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NEW THIS TUESDAY: NIGERIA SECTION, IMB REPORT

Saturday, 24th of August 2013

• NIGERIA SECTION, IMB REPORT

Full report is at http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/8IMBMeeting/8IMB_Report_EN.pdf

 

Nigeria

The pace of improvement in Nigeria’s Polio Programme over the last six months has

been greater than at any other point in its history. Its efforts are starting to show a

real impact. Nigeria has reported 18 wild cases in 2013 compared to 28 for the same

period in 2012.

 

Positivity and confidence in the Programme is growing. Highlights of the last six

months include: greater investment in local health services (building community

goodwill for the Programme); further emphasis on reaching under-served

communities; ‘green shoots’ of better partnership working (including with Muslim

women’s associations); and greater professionalism and ‘grip’ stemming from the

Emergency Operations Centres.

 

Vital to success in Nigeria is the strength of commitment at Local Government Area

(LGA) level and the personal qualities of LGA Chairmen. It is quite clear to all observers

that in the majority of Nigeria’s 774 LGAs, major improvements are being achieved.

However, the contrast with the relatively small number of LGAs where performance

has stagnated could not be starker. In those areas, it is vitally important for the

leadership of the Nigerian Programme to hold to account those key local officials

whose priorities clearly lie elsewhere than with the Polio Programme.

 

The fully committed LGA Chairman who oversees a local programme that is

“eradication standard” is easy to recognise. He attends every polio task force

meeting. He works hand-in-hand with traditional leaders and Programme partners.

He addresses community concerns and needs. He releases Programme funds well

in advance of vaccination campaigns. He does not tolerate poor performing staff.

He seizes control and he drives the Programme forward.

 

Equally, the LGA Chairmen who are not reaching this standard are clearly visible.

A list of poor performing LGAs is on display in the Abuja Emergency Operations

Centre. We commend the Programme for focusing their efforts on these disappointing

LGAs. The LGA Chairmen responsible should continue to receive weekly, if not daily,

telephone calls from the State and Federal level during which they should present

key performance data and the corrective actions being implemented. Ahead of

our next meeting, the IMB will ask for a list of all LGAs who have failed to improve

their performance.

 

Vaccination programmes throughout the world and over time have been forced

to deal with anti-vaccine rumours. Based on junk science, outright lies and

propaganda, these rumours are often propagated by high profile individuals who

put self-promotion and self-interest above the lives of children. All parents want the

best for their children. But how do they know what is best? How do they distinguish

between misinformation and the truth? As we describe later in this report, there

has recently been a surge of anti-polio-vaccine propaganda in Nigeria, which makes

this task even harder for parents.

 

In speaking recently to parents who had refused the polio vaccine in Nigeria, IMB

sources heard mothers and fathers ask very intelligent and pointed questions that any

parent would like to know the answer to.

“I have children over five years old and they were vaccinated. Why?”

“What is an excess dose? How much is too much?”

“For other ailments I have to buy drugs. But polio vaccine is free. Why?”

“How can I be sure of the safety of the vaccine?”

“There has been no polio here for years. But it is difficult getting three meals a

day. Why not address that instead?”

“I saw vaccinators and asked them what polio was. The answers were not

clear. Who can I trust?”

“Why do vaccinators keep coming back again and again and again?”

 

To those who work in the Polio Programme, the answers may seem obvious. But for

parents, these questions are vital and the answers too often absent. This divide, where

it happens, must be bridged or it will remain yet another reason why the polio virus

survives to kill and maim. Parents must have access to information and the facts about

polio and the polio vaccine.

 

Vaccinators and social mobilisers play an important role in providing this information.

The former group need to receive adequate training in how to handle and respond

to parents’ queries on the door step. Refusal situations can be role-played during

campaign preparation. Vaccinators need to be selected on the basis of their ability

to communicate with parents in a professional, courteous and persuasive manner.

The latter group, social mobilisers, are doing fine work in Nigeria but their numbers

remain limited. They need to be supported to do the maximum outreach possible in

between campaigns and their numbers need to be expanded further so that every

low performing LGA is served.

 

Vital though their work is, vaccinators and social mobilisers are not the sole source

of information for parents. Every single individual in the Programme from every

single partner has a role to play in communicating the facts to the people. We urge

all officials to take personal responsibility for ensuring that the information they

themselves have is available also to those on the front line and in particular to

parents. A river of knowledge can wash away the trepidation with which many regard

the polio vaccine.

 

Later in this report (“Engaged Communities Eradicate Polio”), we focus specifically on

the communications challenges that the Programme now faces – in all of the endemic

countries, but particularly in Nigeria. If the Nigerian Programme can take these

messages to heart, it can further transform its Polio Programme.

Since the IMB last met in October 2012, Nigeria has suffered a spate of attacks on its

brave polio workers. These men and women died serving their country. There is only

one way to honour their memory – to push on in the quest for a polio-free country.

We commend the Nigeria Programme for doing exactly this.

 

Insecurity in Nigeria is most challenging in the North East States of Borno and Yobe.

These two states currently account for 69% of wild polio cases in Nigeria (and hence

at the time of our meeting in the entire continent of Africa) in 2013. Population

immunity has steadily declined. In Yobe, a quarter of non-polio AFP cases in quarter

four of 2012 had received zero doses of polio vaccine. In Borno, over 335,000

children (32% of the target population) were missed during the April 2013 campaign.

Polio will not be eradicated in Nigeria unless these trends are reversed.

 

Tackling insecurity is a complex issue. Picking the correct mix of strategies will vary

not just state to state but from district to district and ward to ward. The IMB is deeply

conscious of the sensitivities involved and the need to allow negotiations to take

place away from the full glare of publicity where necessary. We urge the leadership of

the Nigerian Programme to assure itself that every possible step is being taken ensure

that children are protected against the polio virus despite the on-going insecurity.

The Nigerian Programme knows better than anyone that eradication will be achieved

only if the improvements seen over the last six months continue. If this occurs (with

the communications and security problems in particular being more firmly gripped),

then the IMB believes that Nigeria can be polio-free by the end of 2014.

 

We recommend that Nigeria urgently finalise a more detailed operational

plan to deal with the security issues that it faces, drawing on the experiences

of Afghanistan and Pakistan.