2017 Nigeria Polio Eradication Emergency Plan

From Nigeria's National Primary Health Care Development Agency (NPHCDA), this report reviews progress made to date to meet the 2016 National Polio Eradication Emergency Plan (NPEEP) and sets forth intentions for 2017 with regard to Nigeria's polio eradication programme. Having been removed from the list of polio-endemic countries by the World Health Organization (WHO) on September 25 2015, Nigeria was returned to that list when, in August 2016 (2 years after the last case in July 2014), Nigeria experienced a resurgence of wild polio virus (WPV). Four new cases were detected in Gwoza, Jere, and Monguno Local Government Areas (LGAs) of Borno State. Circulating vaccine derived poliovirus type 2 (cVDPV2) was also detected from an environmental surveillance site in Maiduguri LGA with isolates collected on March 23 2016, and from 1 acute flaccid paralysis (AFP) case in Sokoto state. A robust emergency response plan was timely implemented with leadership and oversight by the Nigerian Government at Federal and State levels through the Emergency Operations Center (EOC). In 2017, the programme will aim to achieve and sustain interruption of polio virus transmission, with special focus on the most vulnerable, high-risk, and insecure populations.

To strengthen coordination and respond effectively to the polioviruses outbreaks, a multi-national Lake Chad Basin Polio Task Team, or TT (governments and partners) was established in N'Djamena. The TT is working closely with the Multi-National Lake Chad Basin Joint Military Task Force to ensure synchronised vaccination and surveillance activities are implemented in the insecure areas. In addition, the Ministers of Health of these countries declared the polio outbreak in Borno State a public health emergency for the region. The declaration facilitated the mobilisation of political leadership at all levels, security forces and adequate resources (domestic and international) for a high-quality response to stop the outbreak before the end of 2017.

NPHCDA stresses that it is imperative that the programme continues to address outstanding 2016 challenges, including inaccessibility in security-compromised areas of Borno, population immunity gaps among the most vulnerable populations, risks of complacency, and surveillance gaps at ward level. The initial removal of Nigeria from the list of polio-endemic countries was misinterpreted by many parties to mean that polio virus has been eradicated from Nigeria. This created a sense of complacency that the "job is finished", resulting in a new wave of challenges: wavering political support, reduced counterpart funding, non-compliance in some communities, and "fatigue". The economic recession in Nigeria has also contributed to reduced local resources and prioritisation of other activities.

With one of the targets for the year being to achieve and sustain polio-free (WPV, cVDPV) status by December 2017, the 2017 NPEEP outlines key strategic priorities to ensure that interruption of poliovirus transmission is achieved and sustained, by:

• Sustaining resilience: intensifying social mobilisation
  • As noted above, the reclassification of Nigeria as a polio-endemic country has the potential to demotivate key stakeholders including caregivers, donors, frontline workers, and community, traditional, religious, and political leaders. Communication and advocacy efforts in 2017 will entail rebuilding trust in the ability of the country to contain the outbreak and interrupt transmission and galvanising all stakeholders to appreciate the fact that although the outbreak is geographically limited to the northeast zone, the entire country is still at risk from poliomyelitis. Consequently, there is need to secure stronger commitment from political, traditional, and religious leaders at all levels through reinvigorated systematic engagement.
  • Caregivers, frontline workers, and communities need to be motivated to continue to ensure that every eligible child is immunised during supplemental immunisation campaigns and through routine immunisation services.
  • Global advocacy discourse will be hinged on the message that Nigeria has the technical capacity and political will to contain the outbreak, stop transmission, and achieve eradication. The concept of placing polio within the broader health context of child survival in messaging was started in 2016. This will be sustained in 2017 with entertainment-education as the key channel for message dissemination at the community level, which will happen through channels such as mobile theatre (a.k.a. majigi), viewing centres, praise singers, and other community entertainers and new technologies.
  • States will be supported to develop and produce customised behaviour change communication (BCC) materials to suit their peculiarities. Also, States will be encouraged and supported technically to systematically engage the mass and traditional media through regular orientation opportunities and the continual roll-out of key themes.
  • Household and community mobilisers will continue to play a pivotal role in delivering integrated messages at the household level to increase the risk perception of caregivers and build trust for immunisation. The scope of the volunteer community mobiliser (VCM) network will be expanded to other critical high-risk States, especially Adamawa, Gombe, and Taraba, as may be guided by the EOC. The VCM network will be systematically engaged to track movement of IDPs in IDP camps and host communities in the northeast States. Strict adherence to the accountability framework for all communication personnel at the operational level will be promoted.
  • New mobile phone technology will be rolled out to further enhance household and community engagement, generate demand, and reduce proportion of missed children.
  • The interpersonal communication (IPC) training with a new training module, kick-started in Borno State in 2016, will be reviewed to fine-tune the module for adaptation for use in other high-risk States and the IPC training expanded to those States.
  • The Northern Traditional Leaders Committee (NTLC), the Da'awah Coordination Council of Nigeria (DCCN), and the Christian Association of Nigeria (CAN) and other community–based organisations (CBOs), including youth groups, Polio Survival Groups (PSGs), will be further engaged to build trust.
• Enhancing SIA quality in security-challenged areas and internally displaced person (IDP) camps - e.g., the community structure will be systematically engaged in the entire process of SIAs implementation. Youth, traditional leadership, CBOs, and civil society organisations (CSOs) will be engaged. They will assist in identifying local guides and providing vigilante support to the teams during the Immunization Plus Days (IPDs) preparation and implementation.
• Increasing access to vaccination in security-challenged areas and internally displaced person (IDP) camps - e.g., engagement of LGA chairmen, traditional and religious leaders, and other stakeholders will be scaled up to build trust for the programme at the operational level.
• Ensuring robust outbreak response across all states - e.g., for areas with insecurity, comprehensive plans in collaboration with the military and local security network (Vigilante, civilian Joint Task Force (JTF), and local community leadership) are required to implement any response.
• Enhancing routine immunisation (RI) - e.g., during walk-throughs, the areas for outreach sessions will be determined in agreement with traditional leaders.
• Intensifying surveillance (of AFP) - e.g., a network of informants (including traditional leaders/Ardos) of nomadic populations will be identified and trained in under-served communities, including nomadic communities and border and hard-to-reach areas to boost AFP detection and reporting. Regular sensitisation and feedback sessions will be conducted with these informants and any outstanding performance will be recognised and rewarded.
• Strengthening cross-border collaboration - e.g., during SIAs, inter-border synchronisation meetings facilitated by the Lake Chad TT are held and attended by officials from across the borders, leading to joint plans and synchronisation of vaccination sessions by both countries teams.
• Polio transition planning - e.g., the country completed the asset mapping process documenting human resources and physical assets costs, as well as documentation of a compendium of best practices in Nigeria. A simulation exercise to define transition strategies for all polio functions into these thematic areas of government focus was done, with a report available and awaiting endorsement. Ongoing engagements with partners and stakeholders continue with presentations to the Inter-agency Coordination Committee (ICC) for endorsement of Transition planning activities for the year 2017.

The report explores monitoring and evaluation strategies, as well as approaches to oversight and management. One key point to emerge from the latter section, echoing the above: Traditional leaders play a very important role in the Polio Eradication Initiative (PEI) programme. They have been incorporated in all the task forces - from presidential to the LGA task force. Aside from their involvement in various task forces, the traditional authorities in northern Nigeria have an organisation called the Northern Traditional Leaders Committee on PHC [primary health care] Delivery (NTLC), whose mandate among others is to lead the process of achieving PEI and RI goals through systematic involvement in activities for polio eradication. They have established committees at Emirate and District levels that coordinate activities in the LGAs, wards, and settlements. These committees are involved in advocacy, micro planning, vaccination team selection, supervision of IPD activities, resolution of non-compliance, and promotion of community demand for vaccination services. NTLC as well as the religious leaders through established structures such as the Nigeria Inter-Faith Action Association (NIFAA) and Federation of Muslim Women Associations in Nigeria (FOMWAN) will be expected to participate in the national coordination committees and thereby support planning, implementation, and evaluation of priority activities in the 2017 NPEEP. In 2017, continued focus will be placed on the engagement of the DCCN together with the NTLC.

"Enforcement of accountability continues to underpin all aspects of Nigeria's polio eradication programme and has been the game changer since 2013. The EOC will continue to ensure that all programme officers are held accountable while delivering on their assigned mandates." For example: "The individuals who demonstrate strong performance should be recognized through a reward programme. The programme has developed a reward scheme to recognize top performers in wards, LGAs and states. This was piloted in 31/44 LGAs of Kano state during the December 2013 IPDs campaign. An award certificate was issued to winning LGAs. However, these rewards may include public recognition, a congratulatory meeting with a senior leader, a mention in the media, enrollment in training of choice, etc."