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Review of Routine Immunisation - Nigeria

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Expert Review Committee (ERC) Meeting on Polio Eradication in Nigeria

Summary

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 gives a review of Nigeria's routine immunisation (RI) programme activities from 2006 into 2007. It reports against the previous 11th ERC meeting recommendations, performance to date and priority activities for the second half of 2007.



The 11the ERC meeting provided the following two major recommendations in the area of RI in Nigeria:



Recommendation 1: Expand the Reach Every Ward (REW) strategy to the remaining 40% of legal government areas (LGAs) by the end of 2007.

Status: Plans to commence REW training in place for May 2007.


Recommendation 2: Encourage all states to initiate quarterly feedback bulletins on RI coverage to authorities at the federal and state levels.

Status: Achieved and ongoing.


Routine immunisation performance data indicates the number of immunisation sites in Nigeria has increased drastically between 2005 and 2006, through an increase in fixed posts from 3825 to 11,696, and outreach sites from 341 to 5,451. Between 2006 and 2007, a less drastic increase in these numbers was seen, with 16,626 fixed posts and 7,165 outreach posts following the first quarter of 2007.


Nigeria's RI programme saw four major acheivements in 2006:

  1. The REW strategy let to a marked increase in RI service delivery points, both fixed and outreach.
  2. Immunisation Plus Days (IPDs) were used to deliver RI vaccines and build the RI skills of implementing health workers.
  3. A substantial increase was recorded in the number of children vaccinated.
  4. Progress was made in improving the RI monitoring system, through certification and data verification.


RI activities are supported by a range of partners working in different states throughout the country, and through the United Nations Children's Fund (UNICEF) and WHO across all states and at a national level. The Reach Every Ward strategy has been implemented predominantly in the southern states, covering 57.6% of the country.



Overall, performance in the first quarter of 2007 in all RI indicators reflect improvement from the same quarter of 2006. However, it was stated that the polio High Risk (HR) States are not making enough progress in RI outside of the IPDs and that more efforts are needed in order to sustain the growth of RI services across the country. In addition, special attention should be given to enhancing population immunity in the HR states in order to sustain current reduction in poliovirus disease burden.

The main RI issues for Nigeria's programme in 2007 were presented here as: increasing access to high quality RI services; ensuring data quality; and implementing measures that will result in sustainable RI services.

The following priorities for RI activities in the remainder of 2007 were addressed:

  • Increasing access to RI services - through microplanning and expansion of REW strategy to all states.
  • Enhancing population immunity in HR states - through targeted sessions in HR areas and modified REW approaches.
  • Building capacity of health workers at all levels - through additional training, especially in data
    management.
  • Improving data quality - through development/dissemination of standard operating procedures on RI data
    management, regular monitoring of key indicators at all levels, and monthly review meetings and supervisory
    schedules at all levels.
  • Enhancing vaccination management at all levels.
  • Enhancing ownership at LGA and state level - by strengthening support for community linking committees.
  • Resource mobilisation at local and international levels.
  • Coordination of partners active in RI - by harmonising deployment of available resources to streamline RI efforts.


The presenters concluded with the following questions for the ERC:



Are the identified RI priorities for 2007 adequate and appropriate?



Are there additional activities that are required to further enhance quality, coverage and sustainability of RI in Nigeria?