Child mortality in the Democratic Republic of Congo (DRC) is staggering. An estimated 12% of children die before their fifth birthday, many from vaccine-preventable diseases
Vaccines are a leading intervention for preventing childhood mortality. However, a confluence of factors conspire to prevent children from accessing these life-saving measures. In many places, women deliver at home so do not access facility-based health care, where their children can be vaccinated. Other operational inhibitors include confusion or inadequate communication with children’s caretakers around follow-up dosing, vaccine stock outs at health facilities, and poor attitudes among staff, rising in part from unpaid salaries and other demotivating work conditions. In addition, in many places the lack of an effective cold chain (in particular, access to electricity and adequate storage at the national, provincial, and zonal levels) makes conducting mass vaccination campaigns and ensuring a routine supply at health facilities impossible under current conditions.
These challenges are particularly acute in the poorest and more remote areas of the country, where ASSP interventions focus: Equator, Kasai Occidental, Maniema, and Province Oriental. Most of the health zones in the targeted districts of those provinces have for many years received no donor assistance beyond what DFID has provided. The rehabilitation of the cold chain infrastructure and re-training of health providers is therefore a prerequisite to raising vaccination coverage.
Measles epidemics in particular are a leading contributor to child mortality, having raged since 2010. More than 200,000 people have been infected with measles in the DRC during these five years, with up to 5,000 children dying from the disease. Outbreaks in ASSP’s remote health zones create sizable logistical challenges, as government and donors often hear of these outbreaks after they are well underway and lack the resources to respond rapidly with vaccination campaigns.