by David Olayemi
The GAVI Partners’ Forum meeting in Dar es Salaam, Tanzania, has come and gone. I almost missed it, but I am glad I did not, as it contained some important lessons for the world and for my beloved country, Nigeria.
It is no longer news that polio remains endemic in Nigeria. In fact, Nigeria is the only country in Africa where it is still so prevalent. This is surprising given that Nigeria is surrounded by nations with less funds and fewer health resources.
Out of reach
Of the 22 million children around the world who are not currently reached by GAVI’s global immunisation campaign, 3.1 million (14%) are in Nigeria.
As a nation, Nigeria is second only to India, where 7.2 million children are not vaccinated. And when we consider that India has a population more than six times as large, in Nigeria there are actually more children per thousand who are not immunised.
Political will
At the moment, only 47% of Nigerian children receive DTP3 (three doses of diphtheria, tetanus and pertussis vaccines – the standard measure of immunisation coverage). This is unacceptable.
As at the time of writing, polio cases in Nigeria this year have risen above 108. That is in spite of the President’s interest in seeing Nigeria join the polio-free league of nations. This clearly demonstrates that political will, evidenced by injecting a lot of money into polio eradication, may not be the answer after all. In fact, there is a sense in which pumping in more money without a robust accountability mechanism is becoming counterproductive.
Reviewing the strategy
Polio must be eradicated from Nigeria. But is it time to review the strategy? If we focus on routine immunisation (RI), and if we can reach 80% RI coverage, as most parts of the world have done, I believe it is possible to eliminate polio from Nigeria by the time the world gathers for another GAVI partners’ forum in 2015.
Save the Children’s recent report, Immunisation for All, makes a number of key recommendations which have particular relevance for Nigeria:
Governments need to develop strategies to address inequalities in immunisation that are integrated into national health plans and that strengthen systems – in this context, I am advocating for the rapid passage of the National Health Bill and adoption of Primary Health Care under One Roof by every state Government in Nigeria.
Empower communities and engage them meaningfully as strategies are developed, implemented and monitored – the strategies we have been using thus far have gaps that need to be addressed. The approach must move to one in which the community is empowered to own the programme. We must also review the monitoring mechanism, as there is a possibility that vaccines may not be getting to a large number of children – potency and reliability of vaccinators have been called into question.
GAVI and other donors should also have a clear exit strategy in place for governments to increase support over time until Nigeria takes over its own immunisation programme.
Support for immunisation from important partners like the Bill and Melinda Gates Foundation, given in the context of strengthened primary healthcare, is commendable.