Lora ShimpLora ShimpSenior Technical Officer – ImmunizationSenior Technical Officer – Immunization

John Snow, Inc / MCHIPJohn Snow, Inc / MCHIP

Learning from Polio Eradication: Community involvement in

reaching under-immunized in northern Nigeria

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

Wild poliovirus situation and NigeriaWild poliovirus situation and Nigeria

• 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

Communication Communication responseresponse

• 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

Nigeria exampleNigeria example

• 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

Nigeria national data: cumulative routine immunization Nigeria national data: cumulative routine immunization coverage for all antigens 2005-2010coverage for all antigens 2005-2010

Source: Routine Administrative Reports

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

2005-2010 Routine OPV3 performance at state level2005-2010 Routine OPV3 performance at state level

Source: Routine Administrative Reports

<50%

50-79.9%

80-90%

>90% 2008 = 57%2010 = 69%

2009 = 63%

Intensified Ward Communication Strategy Intensified Ward Communication Strategy

Phase 1 (since Nov)

Phase 2 (from Jan)

Phase 3 (from Feb)

Repeat

for each

round

Example: progress in resolving persistent non Example: progress in resolving persistent non compliance with a tailored package of interventions compliance with a tailored package of interventions

Source: IPD Tally Sheet data

Trend of children immunized with OPV during IPD Trend of children immunized with OPV during IPD Rounds by month in Sokoto State (Jan – Mar 2011)Rounds by month in Sokoto State (Jan – Mar 2011)

Note: Field reports showedvaccine shortage during Immunization Plus Days (IPDs) in January, resulting in lower coverage compared to February and March.

However, the state has been immunizing children above target (857,167 estimated 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

Illela761 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

TBA monthly tracking and referral of newborns and defaulters to TBA monthly tracking and referral of newborns and defaulters to HFs, by LGA in Sokoto - HFs, by LGA in Sokoto - Jan to March 2011Jan to March 2011

ource: TSHIP monthly data collection

MonthNumber 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 Settlement head in the

Ward

Number of Settlement

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

Summary of traditional leader involvement in monitoring SIAs in Summary of traditional leader involvement in monitoring SIAs in Sokoto – Jan to March 2011Sokoto – Jan to March 2011

Total # Wards in state: 244

Total infants < 12 months: 171,433

Source: TSHIP Record

Settlements, households and children involved in non-compliance Settlements, households and children involved in non-compliance during IPD rounds in Sokoto from January-March 2011during IPD rounds in Sokoto from January-March 2011

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)

Who helped to resolve non-compliance cases?Who helped to resolve non-compliance cases?

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

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

Activities conductedActivities conductedJan-Mar 2011 Jan-Mar 2011

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Bauch

i

Borno

Katsin

a

Soko

toYobe

Zam

fara

Gombe

Jigaw

a

KadunaKan

oKebbi

Niger

Oct-10 Nov-10 Jan-11

SIA Quality in Polio High Risk States SIA Quality in Polio High Risk States Proportion of wards with >10% Missed ChildreProportion of wards with >10% Missed Children

Source: Enhanced Independent Monitoring15

States with reduction in number of under-immunized States with reduction in number of under-immunized (DTP3) – comparison of 2009 and 2010(DTP3) – comparison of 2009 and 2010

No

of u

n-im

mun

ized

Results and lessons learnedResults and lessons learned

• 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.

Thank you!Thank you!