Getting to 100 percent: Enugu’s fight to maintain its polio free status

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Veronica Asogwa is a petty trader in Abakpa Nike, one of the largest suburbs in Enugu State, southeast Nigeria. When the state announced the commencement of the sub-national polio vaccination campaign on January 17, 2020, Asogwa, 37, prepared to take her two-year-old son, Emeka, to a vaccination centre a few kilometres from where she lives with her husband. “I even told my neighbours where I do business who didn’t know about it, because I don’t want anyone to be left out,” she says, adding, “I don’t want to be a victim like my sister.”
About 10 years ago, Asogwa’s elder sister who was living in Sokoto, northwest Nigeria, lost her baby to polio. She did not take him to be vaccinated when the state government began a vaccination programme in collaboration with the World Health Organisation [WHO] and other global partners, to eradicate the disease. A few months later, she lost her son to polio.
We were all saddened with the loss at that time and she never fully recovered psychologically because he was the only son she had,” Asogwa recalls. “So that is why whenever I hear anything that has to do with disease or campaigns for healthy living, I don’t joke about it.”

From January 18–21, 2020, Enugu State conducted the sub-national vaccination against polio. The state targeted an estimated “one million children between 0–59 months,” according to George Ugwu, the Executive Secretary of the Enugu State Primary Health Care Development Agency, which was responsible for the vaccination exercise. A record number of 479 immunisation officers across the 17 local government areas of the state were mobilised.

A signpost on immunisation at one of the centres. Photo credit: Nigeria Health Watch

When the exercise ended on January 21, 2020, a subsequent two-day mop-up exercise was carried out to capture areas that failed to achieve the 100 percent target to ensure that no child was left out in the process. In February, the state announced that it had achieved 100 percent success in the immunisation exercise against polio — a rung higher than the 98.5 percent it recorded in 2019.
This time the Sub-National Immunisation Plus Days we just concluded was very successful. I can categorically say that we recorded 101 percent, even exceeding the numerical mathematical 100 percent,” Ugwu said during the polio-free announcement. “Our national supervisors, partners and other stakeholders were impressed with the success and vast reach of our immunisation teams during the exercise.”
One particular approach — collaboration with traditional rulers, religious leaders and community heads — greatly contributed to the success of the vaccination programme, Ugwu says. These individuals used their positions of authority and influence to mobilise their followers and to create awareness on the need to get their children immunised. Using local health coordinators at LGAs, they reached out to these community influencers to help them create awareness, and make people aware about the upcoming immunisation exercises. This is their method of achieving great turnout in the exercises, and so far it seems to be working for them.

Image credit: Nigeria Health Watch

Ugwu also said that another factor that helped during the exercise, was that each local government in the state engaged in a friendly competition to out-do each other in reaching all the children in their area of supervision.
Meningitis, measles get similar attention
In December 2019, the Enugu State became the first state in Southeast Nigeria to begin mass immunisation against meningitis with a view to preventing maternal mortality. The immunisation was specifically targeted at children between the ages of 0–5 years old. There was a high turnout of people, especially mothers and care-givers who brought their children for the immunisation.
Ugwu said the government is addressing all public health concerns in the state as it affects mothers and newborns, especially with “the just concluded introduction of the second dose of measles into the Routine Immunisation for children between 15 and 23 months of age.” In November 2019, the state ensured that the Measles Second Dose Campaign was transferred into the routine immunisation exercise following campaigns by the Federal Government to immunise more than 28 million children nationwide.
The immunisation programmes against public health diseases in the state, according to Ugwu, is in line with achieving one of the Sustainable Development Goals (SDGs), which is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. The UN SDGs hope to end preventable deaths of newborns and children under 5 years of age. All countries aim to reduce neonatal mortality to as low as 12 per 1,000 live births and under-5 mortality to as low as 25 per 1,000 live births.

Mothers and care-givers with their children at one of the immunisation centres. Photo credit: Nigeria Heath Watch

Last year, Enugu State was in first place nationally in the maternal and child health indices, according to a survey by the Lots Quality Assurance of the National Primary Healthcare Development Agency. The survey is done every quarter to assess the performance and quality of routine immunisation programmes, in order to guide decision making across the states.
A government’s determination to fund healthcare for its citizens
The polio immunisation exercise was funded by the state government. Prior to this, international donors were relied upon to provide funding for activities targeted towards the elimination of polio in Nigeria. The Bill & Melinda Gates Foundation, Gavi, the Vaccine Alliance, Rotary International and WHO are some of the notable funding partners providing funding to eliminate polio in the country.
However, Enugu State is reversing this trend and adopting a more independent approach by providing mobilisation funds to the agencies in charge, to carry out their duties. Last year, the state government provided N100 million to enable the agency benefit from the Basic Healthcare Provision Fund (BHCPF). Another N200 million take-off grant was provided to the agency for Universal Health Coverage. These funds are being channeled into addressing public health issues in the state to avoid outbreaks, Ugwu said.

Immunization officials getting ready with their equipment at one of the centres. Photo credit: Nigeria Health Watch

For the past 14 years, the state had been without polio. The last polio case was in 2006. This, Ugwu says is as a result of the huge funding support from the state government in the light of dwindling funding from international health organizations.
But experts are concerned about the sustainability of funding for health programmes by the state government. “We cannot deny the fact that funding support from international organisations like the WHO, Bill Gates among others are very important in the fight against killer diseases in Nigeria and Africa at large,” Dr. Michael Agada, who works at the public health department of the University of Nigeria Teaching Hospital, said. “HIV/AIDs, malaria and the likes are being eradicated across developing nations of the world because of the enormous grants from these organisations.”
Another challenge according to Ugwu, was accessing the “hard to reach” places in the rural areas. However, he said the agency succeeded in getting to those places by constituting special teams who got access to those areas and administered the vaccines to the target population. The mop-up vaccination also helped in reaching those left out in the first phase of the exercise, he added.

Mothers with their children at the immunization centre. Photo credit: Nigeria Health Watch

The State government is doing a lot to eradicate polio and address other public health concerns by releasing large funds to the agencies involved, and that is why they are seeing results, Agada said. Ugwu is optimistic that the government’s support to public health in the state will continually improve.
Successive governments in the state have been very supportive in our health campaigns and through interventions in primary healthcare programmes,” he said, adding, “We are hopeful that it continues to get better with subsequent interventions.”
Asogwa agrees with Ugwu. She said many more lives would be saved if the government continues with its free public health programmes for the citizens. “I am happy that my child and other children benefited from this and I’m sure it would continue to save more lives in the state,” she said.
Do you know other states providing effective health interventions for polio? Let us know on Twitter @nighealthwatch and Facebook @nigeriahealthwatch

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