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Nepal
September 21, 2004- May 10, 2005
Children vaccinated: 9,839,723
Deaths averted per year:
Other health interventions: Polio vaccine
Other: Phase I 5,490,931 children vaccinated, Phase II 4,203,354 children vaccinated, Phase III 145,438 children vaccinated
Young girl being immunized during the first phase of the campaign.
Vaccinator arriving at immunization point carrying safety box for needles.
Hard to reach children on the outskirts of Kathmandu, Nepal,
with WHO Medical Officer.
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Measles Catch-up Immunization Campaign in Nepal 2004-2005
Nepal, one of the poorest countries in Asia, has a population of approximately 24,516,000 and an estimated gross domestic product of $220 per person. Of the total population, approximately 14.5 % are children under the five and 40.5% of the population are under the age of 15. Nepal has over the last years made gains in the under five mortality mortality rate, from 102 per 1000 live births in 1990 to 64 per live 1000 live births in 2002.
Nepal continues however to face a number of health challenges, including the high rate of measles among children. Measles is the leading cause of all childhood death and disability due to vaccine preventable disease in Nepal; an estimated 150,000 children are infected and
2,700 children die each year. In light of this, and epidemiological data provided by WHO in
2003, the Government of Nepal decided to provide a second immunization opportunity to 10 million children aged between nine months and 15 years. The subsequent measles campaign, designed to be carried out in three phases (September 2004 - April 2005), was the most ambitious health campaign the Ministry of Health has ever carried out.
The first, second, and third phases were conducted in 35 eastern districts, 33 western district and seven Himalayan districts during 21 September to 10 October 2004, 4 January to 29 January 2005, and 21 April to 10 May 2005, respectively. The coverage rate was more than 95% in all three phases. A national survey is currently being conducted to make a final assessment of the campaign coverage.
Vigorous preparation and planning, particularly at district level, took place prior to implementation. Activities included micro planning, cold chain assessment and strengthening, staff training, as well as rigorous logistics planning.
Due to security concerns, an extra effort was made to create as secure an environment as possible for staff and clients. Human right activists played an active role in the campaign by advocating for children’s right to be immunized against measles. The anticipated threats from insurgents was also minimized through a joint appeal made by the National Human
Right Commission, human rights activists, UN agencies, journalists, educational institutes, as well as other political and non-political alliances. This proved a very effective approach and the campaign was able to proceed without external disruption. The active involvement of educational authorities, teachers associations and other related organization also helped in raising the coverage rate. Also, national and international monitors observing campaign implementation provided useful feedback, enabling teams to make necessary improvements over the course of the campaign.
The participation of these diverse partners, the commitment of the Ministry of Health, and the support of civil society has been key to the success of the measles campaign in Nepal.
Recently, at an annual regional technical meeting hosted by WHO in New Delhi, India, the
Nepal measles campaign was referred to as a “model” for similar campaigns in the Region.
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