INTERVIEW: How we protected 5,700 Nigerian children from polio paralysis – NPHCDA Executive Director

On 29 July, a child receives a dose of oral polio vaccine during the UNICEF-supported measles and polio immunization campaign under way in the Ifo refugee camp in North Eastern Province, near the Kenya-Somalia border. The camp for Somalia refugees is among three that comprise the Dadaab camps, located near the town of Dadaab in Garissa District. By 2 August 2011, the crisis in the Horn of Africa affecting primarily Kenya, Somalia, Ethiopia and Djibouti continues, with a worsening drought, rising food prices and an ongoing conflict in Somalia. More than 12 million people are threatened by the regions worst drought in 60 years. Somalia faces one of the worlds most severe food security crises as it continues to endure an extended humanitarian emergency, with tens of thousands fleeing into Kenya and Ethiopia. More than 10,000 Somalis a week are now arriving in the Dadaab camps in north-eastern Kenya, where aid partners are struggling to meet the needs of 400,000 people. In drought-affected areas of Kenya, Somalia, Ethiopia and Djibouti, some 500,000 severely malnourished children are at imminent risk of dying, while a further 1.6 million moderately malnourished children and the wider-affected population are at high risk of disease. In northern Kenya, more than 25 per cent of children suffer from global acute malnutrition. UNICEF, together with Governments, UN, NGO and community partners, is supporting a range of interventions and essential services, especially for the displaced and for refugees, including feeding programmes, immunization mass vaccination campaigns are now underway in drought-affected parts of Kenya and Somalia and other health outreach, as well as access to safe water and to improve sanitation. In Kenya, the Ministry of Health, UNICEF and the World Health Organization (WHO) have reached 290,000 children with polio and measles vaccinations in refugee host communities near the Dadaab camps. UNICEF is providing the vaccines, as well as deworming tablets and vitamin A (to boost childrens immunity). A similar campaign is now under way to immunize children in the Dadaab camps. A joint United Nations appeal for humanitarian assistance for the region requires US$2.5 billion, less than half of which has been committed.

The acting Executive Director of the National Primary Health Care Development Agency, NPHCDA, Emmanuel Odu, in this interview with PEMIUM TIMES’ Nike Adebowale, spoke extensively on the activities of the agency, and developments in Nigeria’s health sector in the outgoing year. He also spoke on what to expect in 2017.

PT: What were the key developments in the health sector in Nigeria in 2016, especially pertaining to the activities of your agency?
Odu: Let me begin with the polio eradication project of the Federal Government. We can remember that Polio, which is a highly infectious disease that mainly afflicts children under the age of 5 years and targets especially the nervous system, has been ravaging Nigerian children for many years, to the extent that in 2008, a total of 798 children were paralyzed in Nigeria.

The government, through the National Primary Healthcare Development Agency and other stakeholders, including development partners, state and local governments worked together seriously, with the federal government in the lead providing the needed vaccines and technical support in state and local government areas, and brought down the number of children paralyzed from 798 in 2008 to 4 in 2016.

As a matter of fact, for the whole of 2015, no child was paralyzed. For much of 2016, there were no children paralyzed. But in August, 4 children were paralyzed in 3 local government areas in Borno State.

The main reason behind this was the fact that, in the security-compromised area as a result insurgency, access of immunisation programme implementation and access by team members was highly compromised. So the children there were not reached with vaccines because of the activities of the insurgents. Because of the gallant effort of the Federal Government under the leadership of President Muhammadu Buhari, the military did a lot of work and began to liberate communities. With the liberation of this communities, access was improved for both the surveillance activities with which we detected cases as well as programme implementation. This was how we were able to detect those number of people.

And the Federal Government mounted a very rapid response, to the extent that immediately, interventions were implemented not only in the 3 local government areas, but in other local government areas where we vaccinated a total of 820,000 children under the age of five. That scope of implementation was expanded in the following two weeks to five states where over five million children were vaccinated in a bid to ensure that the virus that causes it does not spread beyond that place, and indeed is restricted in that environment.
We also took the intervention to halt the spread of the virus beyond the 5 states to 18 states in the North, including the Federal Capital Territory where, repeatedly, we vaccinated 31 million children on a number of occasions.

We are confident that with this activities, the spread of the virus has been contained. As a matter of fact, from that time in August till now, no other child in Nigeria has been reported paralysed. And this is attributable to the gallant effort of not just the vaccination team, but also of state and the federal governments. I will not forget to mention the role of the military. They were involved in the planning processes with us, both at the federal level here in Abuja as well as in our operations in Borno State. And even on ground in those security-compromised areas, they provided support not only by accompanying our vaccination team members for physical protection, they also used the members for their medical call to extend medical services to those security-compromised areas.
And as we make more inroads through the support of the military activities and the vaccination campaign activities, deeper and deeper, we believe very much that the status which we have achieved now in terms of no paralysis since August will be sustained over time.

IMMUNISATION

Another key programme of the Federal Government is routine immunization. It is common knowledge that vaccine preventable diseases are responsible for a majority number of deaths that occur in children under the age of five years. Now, the Federal Government, through the NPHCDA, was able to make available all the vaccines needed throughout the year 2016. We have been able to distribute the vaccines needed by all the states, including the Federal Capital Territory. So throughout this year, we did not lack vaccine in all the states.
And using this vaccine as a matter of fact, our children under the age of one were vaccinated and I can confess that the coverage level of the vaccination, based on administrative data, remains above 90 per cent.

Performance was one of the key areas that we needed to strengthen and in that regard, we trained 11,800 health workers in those areas, in addition to the provision of the needed vaccines.

In addition to that, we provided support to all the states and the FCT in terms of strengthening of the coaching system. Because the system is a strategy for ensuring the retention of the vaccines to make them effective. We achieved that first at the zonal and national level by ensuring that we have effective cold rooms that are functioning 24 hours. Cold rooms that contain vaccines and these are the ones we distribute to all the states. All our zonal offices also have cold stores located in Kano for north-west, in Bauchi for north-east, in Minna for north-central, in Lagos for south-west, in Enugu for south-east, and in Warri for south-south. We ensured that they remained functional throughout the year and remained effective to be able to maintain all our vaccines in those states. We also provided support to all the states and FCT to ensure that their cold stores are in good condition towards ensuring that vaccines remain good for effective administration.

Another component of vaccination has to do with non polio supplemental immunisation. In this category, we implemented maternal neonatal tetanus elimination project, whereby we vaccinate women of child-bearing ages in a way of preventing the occurrence of tetanus in the new born as well as in the mother. Tetanus is a very serious disease condition with high mortality. In other words, those infected by this disease condition, a very high proportion of them die. And fortunately, it is preventable, using the administration of tetanus vaccine. On the routine system, women who are pregnant go to clinics and get administered with the tetanus vaccine. It is required that four doses of the tetanus vaccine is administered to pregnant women. But in the locations where people are at high-risk of this disease, we then employ a supplementary and vaccinate women of childbearing ages. As a matter of fact, a total of 2 million, five hundred thousand women of childbearing ages were vaccinated in high-risk states. The states include Imo, Ebonyi, Enugu, Ondo and some other states.

MEASLES

Now, we also know that measles is one of the causes of death among children under the age of five. In that regard, for the southern part of the country, we have vaccinated 19.1 million children in the age category of 9 to 59 months; in order to fill the gap that may be left in the coverage of measles vaccine. With that, we hope to decrease the incident and therefore deaths among children under the age of five from measles disease.

MATERNAL AND CHILD HEALTH WEEK

Another initiative I would like to speak about is the Maternal and Child Health Week. If you recall, the National Council of Health approved that essential and life-saving intervention and other care and services are delivered twice in a year, precisely May and November every year, to children under the age of five as well as women.

For the main round, we were able to reach 41 million, 287,000 children under the age of five with essential intervention, which include Vitamin A, routine vaccine and measures to prevent women from having malaria. Women were given vitamins, children were de-wormed by using tablets such as Albendazole. For women, we were able to reach 7,708,000 women of childbearing age across the country.

BASIC MIDWIVES SERVICE SCHEME

We have another project known as Basic Midwives Service Scheme. You can recall that in the past, we had a Midwifery Service Scheme whereby we deployed in a period of 3 years approximately 4,000 midwives, nurses as well as health workers. That project came to an end last year. The Federal Government has been able to clear the allowances arrears of all the midwives. So as of today, the Federal Government is not owing midwives anymore. And we are happy to indicate many of them have become permanent employees in the various states as well as the FCT.

The succession programme to that is the Basic Midwives Service Scheme, whereby we enter into an understanding which has become a national policy that the Nursing and Medical Council of Nigeria will award completion certificate to basic midwives who qualify on annual basis. This certificate is after they had undergone the one year mandatory community service programme. And that is in partnership with NPHCDA. So the midwives who graduate, we deploy them to various primary health care centres across the country in a bid to improve services at the community level and to achieve improved maternal care. So far, we have done orientation session for them in 3 locations, in Abuja, Kaduna and Benin, whereby we trained a total 1450 basic midwives and deployed them to various health facilities across the country.

When this batch finishes, next year, we will take a new batch and ongoing basis, will be available to provide services at the community level.

PRIMARY HEALTH CARE REVITALIZATION

At the centre of the primary health care policy of the present administration is the National Primary Healthcare Revitalization Initiative. It is an initiative whereby the Federal Government, through the NPHCDA and the Federal Ministry of Health, set out to ensure that at least one primary health care centre in each of the wards across the country is made fully functional to deliver a number of services to the people in that ward.

You may wonder how it will be selected. We consider that each of the senatorial districts would have one. The first phase is to ensure that 109 plus one are made functional in the first phase of the exercise and the selection process for this first phase is to select one primary healthcare centre per senatorial district, which means every state has three for the first batch.
And the FCT which has only one senatorial zone has one primary healthcare facility, which is located at Kunchigoro, Gwarimpa ward of FCT. Work on that is ongoing and, as matter of fact, the infrastructure component of it has been fully done. Medical equipment are in place and, as a matter of fact, an ambulance is already on ground for referral services if the need arises.

So by and large, we have commenced with the implementation of that initiative now. And the state governments are also prepared to partner with us in that regard, especially in relation to providing the human resources for health. By the time this is finalised, we expect comprehensive services to be delivered by way of the world health service package.

The package includes control of communicable diseases, which include HIV/AIDS, malaria and sexually transmitted diseases, improved immunization in all locations across the country. maternal and newborn care is also part of the package, nutrition is also part of it, so that comprehensive package of services are delivered towards ensuring universal health coverage for all Nigerians. To ensure that this package works well, there are support elements as well. Provision of essential drugs, infrastructure rehabilitation are also part of it, as well as human resources of health, to ensure that adequate human resources are present to run 24 hours services in those facilities.

PRIMARY HEALTH CARE UNDER ONE ROOF

Finally, we have an initiative known as the ‘Primary Health Care Under One Roof.’ It is an initiative that is meant to overcome the structural and operational constraints at the sub-national level, especially at the state level.

Before now, the primary healthcare function is interrogated at the state level, whereby the ministry for local government plays some roles in terms of managing human resources or health workers. And the local government councils that are in charge of the health facility, they are the junior officers from level one to six.

The ministry of health at the state level is known for coordinating roles in terms of managing human resources as well as other resources. We are providing support to the state to have a single unit, a single agency at the state level that has control over human resources, that will coordinate primary healthcare activities throughout the state and that structure is known as the State Primary Healthcare Board.

Now, approximately 30 states have established this board. And the key element of it is that all primary healthcare workers, either the regional workers of local government councils or state ministry for local government, would be transferred to the Board. So that the Board assumes responsibility for the implementation as well as general management of all primary healthcare programmes at the state level. Efforts is on going to make sure that all states establish this board.

HEALTH ACT

Some progress has been made towards the implementation of the Health Act, which we cannot conclude without speaking about. The Health Act makes provision for the Basic Health Care Provision Fund, which will be managed by both the NPHCDA and the NHIS, in terms of providing support to the state towards projects that are defined by the state and local government areas, provided the state or local government areas provide 25 per cent of the cost of such projects. The Fund will be used to supplement that so that in partnership with the state, the resources will be available for implementation of the primary healthcare and then will go further in improving the achievement of the universal health coverage.

The Act requires that the NPHCDA develops the guideline for implementation of the Act, with regards to its component of basic healthcare provision fund. That guideline is being developed and discussions are ongoing at high levels towards operationalising the Act in a time that won’t be too long.

Now, for polio synchronization, yes the neighbouring countries of Cameroon, Central Africa Republic, Niger and Chad will implement the rounds at the same time with us. That is the essence of synchronization, so that it will have a wide geographical coverage as well as impact.
As a matter of fact, there is an international committee, the Lake Chad Basin Committee with representatives from all the five countries. Our representative from Nigeria is from this agency, working and ensuring that the government of the countries in the Lake Chad basin implement in a coordinated way and that has been happening. As a matter of fact, given that some of our displaced persons are also across the border, that synchronisation also helped to enrich on the other side of the border by the neighbouring countries; so it’s a great thing.

PT: How are you filling the funding gap in the immunisation programme?
Odu: Yes, there are funding gaps, especially for 2017. We are working with development partners and other organisations, not only bilateral governments but also private sector organisations like Bill and Melinda Gates Foundation, CDC, WHO, towards ensuring that the funding gaps are filled. And we are optimistic because, for many years, there have been potential funding gaps. And as the years came by, through the committed efforts of the Federal Government of Nigeria, those gaps have always been filled, year in year out. We do believe that, with the commitment of the present administration, working together with partners, the funding gap is likely to be filled.
The government of Nigeria has not failed in terms of securing vaccines for children each year and we believe that 2017 will not be different, especially with the commitment of the present government.

I will also like to say the fund budgeted for polio eradication initiative for 2016, the federal government of Nigeria released that 100 per cent and that is why we are making the progress we have made. We have reached so many children to protect them from this disease condition.

PT: How do you intend to source funds for revitalisation of the Primary Healthcare Centres, PHCs?

Odu: You know there are different stakeholders in this. The Federal Government provided the guideline as well as support, including financial resources. But we also have development partners who are committed to the initiative. By the programmes they implement in support of the various states, we know that they are willing to work with the government to ensure that this initiative is implemented in the states where they are working. A number of state governments are also committed to providing funding support to ensure that it is also implemented in their states under the general coordination of the Federal Government.

UNICEF is also supporting some states. I know that UNICEF has a programme that supports the government of Kebbi, Bauchi, as well as Adamawa states. The World Bank is already supporting Nasarawa, Ondo as well as Adamawa states. That programme is also going to expand to five additional states in the north-east.

They have a good degree of commitment towards the achievement of this PHC revitalisation, ensuring that at least one healthcare centre is functional in a ward. With Federal Government taking the bulk of the support, and with collaboration of these development partners, the Federal Government will be able to achieve it and support the state governments.

PT: Is there a plan for manufacturing vaccines in Nigeria?

Odu: I will like to mention to you that the Federal Government of Nigeria is one of the very few governments in Africa that put funds largely into vaccines and we must applaud the effort of the government in this regards. Routine vaccines are largely procured by the Federal Government of Nigeria, with strong support by the Global Alliance for Vaccines and Immunization, GAVI.

In terms of manufacturing, yes discussions are ongoing and it is one of the priorities of the Federal Government now to initiate the processes and set up the mechanisms for local production of vaccines. If we are able to do that, it will also help not only Nigeria, but other neighbouring countries of West Africa and even beyond. Because the logistics of them getting vaccines from Nigeria will be less capital intensive, compared to when they get it from somewhere far and other continents of the world.

So as a matter of fact, the business case for establishing the facilities and initiating the local vaccine manufacturing is already ongoing. The business case is being developed, the process has begun, consultants are in place. And not only the NPHCDA and the Ministry of Health, but the Ministry of Science and Technology are also in partnership with us in this regard. We look forward to achieving that status of local production of vaccines that our children need across the country.

PT: Is there any introduction of new vaccines in the country?

Odu: Yes. The Federal Government of Nigeria through the NPHCDA has introduced new vaccines, pneumococcal conjugate vaccine (PCV), and that targets one of the living causes of death among children under the age of five, which is pneumonia or respiratory infection. That is also being scaled up across the country now.

Another one is inactivated polio vaccine, which is the injectable version of polio vaccine. That is also being introduced. As a matter of fact, in the rounds of polio campaign that I mentioned earlier, millions of dozens of the inactivated polio vaccine have been used already in the north-east of the country.

In sustaining the case of Borno State, the Federal Government is committed to ensuring that polio is wiped out of Nigeria. In a similar way, the Borno state government is also committed.

Other stakeholders working in partnership with the Federal Government through NPHCDA are also committed, and one of the ways of ensuring the sustainability is in the part of funding.

The Federal Government of Nigeria is prepared to provide adequate funding, judging by the provision of the executive submission of the 2017 budget or appropriation.

PT: Apart from the Boko Haram insurgents, what other challenges do you face in eradicating polio?

Odu: The principal challenge in eradicating polio from Nigeria is the security-compromised area. Otherwise, the technical teams are prepared to work, our partners are supporting us, the Federal Government has mobilised resources and is mobilising resources for continued implementation of this very important initiative.

And by and large, I will also remember to tell you that from 2008 where I mentioned that 798 children are paralysed, from that time till now, we have been able to prevent approximately 5700 children from being paralysed. And how that was arrived at is, taking the 798 children paralysed in 2008 as a baseline. If that trend had continued up till date, and then considering the progress we have made by reducing that number, when that comparison and analysis are made, we arrived at the fact that we have protected at least 5700 children across Nigeria from being paralyzed. That is the ultimate outcome or impact of the polio eradication initiative in Nigeria.

In addition to that, the infrastructure for polio was also used to control Ebola. When there was Ebola outbreak in Lagos, the whole world was panicking. The country was in the state of panic, but the infrastructure for polio was used.

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