Lately, the country has continued to record new cases of wild polio virus. However, in this interview with WINIFRED OGBEBO, the Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr Ado Mohammad, allayed fears that the new cases are as a result of the case surveillance put in place. He also talks about other innovative mechanisms put in place and the federal government’s commitment to eradicate the virus.
The federal government has established a task force on polio eradication and the function is to stop the transmission of the wild polio virus in the country and then exit Nigeria as one of the endemic polio countries.
When the task force was established in March this year, we immediately went to work and we also developed the emergency plan which has the mandate of the president to stop transmission before the end of his tenure which is 2015. So what we’ve really done is that we’ve been ambitious as a group and we’ve given ourselves a timeline to stop transmission before 2013. So we are working very hard on that.
The emergency plan is for the agency for focus. We are looking at improving the quality of the campaign, strengthening the routine immunization, advocacy and providing leadership. So by and large, the mandate of the task force is to provide focused leadership and oversight to the states. We’ve carried out a lot of advocacy to the states and we’ve also restructured how the programme would look like. So what we are doing is to provide focused leadership in terms of stopping the transmission.
We’ve also brought in some new innovations because we realised that there was a problem of quality in the campaign over the years and our children were being missed. We keep on doing campaign but it’s only the same children that are being reached but now we’re getting more children.
Secondly, the surveillance system itself has been bad. What it means is that case searching to most settlements is being reached and we’re beginning to see more and new cases. It’s not as if these cases were not there but because there is active search now, we are beginning to see new cases because new settlements are being discovered. In addition, we’ve also realised that besides missing children, there is some certain underserved population like the nomad Fulanis that are also being missed. So we are now tracking them because a number of the missing cases are from the nomad Fulanis. We’ve also brought in the use of Geographical Information system where we map the country and then use geographical and some new equipment to identify new settlements. You’ll be surprised that new settlements are being identified and discovered.
We are building the capacity of the team because the teams themselves remain the most important component of the whole exercise. We are training them and also identifying how we can get people who are matured because it’s like war and if you don’t go with your best soldiers ,then you’re not likely to win. The team has over the years been a big problem. We send them to location, they don’t reach children or they go but they lack interpersonal skills. So we’ve constituted what is known as ward selection audit a and committee which is supposed to screen, scrutinize and make sure that its only people that are matured, committed and honest that we select as team members. We are building their capacity which was not there. So a lot of things are ongoing in terms of making sure that we improve the quality. In addition the task force has also restructured the team and also moved to enhance the remuneration. You can imagine a team member collects just N500 per day but we’ve beefed that up to N700 and then the workload of a team has also been reduced in the sense that we’ve increased our team members so that averagely, what you will notice is that a team covers about 350 households but what we’ve done now because we’ve restructured the team, is to reduce their workload by increasing their number. Now, we are looking at about 150 households and 90 to 100 households in the rural areas. So with all these innovations, I think we’ve done considerably.
We’ve been able to draw in, new support from partners like the World Health Organisation (WHO) and UNICEF. So far, they’ve provided us with about 3,500 volunteers and we have deployed them to the field and villages where these problems are. These are all combinations of things that we are doing. We have some few challenges especially in those areas. So it’s making it difficult for some of the vaccinators to also access some of the locations but we are surmounting that by engaging women group like the Federation of Muslim Women Association of Nigeria (FOMWAN) and so far so good. They are really on board.
On the issue of non compliance, how far have you gone to co-opt religious leaders to resolving the issue?
The programme has a partnership arrangement with religious leaders under the platform of northern traditional leaders committee which was formed by the Sultan of Sokoto and presently, it’s being led by his representative, the Shehu of Burma. We are deepening that relationship. Few days ago we were in Zamfara for a meeting with them. So far, our traditional institutions have come in fully to support the programme in terms of planning, supervision and resolving issues during campaigns. Most of these issues of non compliances are subjects to these traditional leaders so they are now helping to resolve some of these crises. That is why district heads and village heads who are part of the chain of traditional institutions, now follow the teams, and also attend the evening’s review meetings daily to resolve issues.
Because we realised that religious leaders have their own role to play as most of the issues of non compliances are based on religious reasons, we brought them under the platform of Northern Islamic Religious leaders Committee. You know in Islam there are two major sets. We have the Izalla sect and the T… The problem initially was with the Izalla sect but I am pleased to inform you that at the last regional conference of the Izalla sect, which was held in Abuja, I was there and was able to convince them. So all the members of the Izalla sect are now with us and they are sending messages across to their members to accept the vaccine. So we have more support and more visibility now.
The support also from our political leaders is enormous. It is like a coalition which is gathering momentum. The new face of primary health care now has to do with making sure that we make services available to people in the frontline with them co-owning it. That is what we intend to do. We are desperate to get rid of wild polio virus from Nigeria so that we’ll be able to concentrate and do the wider primary health care service delivery because primary health care is the only platform in which you can improve health outcomes.
Is the federal government considering sanctions against any guardian who refuses his or her ward to be vaccinated?
Let me share something with you. I was in Niger Republic a few weeks ago on the issue of cross border immunization. In my conversation with the officials, it was clear that they have a law in place. In that law, if a parent refused their child to be vaccinated, that parent would be prosecuted. They also want us to have that law in place but this is something that goes beyond me. Some states like Niger, Kebbi, Jigawa have already established that law. Nigeria is a federation; states have their law and federal government also have its own law. I will consult with relevant arms of government within the federal structure and see the possibility of that. But of recent, we’ve been receiving a lot of advice that the law should be put in place. People have to realise that where their right stops, another’s right begins. We cannot allow people to continue to be threat to others. As long as one single child has one wild polio virus, everybody is at risk in because we are highly mobile people and Nigeria is without boundary. Somebody can move from north to east, from east to west, from west to north and south to north. That is why it is very important that we get rid of this virus. People preventing their wards from being immunized are doing a lot of injustice to the rest of the people and to the children too.
The federal government is doing so much to eradicate the virus. It has doubled the domestic resources to it, set up the presidential task force on polio eradication and the president has severally and at different for a, reaffirmed his commitment to stop the transmission of wild polio virus in the country. There is so much we are doing at the federal level; we provide leadership, the vaccine and then we go ahead to plead with the states to ensure that each and every child is vaccinated.
Where and what are the challenges?
The challenges are at the operational level. Everything that needs to be put in place by the federal government has been put in place. The leadership is being provided. The technical support is there. The programme focus is there but the challenges remain at the operational level which is the local government and sometimes some states. We are beginning to get buy-in from governors after several advocacies and mobilization. The local government remains the key to interrupting the transmission of the wild polio virus in Nigeria. What we’ve come to realise is that most of the local government have not keyed into the programme in terms of providing the matching support for the political leadership from the federal government. So we are advocating to the governors to please hold their local government chairmen accountable. The Katsina State government during the flag-off declared to his political appointees that if a single case of wild polio virus is found in their domain, they will also get political poliomyelitis. That should be the word; a child gets paralysed, I paralyse you politically as the chairman of that domain.
Secondly is the quality of the exercise itself. In every immunization round, it’s the same number of children that are being reached meanwhile, leaving a critical mass of same children unimmunized. That has been happening for several years. We need to get these children.
Thirdly, we are beginning to have security challenges in some of these areas so it’s making it difficult for team members to access. But we are coming around that by involving FOMWAN to handle the security challenged areas.
Also, routine immunization has been very poor in some of these areas. Vaccines are being provided and immunization is not being provided in the local government areas. It is a combination of these and then people refusing the vaccine because of misinformation and sometimes mischief.
Another challenge has to do with the performance of the team. No matter the planning, discussion and the monitoring, if that vaccinator that is supposed to drop two drops of opv in the mouth of the child does not do it, then we’ve not started.
So we’ve realised that there is a problem with our monitoring team; people that are not committed are being selected on patronage and we are saying no. So we are restructuring.
Are you hopeful of Nigeria eradicating polio?
Yes, very hopeful with the quality mapping that we’ve done. Though the result is not immediate, we are certain at the end of the day between now and December.
What would you attribute to the upsurge in the first place?
It started last year immediately after the elections. First, the commitment from the local government chairmen and state governors was completely diverted. The programme suffered because the political leadership at a stage was much more interested in the election and campaign. Though it has passed, getting them back on track again is another major challenge. We started getting them on track from January this year after repeated visits and advocacies. There is an indicator that we use to measure it. It’s called the Leadership indicator challenge founded by Bill and Melinda Gates. In terms of participation, you’ll be able to determine if they keyed into the programme or not. So what caused the new cases is because of the derailment of some of our state governors.
Secondly, last year, a lot of children were missed during the routine immunization exercise because there was no vaccine. The quality of the campaign is only beginning to pick up and there is still challenge in terms of the team members at the state and local government.
Another thing is that the surveillance system has picked up. We are beginning to identify new locations and settlements so there’s active case search. So ,some of these cases are from areas that have never been visited by our teams.
So we want a situation when we say we’ve stopped transmission in Nigeria, we’ve actually stopped it.