Polio Eradication in Nigeria - Social Mobilisation Partnership

Presented by: Dr. (Mrs) Dere Awosika, MFR, National Coordinator /Chief Executive, NPI

This PowerPoint presentation was part of a June 2005 joint United Nations Children's Fund (UNICEF)/World Health Organisation (WHO) meeting dedicated to examining communication in the context of the final global push to eradicate polio. At this meeting, country-specific presentations were made by communication practitioners in 16 of the 21 countries which have experienced cases of wild poliovirus in 2004 and/or in 2005 (to June). The total number of global poliovirus cases increased from 784 cases in 2003 to 1,255 cases in 2004, with 1,004 cases reported to August 9 2005 (548 for the same period in 2005). Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to June 2005, and
2. Detailing the planned communication programme for the next 6 to 12 month period, designed to support a reversal of the above trend and achievement of the goal of eradicating polio worldwide.

Nigeria (one of 6 polio endemic countries), experienced an increase in the number of poliovirus cases from 355 (in 2003) to 782 (in 2004). As of April 23rd 2005, 169 cases of poliovirus had been reported vs. 270 cases for the same period in 2004, representing a reduction of 38% to date, from 2004 to 2005.

This presentation commences with an epidemiology update, including a discussion of the immunity gap, the distribution of Wild Polio Virus (WPV) by district, a review of the status of Acute Flaccid Paralysis (AFP) surveillance quality and Oral Polio Vaccine (OPV) coverage by Local Government Area (LGA) from October 2004 to May 2005. Data from the National Immunisation Day (NID) campaign held in April 2005 is provided, with a breakdown by region listing the reasons for children being missed. Data regarding Diphtheria Pertussis Tetanus (DPT3) coverage is also provided in the context of identifying sustainable routine immunisation service delivery/data management as well as timeliness (73%) and completeness (16%) of Routine Immunisation (RI) reports as additional risk factors.

Current risks in the communication environment which specifically impact supplementary immunisation activities (SIA’s) are identified as:

• Polio not a community perceived priority vs measles, malaria, lack of access to safe drinking water etc.;
• Competing social development priorities ie Millenium Development Goals (MDGs); and
• Challenges to sustaining the commitment especially at the state level and downwards.

An overview of the current communication programme is provided. Key components include: a goal to reach all children - with a focus on all children and missed households; to develop detailed ward level microplanning leading to effective social mapping; to sustain momentum at all levels; to further involve religious, traditional & other key leaders; to sustain the involvement of non-governmental organisations (NGOs); to strengthen linkages to routine immunisation; and to improve data collection, management and social monitoring indicators.

Graphs are presented detailing the reasons for children being missed in the April 2005 National Immunisation Day (NID) due to either "no visit being done", "child absent", or "non-compliance". Reasons for non-compliance are also presented, and include: child being sick, religious reasons, too many rounds and unhappiness with vaccinator.

Some of the challenges involved in working with the media are provided, such as: keeping polio on the media agenda given other competing priorities; media (e.g radio/television) demand for direct remuneration; lukewarm attitude to airing of non-localised productions and sustaining the commitment of current media partners.

Specific communication objectives for 2005 are detailed, including a goal to resolve all non-compliance cases and to reach all households. Specific activities to be undertaken in order to achieve these objectives include:

• intensified advocacy involving H.E. Mr. President, Minister, National Assembly, State and LGA chief executives;
• deployment of Community Mobilisers in 8 High Risk states;
• cross-border meeting of Health Ministers, religious and traditional leaders of seven countries; and
• strengthened social mobilisation teams within the National Programme for Immunisation (NPI) zonal structure, UNICEF and WHO teams to support Local Government Areas (LGA)/Ward mobilisation operations.

Training materials have been developed in Hausa to improve the effectiveness of community mobilisers, including flip charts, terms of reference for Community Mobilisers, frequently asked questions and basic messages re: "Reaching Every Child". Calendars with key household messages (on routine immunisation, polio, and HIV/AIDS) have also been developed.

Risks to the programme are also detailed, and include:

• Reaching the hard-to-reach population e.g. the nomads and riverine populations;
• Strengthening the interpersonal communication skills of sweep groups;
• Inadequate response to parents' concerns for convergence of services e.g. potable water;
• Poor environmental sanitation; and
• Funding shortfall of US$20 million.

A Supplementary National Immunisation Day (SNID) was scheduled for August 2005, with two National Immunisation Days (NIDs) scheduled for September and November 2005.

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