Health worker Anab and her colleagues Maryam and Kaltun travel by ambulance, on foot and by donkey to bring routine vaccines to remote and nomadic families in Puntland, Somalia. The hardest part of the job is not the distance. It is trust, and they are winning it.
The day starts at the health centre, long before any child is vaccinated. “Before we leave, we prepare everything we need, like the register cards for the children, the cold boxes, the vaccines,” says Anab, a Save the Children-supported health worker. “We check the coldness of the vaccines and their quantity. If vaccines are exposed to high or low temperatures, their quality and effectiveness decreases.”
Anab works as a vaccine distributor in a three-woman team. Maryam manages registration. Kaltun documents each child and screens them for malnutrition using a MUAC tape, then explains to mothers which services are on offer. A fourth team member, a community mobiliser, is already in the village they are heading to, preparing families for their arrival.
Some of the communities they serve are 250 to 300 kilometres from the nearest health facility. When the ambulance can go no further, the team keeps going.
“If the road is inaccessible to the ambulance, we usually carry the cold boxes on our backs or use a donkey to reach people,” Anab says. “When areas can't be reached by vehicle we have to travel on foot through the mountains.”
FROM CLOSED DOORS TO OPEN ARMS
Somalia has an estimated 1.2 million zero dose children, children who have never received a single routine vaccine, according to WHO and UNICEF estimates. In remote parts of Puntland, families were historically hard to reach and slow to trust outside health services.
“People used to say, 'Get out of our house. We don't need vaccination,'” recalls Mohamud, a community mobiliser who walks up to 15 kilometres at a time to prepare villages for outreach sessions.
Anab has watched that change over the course of her career.
On a recent outreach visit, families were waiting when the team arrived. Over three to four hours they delivered vaccines against measles, diphtheria, whooping cough, pneumonia and tetanus, screened children for malnutrition, and talked with pregnant women about clean water and the full vaccination schedule. Newborns and mothers too unwell to attend were visited at home.
WHAT MAKES IT POSSIBLE
The team's work is supported by Save the Children's GAVI-funded Routine Immunisation project, implemented in partnership with the Federal Ministry of Health, WHO and UNICEF. The project pays for vaccines, cold chain monitoring, fuel, supportive supervision and the community mobilisers and health workers who prepare and follow up each visit, so that outreach can happen as often as once a fortnight.
Since January 2024, the project has delivered third doses of the pentavalent vaccine to 117,675 children, fully immunised 98,721 children aged 12 to 23 months, reached 131,566 zero dose children through routine immunisation and screened 364,782 children for malnutrition. Ninety five per cent of supported facilities maintained the required vaccine cold chain temperature of between plus two and plus eight degrees Celsius.
For Anab, the numbers come back to a single comparison she has seen play out too many times. “The main purpose of vaccinating children is to lower the risk of serious diseases and prevent them. We make sure children receive their full set of vaccines: a vaccinated child is completely different from an unvaccinated one.”
