Following the Africa Regional Certification Commission’s acceptance of the documentation submitted to it by the National Primary Health Care Development Agency (NPHCDA) and Partners, Nigeria has eventually been declared wild poliovirus free. And the glorious event, which took place on 25th August 2020, has aroused excited reactions nationwide. From the reactions, especially by prominent stakeholders, it is obvious that the certification of Nigeria as a polio-free country, and by extension, Africa, is no mean achievement.
Reacting to the good news, the Executive Director, NPHCDA, Dr Faisal Shuaib, had enthused, “It was an amazing moment in history to have had the polio-eradication documentation accepted by the ARCC.” His Excellency, President Muhammadu Buhari was no less enthusiastic. Reacting, he said, “This achievement is not only one of the great successes of this generation of Nigerians, but also one of the obvious dividends of this administration, which is consistent with our progressive investment in the health of our people since 2015.”
But how did we get here?
The journey a polio-free Nigeria has been long, tortuous and tedious. It could be categorized into three phases. In the first phase coinciding with the colonial era, the prevalence of physical disabilities rose significantly in the country. This was attributed to the wild poliovirus and efforts were made to stem the tide. In the second phase which was from the early 1980s to the 2000s, the fight against the virus initiated by the colonial regime was streamlined and strengthened for more impact. The recent past could be regarded as the third phase of the journey. In its terminal period over the last four years, different innovations were massively deployed in a total war against polio that has resulted in the final interment of the dreaded disease.
During the colonial period, the efforts to immunize children against polio were quite limited by several challenges, leaving many children paralysed or dead. After attaining independence, Nigeria’s polio fight took a different turn and especially gained momentum in the 1980s with the implementation of the Expanded Programme on Immunisation. The EPI integrated polio vaccination into primary health care. The establishment of the National Primary Health Care Development Agency, NPHCDA, in 1992 further pushed the struggle to new frontiers. As a federal government body with oversight function for primary health care development, the Agency was saddled with the responsibility supporting states and Local Government Areas (LGAs), and constantly focusing federal attention to the provision of health care at the grassroots through the over 32,000 primary healthcare facilities spread across the country.
NPHCDA’s merger with the National Programme on Immunization (NPI) in 2007 set the allowed better coordination of primary health care service delivery, including efforts to eliminate the wild poliovirus. Working with state governments and partners, NPHCDA took deliberate steps to develop and support human resources for PHC, mobilize resources, set standards and guidelines, support supervision, monitoring and evaluation, and guide provision of immunization services.
Nigeria’s efforts yielded some success, though temporarily. Having interrupted transmission of the virus for 12 months, the country was delisted from the polio-endemic list on September 25, 2015. Unfortunately, another case of wild poliovirus was isolated in a child in Borno State on August 21, 2016. This setback, partly caused by the Boko Haram insurgency which hampered vaccination efforts especially in the North-East, and noncompliance to vaccination by some caregivers, made the Agency go back to the trenches and re-strategize.
First, the federal government, under President Muhammadu Buhari declared a national public health emergency following the outbreak and reintroduced the Presidential Task Force on Polio Eradication to provide political leadership. Headed by the Vice President, Professor Yemi Osinbajo, the task force was expanded to include all the state governors and its mandate broadened to oversee routine immunization and primary health care. With the President ensuring adequate provision of funds for operations and other aspects, total war was declared on polio, with NPHCDA at the forefront.
With a renewed mandate, the NPHCDA promptly introduced new strategies, and also reinvented and reinvigorated the existing ones. Human, material and financial resources were mobilised from government and partners, and deployed to areas of critical need. Timetables were set for implementation of new strategies, the national immunization days were made more regular and outbreak responses were handled more efficiently. Routine immunization was also strengthened nationwide.
Recent initiatives in the NPHCDA to support polio eradication, routine immunization and primary health care
In the last four years, the Agency introduced some innovations and coordination platforms as part of the reinvigorated action plan. They include the National Emergency Routine Immunization Coordination Centre (NERICC), Community Health Influencers, Promoters, and Services Programme (CHIPS), and the National Emergency Maternal and Child Health Intervention Centre (NEMCHIC). Existing policies like the Primary Health Care Under One Roof (PHCUOR) policy were vigorously implemented.
The National Emergency Routine Immunization Coordination Centre (NERICC) was inaugurated by the Executive Director on 4th July, 2017, in line with the strategic vision of NPHCDA to revamp and strengthen Primary Health Care in Nigeria.
The initiative followed the outcome of the 2016/2017 National Immunization Coverage Survey/Multiple Indicator Cluster Survey (NICs/MICs) conducted on Routine Immunization, which put the national immunization coverage at 33%.
The Coordinating Centre, situated at NPHCDA Headquarters is headed by a Programme Manager with members drawn from government and development partners. Specifically, its objective was to coordinate and support day to day efforts to improve routine Immunization coverage from 33% to 85%. The performance of NERICC has been tremendous. Recent evidence shows that routine immunization coverage has increased from 33% in 2017 to 67% in 2019. This chart-busting performance is both unprecedented and excellent by all standards.
The NERICC operates a three-tier administrative framework. There are State Emergency Routine Immunisation Coordination Centre (SERICC) and LGA Emergency Routine Immunisation Coordination Centre (LERICC). Operating at these levels, it has tremendously improved responsiveness in the resolution of routine immunization gaps through establishing emergency immunization operation rooms, work stations as well as a high level emergency responsiveness squad of technical teams. The programme has successfully reached numerous unvaccinated children across the country, ensuring the national target of 85% coverage is achievable in a matter of time.
The CHIPS programme is specially designed to stimulate and support households in communities to seek and obtain primary health care services through interventions at the community level. The programme was flagged off by President Muhammadu Buhari in February 2018 and has helped with the mobilization of community members for health services.
The NEMCHIC is tailored towards providing oversight on reproductive, maternal, newborn, child and adolescent health and nutrition activities at the primary health care and community levels. The establishment of NEMCHIC followed the declaration of a state of public health concern on maternal and child health aimed at the reduction of maternal child deaths. To achieve this goal the NEMCHIC also operates across the three administrative levels; national, state and local government. Thus, we have the State Emergency Maternal and Child Health Intervention Centre (SEMCHIC) and the Local Government Emergency Maternal and Child Health Intervention Centre (LEMCHIC).
As at November 2019, SEMCHIC had been established in five states (Bauchi, Kebbi, Katsina, Gombe and Taraba), while LEMCHICs have been established in 77 Local Government Areas across the country. In all the LGAs where LEMCHIC was established, delivery kits (Mama Kit) were provided to PHC facilities. The community-targeted approach of NEMCHIC interventions is also improving the awareness and demand for health care services at PHC facilities in all the LGAs covered by the intervention.
PHCUOR, on the other hand, is part of a governance reform designed to improve primary health care implementation at the state and sub-state levels. It integrates all PHC services under the authority of a State PHC Board to instil order and reduce fragmentation in PHC management and service delivery. This supports the goals of achieving universal health coverage and aligns with the National Health Act and Sustainable Development Goals.
Efforts at repositioning PHCs in the country also led to the introduction of the Technical Support Unit (TSU). In this programme, the staff of the Agency were engaged in a Computer-Based Test and successful staff were selected to attend Leadership Development Academy to equip them with PHC leadership skills to provide technical support to states and LGAs through quality and standard PHC service delivery.
As a result of all these innovative strategies and commitment to their full and detailed implementation, Nigeria made history on August 21, 2019, achieving three years without a case of polio anywhere in the country. This made Nigerians hopeful that poliovirus would be a thing of the past. Though equally optimistic, NPHCDA could not afford to be complacent. It pushed on with all the necessary vigour, relentlessly pursuing its goals. And the declaration of Nigeria as a polio-free country by the World Health Organisation which we are celebrating is the direct result of all the efforts of several institutions and individuals some of whom are late now, and the staff of the Agency that remained dogged and committed to the course.
In the words of the Executive Director, Dr Faisal Shuaib, the achievement was made possible because “We got the right people at the NPHCDA being in the right places at the right time. We have very hardworking, passionate, determined, and committed health workers ready and willing to sacrifice their time, energy and all and then we have the vaccinators and volunteers in the frontline, who were committed to the fight against polio, and some paid the ultimate price in the line of duty.”
The roles played by the federal government, partners, governors, traditional rulers and the military cannot be overemphasized. They provided the needed resources and the enabling environment for the Agency to carry out its assignment successfully.
The landmark achievement is significant in many ways. First and foremost, the Nigerian child has been saved from the dreaded disease. Secondly, a lot of resources will be saved over the coming years. Routine Immunizations and polio vaccination activities will continue in order to keep children protected and the country free of the virus. However, mass polio campaigns will be implemented less frequently. Savings will be channeled towards addressing other challenging health needs in primary health care. This is indeed progressive in every sense as scarce government resources can now be channelled over time to critical priority areas in health such as efforts to reduce maternal and child morbidity and mortality.