APPLYING LESSONS LEARNED TO FOLLOW-UP CAMPAIGNS, NIGERIA

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APPLYING LESSONS LEARNED TO FOLLOW-UP CAMPAIGNS,
NIGERIA

• A presentation _at_ 8th Annual Meeting of Partners
  for Measles Advocacy. Washington DC, USA
• By
• FMOH/NPHCDA
• - Dr. Emmanuel. I. Odu

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Nigeria Political Map
Admin Levels
Country State LGA Ward Community

• .

North West
North East
North Central
South East
South West
South South
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Administrative coverage results of measles
Catch-up Campaign, 2005/2006 Nigeria.
North Dec 2005
South Oct 2006
Overall coverage 83
Overall coverage 95.3
lt 84
85 94
95 100
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SUMMARY FEATURES OF MEASLES CATCH-UP CAMPAIGN,
NIGERIA 2005/2006
Parameter North South
Implementation dates 06-12 Dec. 2005 03-09 Oct. 2006
Age Category involved (Measles Vaccine) 9months-15YRs 9months-15YRs
of States (T-Population) 19 (29,877,057) 17 (31,630,011)
Reported Coverage 95 83
LGAs with gt 95 Coverage. 211/419 138/355
Key Challenges
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Measles trends, 2005-2008, Nigeria
Measles catch up campaign in Southern states
Measles catch up campaign in Northern states
2007
2008
2005
2006
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Age vaccination status of confirmed measles
cases, Nigeria, Jan Jul 2008 (n8,887)
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Surveillance

• Measles case-based surveillance implemented in
  all states.
• Good performance
• rate of suspected measles cases reported with
  blood specimens gt3 / 100,000 population, of which
  
• gt95 have had blood specimen collection, and
  results available.

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Zonal location of Measles Labs Nigeria
Measles lab
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Lesson learned 1

• Government Funding. Readiness of government to
  provide funds.
• Phased Implementation ensured optimum use of
  limited skilled personnel
• Partnership. Technical resources in-country
  partners Support international partners,
  including Measles Partnership Valuable.
• Involvement of other Ministries, Religious,
  Traditional Community leaders helpful.
• Use of Volunteers helpful.

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Lesson Learned 2

• Controversial population estimates
• Planning. Commenced late more time needed for
  micro-planning and verification
• Procurement of vaccine not bundled created
  logistic problems.
• Delays in clearing forwarding
• Training. Quality decreased on cascading to
  operational levels.
• Duration of implementation. Five days were not
  sufficient.

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Lesson Learned 3

• Timing of implementation. Rainy season in the
  south affected vaccination activities quality
  of supervision.
• Late release of funds by partners.
• Mobilization messages not focused on fixed post
  vaccination.
• Coordination. Weak coordination capability at LGA
  level.
• LLINs Integration concept and practice need to
  be managed well.
• Mop-up Plans. Necessary to have contingency
  (Mop-up) plans.
• Gains registered after the catch-up campaign were
  not sustained throughout the country due to
  failure to achieve reasonable RI coverage levels.
  

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2008 Follow-up Campaigns
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Goal and Objectives

• Goal
• Contribute to Measles Mortality reduction by by
  building on the gains of 2005 and 2006 catch-up
  campaigns
• Objective
• to Vaccinate 95 of all children aged 9 59,
  months in Nigeria, against Measles (regardless of
  their previous immunization status) by December
  2008.
• To use the opportunity to deliver other CS
  interventions.
• Scope 36 states plus FCT

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Interventions

• Measles Vaccine Children aged 9-59 months
  irrespective of previous immunization status
  (target coverage 95) target population
  25,348,212.
• Oral Polio Vaccine (OPV) Children aged 0-59
  months irrespective of previous immunization
  status (target coverage 95) target population
  29,821,426.
• Vitamin A Supplementation Eligible Children aged
  6-59 months (target coverage 95) target
  population 26,839,285.

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Roles Responsibilities Key Stakeholders.
Stakeholder Responsibility Area Remarks
FGN/NPHCDA Procurement of vaccines (Bundled) 50 Operational funds. Payment made, order placed.
States/LGAs Cold Chain Strengthening, Injection Safety/AEFI Monitoring Supervision Provision of AEFI kits, Buckets for running water, Soap, Cups and hand towels, Waste Management. Funding available
Partners WHO, UNICEF, etc. Social Mobilization, Logistics/CC, Monitoring S Funding available
Measles Partnership. Advocacy/Mobilization, Funding Support. 2 visits conducted
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Planning

• Commenced early, 2006 Census figures used.
• National POA developed gt 1year ahead
• National Budget prepared gt 1 year ahead
• Partners mobilized
• International Support MP

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Activity Timelines, IMC 2008 Nigeria.
S/N Date Activity Responsible Comments
1 16-8 Sept. Zonal Level Training of Trainers (TOT) on Micro-planning National Trainers and Partner agencies Zonal Consultants
2 23-24 Sept. State TOT on Micro-planning State Officials, consultants, partners.
3 07-08 Oct. Ward level Training on Micro- planning LGA Team, WFPs
4 13-17 Oct. Development of Ward Micro-plans. LGA Team, WFPs
5 20-22 Oct. National TOT for Implementation NMC, National Trainers
6 27-29 Oct. Zonal Level TOT for Implementation National Trainers and Partner agencies Zonal Consultants
7 03-05 Nov State Level TOT for Implementation State Officials, consultants, partners.
8 13-15 Nov Ward Level training on Implementation State LGA Teams, WFps.
9 19-24 Nov 10-14 Dec Implementation North South
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Timing of Implementation Evidence
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Communication/IEC

• POA distributed to stakeholders
• States informed
• Consultative Meetings North South
• Information sharing
• Views/inputs
• IEC materials finalized.
• Mobilization messages address fixed posts.
• social mobilization messaging for the different
  target groups clarified

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Training

• Training materials and schedules are standardized
  for the operational levels to ensure that content
  and messages do not get diluted while cascading,
• Lessons from previous measles SIAs are
  incorporated at all training levels
• Mapping
• part of the training and micro-planning
  exercises,
• vaccination teams understand the operational use
  of these maps
• to delineate their catchment areas,
• for community mobilization purposes and
• For Monitoring Supervision
• National Zonal TOT for Micro-planning -
  conducted

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Logistics/Cold Chain

• Procurement of Vaccines (MV, OPV) by FGN.
• Bundles MV, Sufficient quantities ordered
• Expected Date of Delivery
• 15/10 (for North)
• 24/10 (for South)
• Vitamin A available.
• Syringes/Needles being cleared at the ports.
• Cold Rooms Dry Stores (National, Zonal States,
  LGAs).
• Waste Mgt options being explored and included in
  Micro-plans.
• Distribution Plan in place.

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M E

• M E tools finalized and harmonize for the
  various interventions at different levels
• With instructions on their use.
• Training on supervision and operational support
  for supervision duly included in implementation
  training.
• Strategy in place for monitoring of zero dose
  measles vaccine recipients outcome for
• advocacy
• programmatic use for strengthening RI
• Planning, Implementation Monitoring/Supervision
  Templates/Forms - finalised.

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Implementation

• Phased. Duration 5 days.
• Scheduled for Dry Season (Nov/Dec) in both North
  South.
• Intervention to delivered at fixed Posts.
• Supervision highly prioritized. To be addressed
  during implementation training. Active
  participation by LGA team
• Supervisors/Monitors to be used extensively.
• Nationwide Distribution of LLINs suspended,
  possibility of distributing in 2-3 States, final
  decision to be reached.

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Conclusion

• The Catch-up campaign implemented in Nigeria 2-3
  years ago achieved significant impact on measles
  morbidity mortality, in view of low disease
  incidence post-SIA.
• Outbreak events affected unvaccinated Children lt
  5 Yrs.
• Gaps in routine vaccination of recent birth
  cohorts
• Gaps in campaign coverage.
• Campaign coverage gaps to be eliminated with
  mop-ups.
• Follow-up campaign to contribute to RI
  Strengthening.
• We so value and count on your support advice
  for which we say thank you.

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THANK YOU