Joint Presentation of the Very High Risk States - Kano, Katsina and Jigawa

This presentation was part of the 12th meeting of the Expert Review Committee on polio eradication in Nigeria, the
first to be held in the country following the global Urgent Stakeholder Consultation on Polio Eradication in Geneva in February 2007.
The meeting reviewed progress made on recommendations since the previous 11th ERC meeting, held in December 2006,
in all major areas of Nigeria's polio eradication and routine immunisation programmes. In attendance were members from the National
Primary Health Care Development Agency (NPHCDA), the World Health Organization (WHO),
the Government of Nigeria, and members from the "Very High Risk" (VHR) states of Kano, Katsina and Jigawa.

This presentation was given jointly by members of Kano, Katsina and Jigawa states in Nigeria, and reported
on key activities and innovations undertaken since December 2006, challenges facing the states in both polio
eradication and routine immunisation (RI) in the latter half of 2007, and the implementation status of previous
ERC meeting recommendations.

The following key acitivies were undertaken between
immunisation rounds across all states:

• Radio and television shows involving religious leaders and state officials.
• Use of women's groups in social mobilisation and resolving non-compliance.
• Strengthening of relationships between religious and traditional institutions through joint meetings and
  workshops.
• Border synchronisation of immunisation activities.
• Immunisation Plus Days (IPDs) post-implementation review and follow-up in areas of concern.

In addition, focus was given to Quranic schools and sensitisation of teachers in these schools. Focal people were
selected in each ward to mobilise neighbouring Quranic schools and aid in resolving non-compliance. A Child
Adoption strategy was also implemented in conjunction with the school systems, and a total of 214,579 children
were immunised in the 2007 IPDs in Katsina state.



Reasons for missed children during supplementary immunisation activities (SIAs) in March 2007 reflect that the
absence of the child and non-compliance are responsible for over 80% of missed children in all three states.
The majority of caregivers seemed to have adequate access to vaccination information.

The following issues were outlined as being of concern to all three states:

• Micro-planning - Non-high risk legal government areas (LGAs) did not support the micro-planning process,
  and there was an inadequate presence of senior supervisors in each ward to guide this process during the last rounds.
• Social Mobilisation - High degree of non-compliance needs to be resolved and negative media coverage needs
  to be dealt with appropriately.
• Training and Team Selection - Insufficient quantity or questionable quality of training aids, concealment
  of non-compliance by vaccinators and the lack of enough health workers to supervise training exercises.
• Data Quality Issues - Data is not analysed at ward and LGA levels, and sometimes reflects abnormally
  high (ie over 100%) coverage rates in certain areas.
• Implementation - Implementation schedule needs to be revised to coincide with high-activity days, and
  states need to show ownership by placing more senior supervisors in the field.
• Routine Immunisation - Lack of accurate monitoring information on which to base decisions, lack of effective
  vaccine distribution to immunisation sites, and low managerial support capacity of state immunisation units to the
  lower level.

The states have also intiated a series of intiatives to address previous ERC recommendations, which address activities
between rounds, as well as pre-implementation and during implementation of immunisation activities. These included: holding
immunisation activities in the major hospitals and motor parks; conducting health facility-based microplanning for all
LGAs; provision of training flip-charts to all wards; and starting implementation on Saturdays so as to be able
to access the Quranic schools throughout the four days of implementation.

The teams intend to use feedback from the ERC to guide programming in the latter half of 2007, and address the immunisation challenges outlined above.