2020 Nigeria Polio Eradication Emergency Plan

From Nigeria's National Primary Health Care Development Agency (NPHCDA), this report presents the context and status of polio eradication efforts in the country - outlining remaining challenges for focus in 2020, as well as goals, targets, milestones, and strategic priorities. The below summary focuses on the communication elements of the 2020 Nigeria Polio Eradication Emergency Plan (NPEEP).

Nigeria marked 39 months as of December 2019 without a case of wild poliovirus (WPV) reported. In 2020, the overall goal of Nigeria's Polio Eradication Initiative (PEI) will be to sustain the interruption of WPV and to contain the current outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2). This will be done by organising quality immunisation campaigns, increasing the reach to inaccessible areas in Borno state, achieving reduction in number of unimmunised children in very-high-risk local government areas (LGAs), and sustaining quality surveillance performance indicators in all LGAs. Key strategies included profiling and vaccination of children liberated from captivity in security-compromised areas, as well as vaccinations at transit points, internally displaced person (IDP) camps, hospitals, markets, etc. Also, surveillance reach in inaccessible areas expanded in Borno State through the community informant network. Community informants submit weekly reports and attend quarterly meetings at the health facility catchment area level.

At the time of this report, the African Regional Certification Committee for Polio Eradication Certification (ARCC) had commenced field verification and reviewing documentation of interruption of wild WPV type 1 (WPV1). If the ARCC is satisfied with its field verification and national documentation, Nigeria will be declared WPV-free and Africa certified to have eradicated WPV1. NPHCDA notes that this milestone will need to be cautiously communicated to the populace, as the country is still transmitting cVDPV2. Also, all stakeholders will be intensely engaged to guide against complacency, which can derail the gains that have been made. In short, in 2020, communication and advocacy efforts will therefore focus on sustaining and strengthening resilience beyond certification and until the country is free from all types of poliovirus.

More specifically, an updated communication plan will be developed based on the Expanded Programme on Immunization (EPI) communication strategy, an overarching guideline for overall polio and routine immunisation (RI) communication activities. Dissemination of the strategy to polio and RI communication actors at all levels through cascaded workshops will be prioritised in early 2020 to ensure harmonisation of interventions and messaging. This framework involves planning for announcement of a WPV-free Nigeria, addressing any rumours and false information, and emphasising the importance of continued polio campaigns and the benefits of RI. A targeted approach will be implemented for all key audiences - political leaders, donors, community influencers (religious and traditional leaders), frontline workers, and family and caregivers - to address the cVPDV2 transmission in the context of the WPV-free status and to seek their continued support for polio vaccination. States will be supported to produce customised behaviour change communication (BCC) materials to suit their specific circumstances.

The framework will also play a role in raising the visibility of the polio programme. It will capture the journey of polio eradication in Nigeria and formally document all programme strategies, innovations, standard operating procedures (SOPs), events, and reference materials. To document and disseminate good practices and lessons learned, an online "library" will be created as a repository of these documents, polio communication materials, tools, and case studies.

Intensive advocacy that commenced in 2019 will continue and be expanded in scope and reach. Political leaders and donors will be sensitised regularly on the need to remain committed to the polio programme, post certification, to sustain the country's polio-free status and to improve RI services. Most donors and partners in the polio landscape will commence their human resource ramp-down in 2020. The programme will sensitise the leadership of partners and donors on how to effectively communicate this ramp-down to avoid any negative impact on personnel attitude and behaviour.

In addition, the Communication Working Group will support the Nomadic and Mobile Population Working Group to develop a communication strategy for mobile and nomadic populations, including collaboration with EPI communication teams of neighbouring Lake Chad countries to leverage on each other's strengths. Communication and social mobilisation along these lines will include, among other activities:

• Conducting advocacy visits and sensitisation meetings with nomadic leaders (at the levels of the states, LGAs, wards, and settlements);
• Enhancing reach to mobile and nomadic populations through the radio and information, education, and communication (IEC) materials (to be used at selected sites such as markets, traditional leaders' houses, telephone, and word of mouth);
• Identifying health workers among mobile populations (nomadic settlements, focal persons in markets and mobile groups);
• Carrying out knowledge, attitudes, and practice (KAP) research on nomads' health-seeking behaviour to guide communication planning;
• Developing a communication plan to engage the leadership and sensitise them on the benefits of vaccination;
• Developing and publishing/broadcasting BCC materials in local languages;
• Updating and geo-referenced mapping of all the major crossing points along international borders;
• Developing an integrated communication plan and assessment tools to inform the health-seeking behaviour of mobile populations; and
• Ensuring adherence to the reporting formats and guidelines on cross-border acute flaccid paralysis (AFP) notification.

According to the NPHCDA, traditional and religious leaders have played a pivotal role in sustaining community trust for the programme and in managing rumours and other misconceptions. The programme will continue to engage traditional and religious leaders, documenting and showcasing their role and achievements as best practices. Integrated community engagement structures like Community Health Influencers, Promoters and Services Programme (CHIPS) will be sensitised and trained on integrated messaging to promote polio vaccination.

Media engagement activities will include:

• Conducting media sensitisation workshops at national and sub-national levels with Journalists Against Polio (JAP) in strategic geopolitical locations;
• Maintaining streamlined messaging on media to check rumours and misinformation;
• Sustaining the Rumour Rapid Response teams at all levels;
• Organising special media appearances by key stakeholders to keep polio issues on the front burner of national discourse;
• Carrying out field trips to specific locations with journalists to document efforts to sustain the achievements made; and
• Supporting states to systematically engage the mass and traditional media.

Regular and timely social data analysis is one of the hallmarks of the Nigerian PEI. The programme will sustain and intensify evidence-based communication and advocacy by conducting KAP surveys, rapid surveys, risk perception surveys, and behavioural surveillance surveys (BSS) to complement routine social data analysis within and in-between rounds. In addition: "Enforcement of accountability continues to underpin all aspects of Nigeria's polio eradication programme."