted for use in other immunization programs targeting vulnerable and hard-to-reach populations.
The immunization strategy in nomadic areas in Zinder, Niger, is being implemented with the support of partners such as GAVI under the Health System Strengthening (HSS) project, and the Bill & Melinda Gates and Aliko Dangote Foundations through the Routine Immunization Strengthening Program (RISP) MoU, operationalized on the ground by Askaan.
