Learning from Polio Eradication: Community involvement in

reaching under-immunized in northern Nigeria

Acknowledgement of slides from: Nigeria NPHCDA; USAID’s JSI/ TSHIP project

•  Continuing transmission of WPV in endemic countries (including Nigeria: 21 WPV cases in 2010; 10 WPV cases as of 1 June 2011)

•  Identification and further analysis of high risk and under-served populations

•  Country prioritization & analysis

•  Global communication indicators developed by UNICEF, WHO, Communications Initiative, MCHIP, BMGF, and others: used for reporting in priority countries to improve measurement within and across countries.

•  Refined strategies to reach under-served and non-compliant communities: system improvements and community-oriented approaches

•  Continually increasing government commitment to polio eradication and immunization (through National Primary Health Care Development Agency), including mass media and advocacy plans and ensuring ongoing engagement of subnational and traditional leaders.

•  Involvement of partners like JSI/TSHIP (Targeted States High Impact Project – USAID funded) in high risk and lower performing states: Bauchi and Sokoto. Building on experience from previous USAID-funded projects, COMPASS and IMMUNIZATIONbasics

•  Women’s groups, traditional birth attendants (TBAs), and religious/traditional leaders participate in identifying and tracking missed children, non-compliant, pregnant women and newborns -- utilizing communication and PEI indicators.

Sokoto and Bauchi states; multiple MCH interventions

0

20

40

60

80

100

120

BCG DPT3 OPV3 Measles YF HepB-3 TT2+

2005 2006 2007 2008 2009 2010

Source:  Rou*ne  Administra*ve  Reports  

2005 = 32% 2007 = 59% 2006 = 49%

Source:  Rou*ne  Administra*ve  Reports  

<50%  

50-­‐79.9%  

80-­‐90%  

>90%   2008 = 57% 2010 = 69%

2009 = 63%

•  Criteria: •  >20% missed children (MC) & >30% non-compliant (NC) •  >50% MC •  polio case in past 6 months

1. Identify high risk wards each round and analyze

reasons for missed children

•  Monitor communication interventions on ground using new communications checklist

•  Recommend improvements and specific messages & interventions based on local situation (ie influencers, reasons for NC)

2. Supervise and assess quality of communication

activities

•  Support intensified communication planning and implementation

•  Involve traditional leaders, birth attendants, local leaders •  Supervise and adjust

3. Identify and implement intensified communication

activities

4. Monitor for change in MC/NC and knowledge, and refine strategies to

improve outcomes

Phase 1 (since Nov)

Phase 2 (from Jan)

Phase 3 (from Feb)

Repeat for each round

Source: IPD Tally Sheet data

Example: Bauchi Local Government Area (LGA)  High-level Traditional Leader involvement:

  resolving NC   meeting with anti-polio religious sects

 Re-engagement of FOMWAN (women’s group) in HR wards for revisit  Promotion of other interventions ( vit. A, TT, etc)

January   February   March  

1,215,063  

1,232,862  

1,247,030  

Target  (857,167)  

Note:  Field  reports  showed  vaccine  shortage  during  Immuniza9on  Plus  Days  (IPDs)  in  January,  resul9ng  in  lower  coverage  compared  to  February  and  March.    

However,  the  state  has  been  immunizing  children  above  target  (857,167  es9mated  children  <  five  in  2011)  in  every  IPD  round  since  the  beginning  of  the  year.

LGA # Children referred & immunized (never been vaccinated)

# of defaulters tracked &

immunized

# of newborns

seen

# of newborns

referred for OPV0

# of newborns receiving

OPV0

# households

visited

# of missed children

Dange Shuni 769 0 0 0 0 660   159  Goronyo 1239 275 101 101 101 320   138  Gwadabawa 2563 589 399 399 399 1320   143  Illela

761 244 73 73 73 240   109  

Sabon Birni 811 0 0 0 0 400   86  Sokoto South 2145   128   85   85   85   2800   334  Wamakko 1095   84   0   0   0   660   1331  Wurno 1323   0   0   0   0   240   147  Total 10706   1320   658   658   658   6640   2447  

Source:    TSHIP  monthly  data  collec9on  

Month  Number  of  

Sultanate/Emir  in  the  LGAs  

Number  of  Sultanate/Emir  involved  during  this  round  of  IPD  

Number  of  district  head  in  the  Ward  

Number  of  district  head  involved  during  this  round  of  IPD  

Number  of  Village  head  in  

the  Ward  

Number  of  Village  head  involved  during  this  round  of  IPD  

Number  of  Se[lement  head  in  the  

Ward  

Number  of  Se[lement  

head  involved  during  this  round  of  IPD  

January   1   0   21   17   177   162   2020   1012  

February   1   0   21   18   177   163   2020   1497  

March   1   0   21   14   177   132   2020   921  

Average   1   0   21   16   177   152   2020   1143  

0%

78% 86%

57%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Percent of Sultanate/Emir involved during

this round of IPD

Percent of district head involved

during this round of IPD

Percent of Village head involved

during this round of IPD

Percent of Settlement head involved during

this round of IPD

Average Total # Wards in state: 244

Total infants < 12 months: 171,433

Source:    TSHIP  Record  

Month   #  of  SeQlement  

#  of  Household    

#  Of  Children  Resolved  

(Immunized)  

#  Of  Outstanding  Children  

Total  #  Of  Children  Involved    

Jan   234   708   1173   604   1777  

Feb   217   737   1270   579   1849  

Mar   199   805   1146   665   1811  

Total   650   2250   3589   1848   5437  

3589

1848

5437

0

1000

2000

3000

4000

5000

6000

# Of Children Resolved

(Immunized)

# Of Outstanding Children

Total # Of Children Involved

The chart beside shows the number of children involved and resolved in non-compliance during IPD rounds in Jan - March 2011

(Source: TSHIP record – Eight LGAs only)

Traditional leader, 214

LGA task force, 6

Women leader, 10

Security, 10 STF, 7

Community Influencer,

44

Political leaders, 9

Religious leader, 60

Month

# of traditional leaders involved

# of LGA task force involved

# of Women leader

involved

# of Community Influencer involved

# of political leaders involved

# of Religious

leader involved

January 663 18 67 77 33 172 February 692 17 17 140 24 131

March 755 25 17 213 27 286

Total 2,110 60 101 430 84 589

N= sub-sample of 360

0 500 1000 1500 2000 2500 3000 3500

# of ward coordination meetings planned

# of ward coordination meetings Held

# of community meetings planned

# of influencers’ meetings planned

# of influencers’ meetings held

# of mosque/church announcements planned

# of mosque/church announcements held

# of RI sessions planned

# of RI sessions supported

294

252

244

94

73

3043

2518

1417

575

Activities January February March Total

# of ward coordination meetings planned 105 85 104 294

# of ward coordination meetings Held 89 75 88 252

# of community meetings planned 97 62 85 244

# of influencers’ meetings planned 30 22 42 94

# of influencers’ meetings held 23 18 32 73

# of mosque/church announcements planned 1004 1026 1013 3043

# of mosque/church announcements held 773 821 924 2518

# of RI sessions planned 480 469 468 1417

# of RI sessions supported 194 185 196 575

Source:  Enhanced  Independent  Monitoring  15

0 20000 40000 60000 80000

100000 120000 140000 160000 180000 200000

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No of un-immunized Children Dec 09 No of un-immunized Children DPT3 Dec 10

n= 22 out of 37 States

No  of  un-­‐im

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•  Preliminary results show improvements in reaching special populations and increases in timely routine immunization.

•  Use of these indicators in Nigeria benefiting polio and immunization and demonstrating the potential role of community influencers for other programs.

•  Building upon experience and collaborating with partners within high-risk communities creates access to leaders trusted by and representative of local communities.

•  Describing and quantifying this contribution can be challenging, given the need for social data that are nuanced.