“Change will come and be sustainable if we work hard and get the appropriate support we need, and that our communities will be free from vaccine preventable diseases”. Hanan Rahma, Health Extension worker, Herkole Afendu Health Post, Assosa woreda, Benishangul Gumuz Regional State, Ethiopia 


Hanan Rahma, 22 years old, is a health extension worker (HEW), who has been working in Herkole Afendu Health Post for the last three years. Sherkole Afendu is located 50 Kms away from Assosa town, and is one of the hard-to-reach kebeles in Assosa woreda. 

Conducting routine immunization used to be difficult in this kebele, according to Hanan, due to the inaccessibility of some villages and low awareness in the community. Hanan indicated that she was once asked by a mother to provide guarantee that if she vaccinated her child, the child would not die. Hanan had to assure the caregiver to vaccinate the child.

The situation has now changed after the International Rescue Committee (IRC) started supporting immunization activities, Hanan says. The use of Enat Mastawesha and defaulter tracing tool (DTT) are among the key approaches introduced by the IRC, and have changed the situation according to Hanan. Enat Mastawesha is a color coded health calendar distributed to all eligible households (houses with pregnant women or infants) in village. The calendar is used by HEWs and the Health Development Armies (HDAs) during home visits, to address identified barriers of caregivers’ knowledge of the timing (and purpose) of critical maternal and child health services including immunization. The DTT is a simple carbon-copy registration form used at the health post to record basic infant/caregiver information and antigens missed for all defaulters in the community.

Using these tools, and with the support of community leaders, Hanan says that HEWs are able to mobilize the community for routine immunization. Hanan is also able to trace defaulter children in a timely manner, in order for the HEWs to get them caught up on missed vaccinations. She said, in 2016, her health post was able to perform well, achieving a Pentavalent 3 coverage of 95%, with Pentavalent1-Pentavalent3 dropout rate of 4%.

 Hanan expressed fulfillment in her job and the transformation of caregiver attitudes towards immunization in her community. Hanan believes her community is now better informed about the value of immunization in protecting their children and keeping them safe from vaccine-preventable illnesses. The same mother who needed reassurance before accepting immunization, now hopes her daughter would grow up healthy, go to school to become a health worker, and come back to help their community live healthier and better lives, just as Hanan is helping them do now.