Polio Eradication Initiative

interview

India has been polio free for a year and Nigeria hopes to follow suite, marking out high risk areas where more effort is needed. But the first round of immunisation this year has seen persistent challenges; caregivers refusing the vaccine, children still being missed, and health worker commitment in need of improvement. Pharmacist Inuwa Ya'u, programme officer for Polio Eradication Initiative at the National Primary Health Care Development Agency, monitors implementation of immunisation across states. He spoke to Daily Trust's Ruby Leo and Judd- Leonard Okafor.


What is the difference between the National macro plans for polio eradication and the way the micro plans are implemented at the local government levels?

Microplans are developed at lower levels. By implication, what it simply means is that they are plans that are developed to enable the team cover the four-day period within available resources, which means the vaccines, target population, resources. Why we do that is to ensure every child in every ward and settlement is covered. Planning is the foundation of every programme.

What I see here is that Jigawa has been using the microplan, but just like in any other state the microplan sometimes does not take us to where we want to go, meaning that some settlements are still being missed.

And at this age, when we are pushing very hard to ensure that we get polio out of Nigeria, teams still do develop their own microplans and they are expected to work with these microplans for any visitor that comes in to know the exact location and to really understand the plans they have for that day.

Unfortunately, some of them don't go with those plans even though they have them. We have had to make some corrections today, but some wards still go along with their microplans.

Does the general implementation on the ground give you hope, as someone involved in the running of the polio eradication programme? Are we getting close?

We have strong hope that we can eradicate polio out of Nigeria. But then there are three basic problems we must overcome. One is the quality of our implementation, that is the way we deliver these vaccines. There are gaps in the human resources, there are gaps in the pluses, there are gaps in even the commitment of some health workers. And to address this, the National Primary Health Care Development Agency, in collaboration with development partners, developed the Accountability Framework, where every person from the highest level to the lowest person giving the vaccines to the children is accountable for his or her own actions.

And we are now changing the training and selection process. The selection used to be between the ward focal person and just the village head. Now we have ward selection committee, comprising five distinguished members of the community that involve the traditional leader, the religious leader, any civil society organisation--to give balance and fairness--and then the ward focal person and also any partner (WHO, UNICEF) that is there in that community. This is the starting point. If we are able to get the right mix of personnel to do the house-to-house team, if we are able to acquire quality practical knowledge of how to do it, and if we are able to improve on our microplan, then the delivery component, which the is supply side of this programme, will improve.

The second component is the demand side. Are we really getting to the communities in the right way? Yes, but there is room for improvement. And unless we are able to do that improvement, we will not be able to reach there. This has to do with the issues on ground. Are we really using the media, especially the local radio stations, to really impact? Is our majigi system really working? Are we really expanding or we are just doing pockets of majigi film shows here and there that will only give us little impact? Are we identifying community champions? It isn't only the structural chairman, governor, commissioner. There are individuals that are highly respected and adored by the community people. They could be politicians, footballers, traders. The programme must identify them. These people must identify with the programme for the people to have confidence, because up till now noncompliance is still an issue.

The third component is underlying health system issues that are beyond the polio programme. When you visit a mother, her major reason why she is not allowing her child to be vaccinated is that if she goes to the nearby health facility for her malaria [stricken] child, she doesn't get attention...so why then would you be coming to her house to give medication? These are broader health system factors that we have to improve along the line for us to really get to the Promised Land.

How would you practically deal with these issues while the round is ongoing?

We need to develop a very robust health system. Government at all levels, the partners that are supporting health systems in Nigeria must come on board to improve the system. If this health system is not improved, it would create a barrier to our house to house strategy to immunising children. It is a broader context, but it is a very important factor that we have to bear in mind. But that should not stop us. If we are able to address the delivery and demand issues, which are programme oriented, I think we will able to reach the Promised Land.

There are other issues, beyond immunisation, that primary health care deals with. How do all those issues come together? People you deal just identify you with polio and that's it?

NPHCDA is a government institution constitutionally empowered to develop policies, direction and resource mobilisation for primary healthcare in Nigeria. Immunisation is one of seven key components of primary health care. We deal with maternal and child health, resource mobilisation, essential medicines, all the broader aspects of primary health care.

Why immunisation? Immunisation has been proven still to be the most cost effective intervention, and everywhere in the world it is the cornerstone of the primary health care. If every PHC facility has a functional immunisation system, I tell you all the remaining components--nutrition, food, hygiene, water--will automatically come to bear under the single platform of primary healthcare.

Secondly, Nigeria is still the only remaining African country where polio is endemic--meaning that all other countries at one point or the other have eliminated poliovirus. We have reached a very good level, and we have made progress. We should also bear in mind that for the past three years, 22 states in the southern part of this country have been polio free. We need to really put in much energy.

Fortunately for us, we have international support, and that support is gingering us. But we cannot do it unless the local government areas and states buy in as much as possible. The level of buy-in is growing.

There are a lot of fantastic components we use to support the LGAs. We have been constructing primary health care centres all over the country; it is one aspect of improving access. We have been mobilising resources to ensure that maternal health is improved. We are now doing this Midwives Service Scheme, which has even gotten an international award.

India has been polio free for a year. Nigeria is getting close but for a handful of states. By analogy, say, nine-tenths of the work is done. Isn't there a risk of complacence with just the final one-tenth?

Complacency, yes. We recorded very huge success in 2010 and the whole world celebrated us, and in 2011 we had some challenges. We were a bit complacent and went down a bit, but now we are coming up. The good thing is that at the highest level, Mr President has made an unequivocal pronouncement to the whole world and demonstrated that with commitment and action.

He has improved resource mobilisation toward polio eradication, and has constituted a presidential task force. This is leadership by example. Mr President sleeps with polio; Mr President wants polio to be eradicated. And good enough through the structure of the Nigerian Governors Forum, headed by the governor of Rivers state, Mr President, the health ministers and the agency are really working very closely with the governors at the second layer.

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