This week we have seen two children passing through our hands with invasive Haemophilus B diseases. Since South Africa introduced the conjugate vaccine against this pathogen, such cases have become rare. Two in one week has created a flutter.

One baby developed the disease before the time at which immunisation is initiated in the routine schedule, and the other had been fully vaccinated (though malnutrition may have reduced the effect of the course of injections). Both cases emanated from an area which had seen community action protesting about the poor state of health services in the area. This action had led to a break in service and the current replacement service has reduced access to immunisation for children through being geographically distant.

These two cases, though not directly related to this disruption in the immunisation programme, remind us rather starkly of how vulnerable children are to poorly managed health services, especially in terms of access.

Both children have died despite going to ICU (not a commonly accessible service in this country’s public health system). Reviewing the cases, we noted that they had both been ill for a couple of days before advice was sought from the formal health system. Was access to a health system close by part of this delay? Many believe that a system of community health workers would reduce such delays for sick children. The evidence for this belief is robust. Taking health care into vulnerable homes is one of the major thrusts of primary health care in South Africa now.  We must make it happen for children!