This issue of The Double Loop tells the story of a Leader in the Movement for Immunization Agenda 2030 (IA2030). Dr. Tusiime Ramadhan is Uganda Country Director of Humanitarian Volunteers International (HVI), a community-based organization that he founded in 2013.
Dr Ramadan works in Western Uganda, a region where internet connectivity is a challenge. In spite of this challenge, he has been an active member of the Movement for Immunization Agenda 20303 (IA2030), implementing learning from colleagues in other countries to treble the number of children immunised per month by HVI volunteers.
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Dr. Tusiime Ramadhan is Uganda Country Director of Humanitarian Volunteers International (HVI), a community-based organization that he founded in 2013. HVI works with the Ugandan Ministry of Health and other partners to carry out health interventions through over 150 community-based health volunteers in the town of Fort Portal and surrounding Kasese, Bunyangabu and Kabarole districts in Western Uganda, on the border with the Democratic Republic of Congo (DRC). Western Uganda is the region in which Dr Ramadhan grew up.
Dr Ramadhan has now retired as a medical doctor, but the spirit of volunteering, the sense of keeping his professional expertise alive, and giving back to the public all motivate him to continue working in health.
One of the ongoing health system challenges of Dr Ramadhan’s region is the proximity to the border with Democratic Republic of Congo (DRC). Dr Ramadhan describes how migration across the border from DRC can overwhelm local health services, especially when outbreaks occur, and vaccines and medicines are used by migrants.
Dr Ramadhan describes identifying and following up zero-dose and under-immunized children in missed and conflict-affected communities as one of his most difficult and important tasks. He sees two particular challenges: accessing hard to reach areas, and suspicion among community members of the motives of vaccinators and vaccination.
“Reaching zero-dose children is a herculean task, but it’s possible”, he writes. “The barriers are poor roads, moving a long distance, climbing mountains to get to homes of people, children fearing strangers and hiding, people suspecting immunisers for others missions rather than immunising children, and people asking for money in order to immunise children.”
Dr Ramadhan also points to challenging local beliefs as a barrier to immunization, particularly that it has a hidden agenda. He says that “Many women and girls in Uganda do not like immunisation for fear of becoming barren or producing only two children in their lifetimes. Producing many children is seen as a sign of success and wealth.”
The COVID-19 pandemic led to disruption in routine immunization, in particular through health worker focus on COVID-19 vaccine roll-out, increased vaccine hesitancy, and disruptions in supply chains. While COVID-19 vaccine introduction led to some actions to strengthen routine immunization, Dr Ramadhan believes these could have been strengthened through more advocacy for political commitment and policy change to integration and alignment between COVID-19 vaccine introduction and national policies to strengthen RI or PHC.