Learning from Polio Eradication: Community involvement in reaching under-immunized in northern Nigeria Acknowledgement of slides from: Nigeria NPHCDA; USAID’s JSI/ TSHIP project
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
mun
ized
• 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.