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Supplementary Immunisation Activities (SIAs) Operations and Quality

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Expert Review Committee (ERC) Meeting on Polio Eradication

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 convened 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 Government of Nigeria, and members from the "Very High Risk" (VHR) states of Kano, Katsina and Jigawa.



This presentation outlines the operations and quality of supplementary immunisation activities (SIAs) in Nigeria. It recaps activities held in January to April of 2007; trends of children immunised through January to March of 2007; trends of child survival intervention incentives; core process indicators and monitoring data; and challenges and priorities for the second half of 2007.



In January and March of 2007 respectively, one national and one sub national Immunisation Plus Day (IPD) was implemented. A second round of subnational IPDs is scheduled for June 2007. Innovations to improve SIA quality in the future include:

  • Re-engaging the community - Through community dialogues and increased involvement of traditional and religious leaders.
  • Improved micro-planning - Practical training of how to review microplans and draw daily implementation maps.
  • Improving performance of vaccination teams - Through enhanced practical training, increased time for training and involvement of community leaders.
  • Involvement of grass-roots religious leaders - Imams visiting Quranic schools with vaccinators.
  • Engagement of town announcers and mosque megaphones.



In order to address recommendations from the 11th ERC meeting, significant efforts were made towards improving microplans and maps at the ward level. Training in the high-risk wards was changed to include more practical training, and is now supervised by senior supervisors. Additional funding to this programme area has alleviated previous logistical problems.



Monitoring data indicates that a 22% increase in the number of children immunised was seen between September 2006 and March 2007 IPDs in Kano and Kaduna states. End-process monitoring was done by four independent monitoring in each ward, overseen by senior supervisors in each case.



The impact and involvement of religious leaders in immunisation has shown dramatic positive trends in the
first quarter of 2007, with an almost 500% increase in the number of children immunised in Quaranic schools in Kano state. To increase the attractiveness of immunisation activities to parents, the programme also introduced a predictable pattern of "pluses" (or incentives), including anti-helminthics, oral rehydration salts (ORS), paracetamol and soap.



Challenges remaining to the programme include:

  1. Sustaining and improving the introduced innovations.
  2. Vaccination team selection and performance
  3. Reaching hard-to-reach and border areas effectively during implementation.



The objectives of the June to December 2007 SIA activities will therefore focus on accelerating gains in
immunity in children in northern Nigeria through improved quality and intensity of immunisation activities, while maintaining southern Nigeria as polio-free. The priorities for this period will include:

  • Preparing and implementing high-quality IPDs.
  • Implementing IPDs on Saturday instead of Thursday in order to reach more children in Quaranic schools, and to allow for
    the announcement of activities during Friday prayer.
  • Enhancing oral polio vaccine (OPV) immunity between rounds through intensified routine immunisation.



In conclusion, the presenters asked the following question of the ERC:


Are the priorities identified for the second half of 2007 adequate and appropriate to ensure that progress registered in 2006 and the first quarter of 2007 is sustained and wild poliovirus interruption is acheived?