Sixty-four-year-old Margarida Matsinhe has won the 2013 Gates Vaccine Innovation Award for her “instrumental” work in overhauling the vaccine system in her native Mozambique.
Bill Gates, co-chair of the Bill & Melinda Gates Foundation, made the announcement on Wednesday in his annual letter. The award recognizes “revolutionary ways” for immunizing the world’s poorest children. Nominees are assessed on innovation and creativity, impact and scale.
Matsinhe, a field officer with the non-profit VillageReach, has worked in vaccine delivery in Mozambique for more than 30 years, including during the country’s civil war and post-war reconstruction period. She currently serves on the government’s Committee of Experts on Immunisation and advises leaders on vaccine quality and distribution strategies.
Partly as a result of her work, Mozambique has achieved vaccine coverage of 95 percent, but Matsinhe says her goal is no less than 100 percent.
AllAfrica’s Lauren Everitt spoke with Matsinhe about her reaction to the award and to learn what she has set her sights on next.
How did you become interested in vaccines and vaccine delivery?
I started working in vaccines in the 1970s through a health program for school children that offered vaccine immunizations and health education.
I’ve been working for VillageReach for 14 months now. Before working for VillageReach, I worked for the Ministry of Health and I was the chief of the national immunization coverage program. After the civil war ended in 1992 I worked in the government on trying to restart immunization coverage in the country.
How has the vaccine program changed since the civil war?
During the 16 years of war there was no immunization or vaccination program. The national programs were suspended. The children who were born during that time did not get any vaccines. So the situation after the civil war was critical. Now I see how it’s becoming better and better.
Ten years ago Mozambique still had a lot of diseases that we don’t see today because of the vaccines. Today the situation is very different.
You do not see children under 20 who have polio, so that means the program we’ve been using since 1992 has had positive results, especially for children who were born after the Civil War. Nowadays in the health centers it’s rare to find children who have been admitted to the hospital because of a disease caused by the lack of vaccine.
From my experience, I’ve come to the conclusion that vaccines are very important tools to protect children for the rest of their lives.
How did you manage to help boost vaccination numbers so dramatically in Mozambique?
I’ve always been working on public health and that has to do with changing the behavior of a population. Behavior change starts with the parents, who form the habit of participating in the vaccine programs.
Their children will then have the vaccinations and protection. This will bring positive results because we’ll have a healthy population, and children will be secure during their childhood.
What motivates you?
I took this on as a challenge because women are the ones who demand vaccines for themselves and their children. The quality of life of a child who has vaccines is very different from that of a child who did not get vaccinated. So that motivates me.
Today the mortality of children under one year has been reduced by about 50 percent. This also gives me motivation to fight for vaccines that are of a good quality and to make them available to the last mile, for the people who really need them in the communities.
What is the government’s role in vaccination?
I think that to make vaccines available to every mother and every child is an obligation of the government. It’s a right for mothers and children to be able to get vaccines. That’s why I am fighting for 100 percent vaccine coverage. We have achieved 95 percent, but I want everyone who is born in this country to have a chance to get a vaccine.
I’m aware that reaching 100 percent coverage will not be easy. But I’m doing everything I can to try to make sure that one day in a short time we reach that goal. For that challenge I’m counting on everyone in society. Everyone, including schools and health centers, has to pitch in to help educate others about immunizations.
What has the government done so far?
The government has started to do something about vaccines. It has created the Mozambican Committee of Experts on Immunisation (CoPI) that works with the minister of health to advise him about the program, the quality of vaccines and how vaccine distribution should work. The minister of health also learns what kind of information people need in the communities. This is helping in a very positive way.
But it’s still a challenge because the system is still not working properly, especially at the end point – distribution, for example. Also, the incentives for people who work on the program in different communities are low, so that’s still a challenge. Although there is big political interest, people still lack clear information that would give them motivation and understanding for why these programs are so important to everyone in their local communities.
The government is also working to find more partners, both locally and internationally, who are interested in supporting these programs. At the central level of the government there’s a lot of interest in recruiting international partners who can help with the vaccination program.
The Ministry of Health and the government also host a one-week vaccine campaign to get to large numbers of children who didn’t get vaccines.
Many national and international organizations and partners are helping put these programs on.
What has been the biggest challenge in increasing vaccine distribution?
One of the biggest challenges is the know-how of the people who manage the vaccines in the last mile. This has to be worked on because the distribution is happening, the vaccines are getting to the last-mile care centers on time. But the health workers do not always have important information, such as how to maintain the vaccine’s quality and how to distribute it to the people who need it.
So this is the biggest challenge I see now – how to get training to the people who manage the vaccine at the first-line health centers.
It’s very important to get the vaccines to the health centers, but it’s also important to ensure that the people who will be managing the vaccines know how to use them. If the quality of the knowledge is good, then the coverage will be good.
What accomplishment are you most proud of?
What makes me proud is that when I go to the hospital and other places where I used to see children dying, they aren’t dying anymore. There are few children dying from diseases that have vaccines.
How did you help to address the stock-outs?
During the civil war, I used to go to the health centers to distribute the vaccines to make sure they would have them available, although it was dangerous to travel and there was war in the north. It was a challenge but I didn’t want there to be a stock-out in the health centers.
Now to control the stock-outs you must plan. You need to know who you are working for, how many people you are delivering the vaccine to, the population’s size. You plan according to how many vaccines you have and how many you need.
You also need to have backups. It might not be possible to travel to a health facility because the road has been cut off by floods or another calamity. So it’s always good to plan for that. You have to think about the challenges and obstacles that might come up.
You must also take into account the condition of the health center. Most of the health centers in Mozambique don’t have electricity so they use paraffin or gas. Only a few use electricity. So it’s not only about planning the quantity of vaccines and the logistics for getting them there, you also have to make sure the fridge at the health center will be running and things like that.
How do you incentivize mothers to bring their children in to be vaccinated?
We use two models to ensure that mothers vaccinate their children. First we have health centers that mothers and children can come to.
For mothers who live more than 10km away from a health center, they are assisted by a mobile brigade that goes to where they are. Once a month this mobile brigade will go to a place where they can meet these mothers and vaccinate their children.
We also have agents who live in the communities. They’re not doctors or nurses, but they’ve been trained in first aid and on how to educate the community on health issues. The government has introduced these agents in all communities. They are responsible for sensitizing the public and informing community leaders about vaccines. So they work with the authorities and the community health centers to keep the program running.
What do you hope to do next?
I want to continue working on vaccine distribution and immunization. My most important goal now is to train the people in the health centers.
This is the big challenge. I want to help the people who manage the vaccines and make sure that the women and children are getting them.
These people must be trained. They have to be informed of the importance of vaccines. It’s not only about getting vaccines to people, but people must get quality vaccines at the right time. Those things have to do with the people managing them.
I also want to continue sensitizing people in communities about the importance of vaccines and the immunization program.
What will you do with the prize?
First of all I didn’t expect to win so I didn’t have time to think about what to do with it. I just wanted to share my ideas and experience about what has been done in Mozambique.
I’m now 64 years old so I’ve thought about one day having a good life after working hard all these years.
Does this mean you’ll retire?
I retired from the government eight years ago, but I still wanted to continue to work on vaccines and immunizations. I’ve been working with some NGOs. I’m active in the anti-tobacco movement in Mozambique. I’m a member of CoPI.
So my idea was not to retire. I’m still going to work. I’m working with the government in terms of changing the tobacco legislation in this country. I want to continue working on vaccines and immunizations until I’m too tired to anymore.
Is there anything else you would like to add?
I want to thank every person that was a part of this award. I’m thankful for all the effort that has been made by different organizations in improving the vaccination program in Mozambique.
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