Author Danjuma Gambo, February 5 2014: Professor in the Department of Mass Communication at the University of Maiduguri, Nigeria, and expert panellist on three polio communication reviews in Nigeria and India reflects on some of the challenges he believes face Nigeria's polio eradication efforts.
Substantial human, material and financial resources have been invested by partners in the polio eradication effort in Nigeria. Despite such a huge investment, there is little, if any, hope in sight that the interruption of transmission of the virus can be achieved within the stipulated period. Of late, especially with the reported successes recorded by India towards eradication, there seems to be profound disappointment in the international community that, instead of sustaining even the little successes in Nigeria, the PEI [Polio Eradication Initiative] is overwhelmed by religious and political controversies, policy and programme inconsistencies, if not outright failures. All along, polio partners and the Nigerian government appeared to be convinced that poor logistics, cold chain and inefficient implementation were the key issues that needed attention. Until 2002, particularly when the integrity of the PEI came under a serious challenge from Muslim leaders and some curious enthusiasts, most resources were deployed towards enhancing vaccine delivery and administration. Little attention was paid to communication or social mobilisation issues.
Relatively huge successes have been recorded so far, but religion, culture, tradition and local politics remain significant impediments to polio eradication in Nigeria. The apparent failure of the state to deliver basic infrastructure and services to the people, though beyond the mandate of the PEI, is at the centre of resistance to the programme in some sections of the country. Much of the people's anger is borne out of frustration at the failure of government to enhance the quality of life of ordinary people, despite the huge financial resources at its disposal.
Also, key communication issues are yet to be resolved. First, there should be a radical overhaul of the existing polio eradication management structure. By their present membership and modus operandi, there is no real hope that The Core Group, Inter-agency Coordinating Committee and the Expert Review Committee [* see notes, below] can move Nigeria to eradication. They need to be reinvigorated.
Second, the ongoing polio communication reviews could have been more helpful to Nigeria, but most recommendations are either not clearly understood by the national team or do not get through for consideration and approval by the above mentioned PEI management structures. This may be due to the non-inclusion of communication specialists in critical structures such as the ERC. Consequently, few communication-related recommendations are put to the attention of the ERC [Expert Review Committee], and agencies are free to pick whatever recommendations they wish to implement. The rest are left until another review session.
The next communication question is whether the social mobilisation resources deployed in Nigeria are appropriate and adequate to address the needs of the PEI. There seems to be no sufficient data on the number and quality of social mobilisation personnel operating in the different parts of the country. But from the shifts in the recruitment policies of some partner agencies, such as UNICEF [the United Nations Children's Fund], it is obvious that not many good, committed hands can be attracted and retained under this circumstance. The policy of recruiting social mobilisation personnel through a third party has made the job so unattractive that even the few good hands have been forced to leave. The resultant high personnel turnover has done more harm to the programme than good. It is clear that the remaining personnel cannot give what they do not have. As we move forward, it imperative to rethink this policy.
While the world celebrates the interruption of polio transmission by India, there is an emerging programme of exporting the model to Nigeria. But Nigeria does not lack models, technical personnel or even financial resources to interrupt transmission. Rather, the entire programme seems to be alien, in the sense that the perceived need to eradicate the disease is not original to the country, but a result of external pressure. It has been alleged in many quarters that the seeming foot dragging towards polio eradication in Nigeria is attributable to the benefits accruing to some layers in the programme.
The recent upsurge of violence in the north-eastern parts of the country presents a new challenge to polio eradication in Nigeria. Already, even the little that was left of the health infrastructure in the rural areas has been destroyed. There is serious threat to life and property to the extent that almost all government officials have been forced to move out of many local government areas. Unfortunately, many under five children are found in these security compromised areas. They must be reached with the OPV [oral polio vaccine]. More than ever before, Nigeria needs special logistics and experienced personnel to reach such vulnerable children. Avoiding the areas due to insecurity, which is the current attitude to the affected areas, is not a good response. This issue should engage the attention of experts in the coming months and years. Discussion on the way forward may benefit from experiences from conflict-prone areas such as Pakistan, Afghanistan, Iraq and Mali. The earlier steps are taken to address the challenge, the better.
Image credit: ImformAfrica
* Editor's note: The Inter-Agency Coordination Committee (ICC) is chaired by the Honorable Minister of Health and oversees all immunization activities in the country including polio eradication. Membership of the ICC is from the Federal Ministry of Health, National Primary Health Care Development Agency (NPHCDA), the National Agency for Food and Drug Administration and Control and Partner Agencies including the Association of Local Governments of Nigeria. The ICC is responsible to ensuring coordination of polio eradication activities with the broader immunization and Primary Health Care agenda in Nigeria.
The Core Group is chaired by the CEO/ED [Chief Executive Officer/Executive Director]of NPHCDA with members from NPHCDA, relevant ministries, international organizations, donors and civil society. Working groups including in the areas of operations, vaccines, logistics, monitoring and evaluation, routine immunization and social mobilization support The Core Group.
The Expert Review Committee (ERC) is a body of Nigerian and International Experts convened to provide independent oversight and review of the polio programme.