About 80% of the population in Colombia’s Putumayo Department lives in dispersed rural areas. Reaching them requires navigating rivers for five to six hours. “This makes it difficult for the population to travel to the health posts, and very difficult for the vaccines to reach all the communities and for the vaccination schedules to be complete,” said Carolina Echeverry, Secretary of Health for Putumayo Department.
— Putumayo, Colombia, October 22, 2024 —
Technical cooperation between the Government of Canada and the Pan American Health Organization (PAHO/WHO) has improved the coverage of vaccination schedules to prevent diseases and protect lives in remote areas of the country.
Putumayo, located in the Colombian Amazon, is one of the departments prioritized as part of Canada's Can GIVE global initiative to improve access to vaccines, particularly for vulnerable communities. In Colombia, CANGive is contributing to equitable access to COVID-19 vaccines and vaccines in the Expanded Program on Immunization (EPI).
During 2023 and 2024, CANGive invested 14.9 million Canadian dollars (about US$10.9 million) in Colombia, funding that is administered through PAHO. PAHO has directed the resources into acquiring equipment and supplies for the cold chain that allows for transportation and storage of vaccines, for support for immunization campaigns, and for strengthening human talent and information systems. In alliance with UNICEF as well, PAHO reaches remote areas of Colombia that need both additional immunization and strengthening of health systems. In consultation with the Colombian Government, PAHO identified 10 Colombian departments where vaccination coverage among children under 5 years of age was low: Caquetá, Putumayo, Amazonas, Arauca, Vaupés, Chocó, La Guajira, Nariño, Guainía and Vichada.
Jaid Constanza Rojas, PAHO’s national immunization consultant in Colombia, explained that support to territories is based on need identified by departmental and municipal health authorities. “In Putumayo, we identified that coverage levels were low, especially in riverside areas. We decided to give them a boat so that they could go every day to complete vaccination schedules in a timely manner and do the required follow-up,” she said.
“This boat is a blessing,” said Sara Jiménez, member of a vaccination team that traveled by river to get to the Las Vegas Indigenous reservation in Colombia’s Putumayo Department near the border with Ecuador. The boat – purchased by PAHO with Canadian funding – transported her and 19 other vaccinators to the reservation on the banks of a river deep in the jungle, and it has made all the difference to their mission of preventing disease. “Before, we had to pay very high costs to come here,” Jimenez said. “We had to get up very early in the morning to get a boat and conduct the vaccination visit in a hurry.”
One of her colleagues, Libardo Chará, added that “previously it was very difficult; we had to go by public passenger boats.” The vaccination teams could travel to remote communities a few times a year when resources were available. “But vaccination schedules were not completed as they should be, they were irregular,” he said. “The children were behind. Some older children did not even have their first vaccination.”
Echeverry, the state health secretary, emphasized that “help with boats and motors has allowed vaccines to be transported to remote areas, guaranteeing that the vaccines are applied to the entire population, especially to children under five years of age.”
Because of the boat, “now we arrive in an easy way and [vaccination] is done on the date and time indicated,” said Chará. Jimenez said, “Now we go to each house with time to talk to the families and have the vaccination schedules up to date. Parents sometimes don't have the money to take their children to town to get vaccinated. Now they feel very grateful.”
The work of the vaccination teams in Puerto Caicedo, a municipality in Putumayo, begins before seven in the morning. The teams enter the local Alcides Jiménez Hospital to prepare for the day, dividing themselves by zones or villages.
“They pick up the vaccines and make land or river routes,” said Yolanda Ortega, a vaccination nurse. “To prevent immunopreventable diseases, they travel in search of children to follow up on their vaccination schedules…They carry out house-to-house vaccinations.”
Martha Chachinoy, another vaccinator in the municipality, explained that they must start before dawn, navigate the rivers of the jungle region, and continue the journey with hikes between villages or hills.
The morning was calm on the day the vaccination team arrived at the Las Vegas Indigenous reservation. After getting off the boat, the team approached the house where Angie Paí held her six-month-old son in her arms, ready to be vaccinated. “It’s important to prevent the children from getting sick,” she said, adding that the boat makes it easier for the vaccination teams to reach her home.
Esteban López, manager of the Alcides Jiménez Hospital, confirmed that delivery of the boat helps reduce gaps in access to vaccination.
“Before, the hospital had to pay high transportation costs,” he said. “Private boat transportation could range from 800,000 to one million pesos (about US$250) for each brigade. After the donation [of the boat], the operational deployment costs are lower. We have fuel and driver-supply contracts, and this helps to increase the number of [vaccination] days, achieving greater coverage,” he emphasized.
According to Colombia’s Ministry of Health and Social Protection (MHSP), the EPI includes 22 vaccines that protect against more than 30 diseases. The target population is children, adolescents, pregnant women, adults over 60 years of age, and people with comorbidities.
Elvin Janeth Botina, head of the public health office of the Secretariat of Health of Putumayo, explained that vaccination is reaching everyone at the critical stages of their lives, from childhood to adulthood. “Vaccination is very important to prevent diseases such as acute respiratory infection, COVID-19 and yellow fever, among others,” he said.
“We are going to be able to meet the vaccination goal, with coverage of 95%, in municipalities that were not meeting it,” said Carolina Revelo, a professional nurse who works with the information system of the EPI in Putumayo.
Martha Chachinoy said, “If the children are well, the parents are well. I have been working in vaccination for 26 years and I love it. It’s nice to see the children grow up. It is very gratifying.”
PAHO will continue to work alongside the MHSP and health partners in Colombia to improve access to essential vaccination services and bolster vaccination coverage, targeting vulnerable populations. The financial support of the Government of Canada, under the CANGive initiative, has been instrumental in supporting regional efforts to recover and strengthen immunization programs in Colombia and throughout the Americas.
