The Game Changer

UNICEF QUARTERLY NEWSLETTER ON POLIO ERADICATION INITIATIVE IN NIGERIA MARCH 2012

NIGERIA INAUGURATES A PRESIDENTIAL TASK FORCE TO ERADICATE POLIO

ACCOUNTABILITY FRAMEWORK

INDEPENDENT MONITORING BOARD

NIGERIA IS NOT HEADING FOR SUCCESS

MISSED CHILDREN AND NON COMPLIANCE

Over 2,150 community mobilizers to be deployed in the most high risk settlements
UNICEF NEWSLETTER ON THE SITUATION OF CHILDREN IN MADAGASCAR

(c) UNICEF Nigeria/2012/Andriamasinoro

Evening Meeting (daily debriefing) of the Ward Focal Persons at the Immunization Office of Gusau LGA, during the February Immunization Plus Days, in Zamfara State.
WITH THE CONTRIBUTION OF TOMMI LAULAJAINEN Chief of Communication (Polio) PARYSS OLIVIER KOUTA Senior Communication for Development Specialist NAUREEN NAQVI Communication for Development Specialist MIRZA MASHUR MAHMED Monitoring and Evaluation Specialist NOAH MATARUSE Data and Monitoring Specialist OGU ENEMAKU Communication Officer LALAINA FATRATRA ANDRIAMASINORO Communication Specialist KEBEBEW FIKRU DAKA Social Mobilization and Development Specialist DR. AL-UMRA UMAR KHAN Social Mobilization and Development Specialist PANCHANAM ACHARI UNICEF STOP Consultant HAUWA ZAHRADEEN Social Mobilization Consultant WRITERS TOMMI LAULAJAINEN Chief of Communication (Polio) LALAINA FATRATRA ANDRIAMASINORO Communication Specialist OGU ENEMAKU Communication Officer NOAH MATARUSE Data and Monitoring Specialist PANCHANAM ACHARI UNICEF STOP Consultant FACTS CHECK MIRZA MASHUR MAHMED Monitoring and Evaluation Specialist NOAH MATARUSE Data and Monitoring Specialist EDITED BY TOMMI LAULAJAINEN Chief of Communication (Polio) OGU ENEMAKU Communication Officer LAYOUT AND DESIGN LALAINA FATRATRA ANDRIAMASINORO Communication Specialist

THE GAME CHANGER : What is in the name?

The Game Changer refers to the critical issues which can either make or break Nigerias polio eradication efforts to achieve a polio free Nigeria by 2012. The newsletter will feature and discuss game changing initiatives as well as challenges and opportunities the Nigerian Polio Eradication Initiative is facing in its efforts to reach the global eradication goal.

Nigeria CO March 2012

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SITUATION

Facing challenges in community engagement whilst dealing with deteriorating security situation

ANALYSIS

Nigeria is not heading for success unless its plan under development is made into something very special

IN FOCUS

Accountability Framework: President Jonathan inaugurates a Presidential Task Force to eradicate polio

SOCIAL MOBILIZATION

Over 2,150 Volunteer Community Mobilizers to be deployed in the most high-risk settlements

ADVOCACY

Kaduna State calls for renewed commitment of LGA chairmen in the fight against polio

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CAPACITY BUILDING

Improving interpersonal communication skills to resolve persistent non-compliance

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FROM THE FIELD

Immunization Plus Days: the reality on the ground in one of the most high risk areas of Zamfara State

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The Challenges POLIO SITUATION IN NIGERIA

March 2012

Situation

Facing challenges in community engagement whilst dealing with a deteriorating security situation
missed children in February campaign due to refusals. In many of the high risk wards where campaigns do not achieve 90% coverage, this means that upwards of 3% of all children are missed due to refusal. States like Yobe (62%), Gombe (29%), Kebbi (26%), Sokoto (26%) and Zamfara (26%) still have a high proportion of unresolved non-compliance even after revisiting the households. In the February campaign, Kano had the highest non-compliance (40%). In Jigawa, no felt need is a dominating reason for refusal, with almost 39% of caregivers refusing OPV citing this reason. Many social studies have revealed that high risk populations in Nigeria do not know how many doses of Oral Polio Vaccine (OPV) their children require. Additionally, caregivers have concerns over the safety and effectiveness of OPV, or do not feel their children are susceptible to polio, which could contribute to the response of no felt need. Other social and political norms also contribute to refusals. According to the latest data analysis, the main reasons for non-compliance are given as no felt need - (25%), no reason - (22%), no care giver consent - (12%), too many rounds (11%), and OPV safety (8%). In Gombe, for example, no caregiver consent is the second biggest reason for refusals. A total of 51% of the caregivers were informed about Immunization Plus Days by town announcers followed by radio/TV (25%), and traditional leaders (12%). February data analysis also revealed that 55% of the decisions for immunization were taken by the husbands while 30% by the mothers. The Latest Independent Monitoring Board Report mentioned that Nigeria is not heading for success, unless its emergency plan currently under development is made into something very special. As cases escalate in Nigeria and Pakistan, the world is facing an emergency a resurgence of polio - if the virus is not eradicated once and for all. If the global effort to eradicate polio fails, it is possible that within just a decade 250,000 children each year could be paralysed or die as a result of the disease.

(c) UNICEF Nigeria/2012/Andriamasinoro

Administration of OPV in the village of Yarbachaka, Wanke Ward, Gusau LGA during the February IPDs

Nigeria is one of the most entrenched reservoirs of wild poliovirus in the world. It is the only country with on-going transmission of all three serotypes: wild poliovirus type 1, wild poliovirus type 3, and circulating vaccine-derived poliovirus type 2. Nigeria remains the only polio-endemic country in Africa. As of 2nd of March, already four (4) new cases of wild poliovirus have been reported from Borno, Sokoto, Kaduna and Zamfara States. With 62 WPV cases in 2011, Nigeria is experiencing a surge of polio. The programme is addressing challenges in campaign quality and community engagement whilst dealing with a deteriorating security situation. States like Kaduna, Kano, Yobe and Sokoto have faced repeated threats or incidents of violence during the first two months of 2012, and bombings and killings have become almost routine occurrences in Borno. The worsening security situation in these states risks further declines in campaign coverage.

followed by Kebbi (9.1%), Kano (8.6%) and Katsina (7.3%). Non-compliance as a reason for missed children has increased from 26% in December to 27% in February. Child absent remains the main reason for missed children, accounting for over 65% of missed children according to the February data analysis. Children who are absent when vaccination teams visit are usually at playgrounds (30%), which are most often not far from their homes. Other times, they may be at social events (29%), which often take place in or near the household. In Jigawa, for example, 37% of children absent from the house in the February campaign were identified to be in the playground, while 13% were in the fields, and 20% were attending a social event with their mother or father. The situation of absent children is being monitored and during programme review meetings it is emphasized that activities to address this phenomenon need to be included in the microplans.

Spotlight on missed children

In Nigerias high-risk states, the proportion of missed children has shown a slightly increasing trend in the last two rounds: 6.1% in December and 7.0% in February. According to February Immunization Plus Days (IPDs) data analysis, Jigawa has the highest percentage of missed children (10.2%)

Persistent refusals
Persistent community resistance to the programme is profoundly impacting progress in Nigeria. In Nigeria, caregivers still refuse to vaccinate their children more frequently than in any other country in the world, with 3.2% of

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The Challenges

March 2012

Analysis

INDEPENDENT MONITORING BOARD REPORT ON NIGERIA

Nigeria is not heading for success unless its plan is made into something very special
been effectively enacted. The plan gave particular importance to Local Government Authority (LGA) polio task forces. In seven of the 12 high-risk states, more than half of these task forces entirely failed to meet during the last quarter of 2011. A lot of effort has gone into high-level advocacy, but this has shown no impact on the proportion of states or LGAs that have a functional task force. More importantly, it seems to have had minimal effect on the quality of vaccination days in most states and LGAs. The problems do not rest with vaccination alone. Plentiful genetic evidence demonstrates that cases of polio are not being detected. Rapid surveillance reviews have provided states with long lists of improvements that need to be made. Of the 12 high-risk states, eight have persistent transmission. Six of these eight failed to meet their end-2011 Major Process Indicator targets set by the 2010-12 Strategic Plan. Every one of these eight states has a considerable way to go before it can feasibly become polio-free. We reserve particular concern for Borno and Kano. In Borno, not one of the LGAs infected in 2011 had a functional task force. In Kano, only one quarter did. By almost any measure that one chooses to examine, these two states have the worst polio vaccination coverage of any in Nigeria. They are perilously far from being able to stop transmission. Both states had type 1, type 3 and cVDPV cases in 2011, further evidence of disastrous weaknesses in their vaccination campaigns. The issue of refusals has historically been a great concern for Nigeria, and remains so. Of all missed children in 2011, 24% were missed because their parents refused the vaccine. Even if every other problem with the programme could be sorted out, the refusals issue alone is sufficient to undermine success. Though the situation looks dire overall, there are some glimmers of hope. An intensive local-level communications strategy seems to be having an impact. Refusals declined from 2010 to 2011, and parents awareness of campaigns improved markedly. Additional methods are now being employed to understand and overcome reasons for refusal. This is crucial work. The programme has also taken steps to focus more attention on nomadic populations, although a pilot project in Kano demonstrated the very low level from which this work is starting. The project found several unreported cases of paralysis and no specific micro plans relating to nomadic communities. The security situation in Nigeria is far worse than it was a year ago. We sympathise with the difficulties that this may present to the programme. The programme must strive for better performance to mitigate these challenges. As we discuss later, country programmes need to be able to deal with insecurity if they have a genuine ambition of stopping polio transmission. The elections last year were used as an excuse for deteriorating performance. We can see why they caused problems. But such external factors cannot present one surprise after another. They will not go away, so they need to be anticipated, mitigated, and innovative ways found to manoeuvre around them. In 2011 the majority of polio cases in Borno State were on or near Lake Chad, at the borders between four countries. This area may need a specific strategy to reach the mobile populations that traverse the lake. We welcome the establishment of a Presidential Task Force in October 2011. This group has an important and considerable mission ahead of it. The country is in the final stages of agreeing its emergency plan. We have not yet seen this in detail. We are concerned that this plan may represent more of the same. The 2011 plan had far too little impact. The 2012 plan needs not just to be a convincing improvement. It needs to be an improvement of such magnitude that it can realistically stop polio. The Presidential Task Force needs to convince itself that this is the case before the plan is finalised. From what we see of its outline, we are not at all convinced. The country needs to urgently look at what more it can do. This programme is not on a trajectory for success. This is the time to pull out all of the stops.

(c) UNICEF Nigeria/2012/Andriamasinoro

Non-compliant household in the village of Yarbachaka, Wanke Ward, Gusau LGA during the February Immunization Plus Days

Though the south of Nigeria is free of polio, the north of the country is a dangerous hotbed of ongoing transmission. Nigerias northern states hold the key to stopping polio in West and Central Africa. Surrounding countries have been repeatedly infected by virus exported from here. We are gravely concerned by the poor performance of Nigerias programme. We cannot understand why the previously lauded leadership could have failed so seriously. The countrys plan for 2011 seemed to hold reasonable promise, but most of its 12 high risk states failed to implement key elements of the plan. Keystones such as the Abuja commitments essentially fell apart for much of the year. Vaccination coverage has barely improved at all since the beginning of 2010. Rapid and considerable improvements are needed if the country is to stand any chance at all of extinguishing this terrible disease. We have previously congratulated Nigeria on its performance in 2010. Case numbers fell by 95% compared to the year before. This provided hope that the country would be able to build on this success, but that dream was in tatters over the last year. The core elements of the 2011 plan were clear, but have simply not

Report issued by IMB in February

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The Challenges ACCOUNTABILITY FRAMEWORK

March 2012
(c) UNICEF Nigeria/2012/Andriamasinoro

In Focus

President Jonathan inaugurates a Presidential Task Force to eradicate polio in Nigeria

President Jonathan who assured that he was not backing down on his pledge in Australia during CHOGM, of eradicating polio before he leaves office in 2015 said, We cannot begin to say that the Nigeria population is high or big that is why we cannot eradicate polio, that is no excuse because countries that have over one billion people have done that. We are just about 170 million people so, we have no excuse. President Jonathan thanked Nigerias development partners especially the governments of Japan, United Kingdom, the United States, Germany, Rotary International and the Bill and Melinda Gates Foundation. In his response, Dr Pate assured of the committees determination to work day and night to ensure that the mandate given to them by the president was achieved. Eradication in Nigeria is doable and feasible, considering the fact that many states (22) had been without polio cases in the past two years and the number of cases reported in 2011 were localized to eight states, he said. Dr Pate noted that, in 2010, the country was celebrated for taking giant strides towards eradication of polio transmission as we recorded the lowest annual number of cases (21) that year compared to 388 cases in 2009. This represented a huge 95 per cent reduction. Other members of the committee are Mr. G. Dantang, Chairman Senate Committee on Health, Mr. N. Elumelu, Chairman House Committee on Health, Mr. Ado J. G. Muhammad Executive Director/CEO, NPHCDA, Salma Anas Kolo, Mr. Hassan Hussien Adamu, Mr. Abubakar Labaran Yusuf, Mr. Muhammed Nasidi Danladi, Mr. Abdullahi Maigwandu and Mr. Abubakar Aliyu. Others are Mr. Shehu Aliyu Samba, Mr. Muhammed Kabiru, Mr. Hide Idris, Mr. Sunday Nwangele, Mr. Mansur Kabir, Mr. Asishana Okauru, Mr. Umar Ibn Elkanemi, Emir of Bama, Sunday Onuoha, a bishop, Mr. David Okello, Mrs. Suomi Sakai, Mr. Busuyi Onabolu and Mrs. Maryam Othman.

(c) UNICEF Nigeria/2012/Andriamasinoro

New hope for Nigerian children with the commitment of the Federal Government to increase funding for polio eradication from USD 17m to USD 30m. Photo taken in the village of Sabon Gida, Zamfara State.

President Goodluck Jonathan has inaugurated a Presidential Task Force on Eradication of Polio, in line with his pledge during the last Commonwealth Heads of Government meeting in Perth, Australia. Addressing members of the Task Force at the Presidential Villa, Abuja, on Thursday, March 1, President Goodluck Jonathan said government was increasing the funding for polio eradication in the country from its current funding of $17 million to $30 million and pledged to increase the funding in the future. My commitment to the people of this country is that between now and 2015 when my term of office is expected to end, we will work day and night to make sure that we eradicate polio. For that reason, we have also increased the amount of money we bring into polio eradication from $17 million to $30 million and if we have challenges, we will look for more money, the President said. He noted that the occurrence of polio in the country was an embarrassment to him, adding that the size of Nigerias population should not be an excuse to tackle the problem of polio noting that countries with over one billion population have successfully eradicated polio. I believe Nigerians that are here are as embarrassed as myself whenever issues of polio are mentioned in the papers,

that Nigeria is still a sanctuary of wild polio and we are becoming a threat to other countries. It is quite embarrassing especially considering the fact that polio is a disease that we can conveniently eradicate. It could have been done some years back, we dont need rocket science to eradicate polio, it is simple vaccination, Mr. Jonathan said. So, it takes the will of government from federal through the state to the local governments and the traditional institution to educate the people to accept the vaccination, the Nigerian leader said adding that in Australia during the CHOGM, I pledged that before I leave office in this country we must eradicate polio. Luckily for us, out of the 36 states and the federal capital territory, the disease is now limited to about eight states. The Presidential Task Force chaired by Minister of State Health, Dr Mohammed Pete among other things is to focus on the most vulnerable highest risk wards, local governments and states and monitoring their progress monthly through the LG and states accountability framework, leading monthly reviews on polio eradication and mobilize specific states, LG, partners, traditional and religious leaders, civil societies, the media and the general public to ensure high quality funded polio eradication activities.The eight most affected states are Kano, Jigawa, Katsina, Sokoto, Zamfara, Kebbi, Borno and Yobe.

Notes issued by the State House on March 1st, 2012

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The Challenges

March 2012

Social Mobilization

REDUCING MISSED CHILDREN AND REFUSALS TO POLIO IMMUNIZATION

Over 2,150 Volunteer Community Mobilizers to be deployed in the most high-risk settlements

(c) UNICEF Nigeria/2012/Andriamasinoro

House-to-House Immunization team in the village of Yarbachaka, Wanke Ward, Gusau LGA during the February Immunization Plus Days, in Zamfara State

With the support of Bill and Melinda Gates Foundation and the Centers for Disease Control and Prevention (CDC), NPHCDA, UNICEF and PEI partners are starting to scale up a Volunteer Community Mobilizer Network targeting the most high-risk states Kebbi, Kano and Sokoto by March and Zamfara, Jigawa, Borno, Katsina and Yobe by May 2012. This initiative is part of the Nigeria PEI Emergency Plan and will contribute to reducing the percentage of missed children through targeted interventions house-to-house to generate demand for and acceptance of oral polio vaccine. In total, over 2,150 settlement level volunteer mobilizers will be recruited, trained and deployed in the settlements (villages) where missed children and refusals of oral polio vaccine are still persistent. In this first phase, these volunteer mobilizers cover 557 settlements in Kano, 200 in Kebbi and 200 in Sokoto. The first training of trainers (ToT) session took place in Kebbi and Kano

early March with cascade training for settlement volunteers to follow so that at least 200 mobilizers will be operational in some of the high risk settlements before the March IPDs at the end of the month. Through this extensive social mobilization effort and increased house-to-house behavior change communication, Polio Eradication Initiative aims to achieve the goal of immunizing all missed children in those high risk settlements, and make Nigeria polio-free, Dr. Suomi Sakai, UNICEF Nigeria Representative stated on behalf of Polio Eradication Initiative partners. Selected from their settlement, the volunteer community mobilizers will be trained to work as change agents in their respective communities. They will be responsible for resolving noncompliance and tracking unimmunized children in their own high risk settlement and carrying out door-todoor communication interventions with caregivers on issues related

to immunization and key household practices. The volunteer community mobilizers will (i) identify, characterize and facilitate the vaccination of chronically missed children, (ii) mobilize noncompliant parents through community friendly approach and resolve all cases of non-compliance, and (iii) create a conducive environment in the community through networking and partnership. Interpersonal counselling on immunization and key household practices carried out door-to-door and person-to-person will be the core of all volunteers work. The fact that the volunteers will also provide information to the community on key household practices such as nutrition, basic sanitation & hygiene practices is seen as important to counter polio fatigue at community level. The volunteers will also disseminate information on existing health services and explain the need for timely utilization of health services.

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The Challenges
(c) UNICEF Nigeria/2012/Andriamasinoro

March 2012

Social Mobilization
(c) UNICEF Nigeria/2012/Andriamasinoro

Bala is a town announcer in the village of Yarbachaka, Wanke Ward, Gusau LGA in Zamfara. Town announcers play a key role within the communities. According to the February data analysis, 51% of the caregivers were informed about Immunization Plus Days by town announcers.

Several pilot projects which have engaged and empowered community volunteers in the efforts to reduce missed children and non-compliance have shown encouraging results in the country. These volunteers are expected to be a fountainhead of community participation in health programmes in Nigeria, said Dr. Ado Muhammad, Executive Director of the National Primary Health Care Development Agency. In this framework, NPHCDA and PEI Partners have initiated a training of trainers session at state level to strengthen the capacity of the

identified volunteer ward supervisors to manage and monitor this project at their level. These training sessions will be followed by a cascade training for all the volunteer community mobilizers at community levels. In October 2011, 22nd Expert Review Committee recommendations clearly emphasize the need to strengthen community empowerment through scaling up community-based innovative approaches following intensified ward communication strategy (IWCS). Nigeria remains the only polio-endemic country in Africa. In 2011, 62 cases of

wild poliovirus had been reported in eight Nigerian states, compared with 21 cases in 2010. States in the north of the country are the main source of polio infections elsewhere in Nigeria and in neighbouring countries. As cases escalate in Nigeria and Pakistan, the world is facing a resurgence of polio if the virus is not eradicated once and for all. If the global effort to eradicate polio fails, it is possible that within just a decade, 250,000 children each year could be paralysed or die as a result of the disease.

Highlights
KEBBI STATE

Musical edutainment programme for polio awareness

From 15th-19th February 2012, the State Social Mobilization Committee and UNICEF in collaboration with Rotary International and WHO conducted a musical edutainment event by engaging the Polio Ambassador of Rotary International Dr. Adamu Dan Maraya Jos (International Traditional Hausa Singer) and a group of adult polio victims in 10 high risk pockets of Birnin Kebbi and Jega Local Government Area of Kebbi State. The Hausa Musician mobilized the audience with his popular songs emphasizing the importance of Polio Vaccine and immunization in childrens lives. Over 10,000 members of the general public gathered and participated in the event.

First phase: 557 volunteer community mobilizers in Kano, 200 in Kebbi and 200 in Sokoto One volunteer will be on average responsible for 200 households in a settlement One ward supervisor will be responsible for a cluster of 10 volunteer community mobilizers The initiative is funded by the Bill and Melinda Gates Foundation and the Centres for Disease Control and Prevention (CDC)

JIGAWA STATE

Community Leaders Against Polio project

On February 25th, the Jigawa State Government officially launched the Community Leaders Against Polio project (CLAP). The Governor of Jigawa committeed at the event to stop the transmission of polio by the end of the year by immunizing all eligible children against preventable childhood diseases and reinforcing primary health care services. The Governor also called on all community leaders to help vaccinators and social mobilization teams to convince non-compliant households to accept Oral Polio Vaccine, to support the implementation and supervision of immunization campaigns and Immunization Plus Days.

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The Challenges POLIO-FREE TORCH CAMPAIGN

March 2012

Advocacy

Kaduna State calls for renewed commitment of Local Government Chairmen in the fight against polio
(c) UNICEF Nigeria/2012/Andriamasinoro

Nigeria remains the only polio-endemic country in Africa. As of March 2nd, already four (4) new cases of wild poliovirus (WPV1 & WPV3) have been reported from Borno, Sokoto, Kaduna and Zamfara States. In 2011, 62 cases of wild poliovirus had been reported in eight Nigerian states, compared with 21 cases in 2010. States in the north of the country are the main source of polio infections elsewhere in Nigeria and in neighbouring countries. If you do not allow your children to get immunized against polio, you are compromising their future, the Executive Director of the NPHCDA, Dr. Ado Muhammad stated during the Polio Free Torch Event in Kaduna. In Nigeria, non-compliance as a reason for missed children has increased from 26% in December to 27% in February. States like Yobe (62%), Gombe (29%), Kebbi (26%), Sokoto (26%) and Zamfara (26%) still have a high proportion of unresolved non-compliance even after the households have been revisited. The Polio-Free Torch Campaign is an intensive 4-month media and event marketing strategy designed to mobilize wide support from a variety of stakeholders at national and state levels for the last lap of the polio eradication efforts in Nigeria. A partnership has been initiated with the Nigerian Olympic Committee linking the race towards London 2012 Olympics to the race to eradicate polio by 2012. TV and print advertising uses Nigerian Olympic icons as messengers. The overall objectives of the campaign are to (i) reinforce and maintain political commitment at National, State and LGA levels for the Polio Eradication Initiative by organizing special PolioFree Torch Advocacy Events at National and High Risks State levels; (ii) address caregivers resistance to Oral Polio Vaccine through an intensive radio campaign; and (ii) mobilize new partners, including the Private Sector, to generate sustainable support to the Polio Eradication Initiative in Nigeria. The Polio-Free Torch Event was also launched in Kebbi State on February 14th.

Launch of the Polio-Free Torch Event in Kaduna State on February 11th, by H.E. The Executive Governor and the CEO/ED of the National Primary Health Care Development Agency

On 11 February 2012, Kaduna State launched the Polio-Free Torch Campaign designed to overcome resistance to polio immunization and reinforce the commitment of all stakeholders to make Nigeria polio-free by the London Olympic Games in 2012. Even though we have been free from polio since 2009, the fight against polio in Kaduna is not yet over. This is because Kaduna is surrounded by polio-infected states, and there are still some resistance to polio immunization programmes, H.E. Sir Ibrahim Patrick Yakowa, the Executive Governor of Kaduna State said during the ceremonial launch. I urge all the Local Government Chairmen in the State to ensure regular meetings of the Local Government Task Forces on Immunization and active engagement of stakeholders, especially traditional and religious leaders in the campaign against polio in their respective areas, he continued. In 2011, Kaduna State conducted nine (9) rounds of Immunization Plus Days. The State has made tremendous progress in the fight against polio. In 2008, the State had recorded a total of 49 polio cases. This number dropped

to 16 cases in 2009 and the last case was recorded in Ikara Local Government Area in June 2009. We need a renewed sense of commitment and a sense of moral obligation to do something about polio eradication. We also need a solution-oriented partnership by all stakeholders and development partners to finish the battle against polio, reinforced Mr. James Mugaju, UNICEF Chief of Kaduna Office, on behalf of Polio Eradication Initiative partners. Routine immunization coverage remains low in Kaduna State. Immunization coverage for DPT-3 dropped from 75% in 2010 to 61% in 2011, which showed that none of the LGAs reached the target of 85% coverage. At national level, routine immunization coverage also remains below 80%, with sub-optimal performance by northern states. Reaching every infant with immunization services against common childhood killer diseases continues to remain a challenge in Nigeria. Persistent community resistance to the polio immunization programme is profoundly impacting progress. Caregivers in Nigeria still refuse to vaccinate their children more frequently than in any other country in the world, Mr. James Mugaju continued.

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The Challenges
The campaign was launched at National level by the Vice-President of the Federal Republic of Nigeria. This campaign kick-off at the federal level has initiated a series of State level launches in the Northern States which are still considered at very high risk from the wild polio virus: Niger in October, Kano in November, Jigawa in December, and Kaduna and Kebbi in February. The

March 2012
Torch will continue to travel to Zamfara, Bauchi, Yobe, Gombe and Sokoto. In Niger State, the Governor committed to release funds for polio eradication programmes in the state. He also instructed all local government chairmen to rise up to the task of eradicating polio from the State. In Kano, one of the highest risks States in the country, the torch campaign served as a symbol

Advocacy
of renewing the commitments of all the main stakeholders. Radio spots are running in all Northern radio stations in four (4) languages. The TV spot will run until March 2012, as well print ads in newspapers. Private sector companies have also expressed their interest to support this special advocacy campaign. Flash IT Solutions is among the companies responding to the call for support issued by Polio Eradication Initiative partners, by designing and hosting free of charge a dedicated website for the campaign. The telecommunication company, Visafone, also supported the campaign by financing two (series) of the print advertisement in national newspapers. Tradewindz, a Lagos-based communication agency, agreed to produce free of charge, a video documentary on the Polio-Free Torch Campaign. Through its connection with national media houses in Nigeria, Tradewindz will broadcast the final video documentary on Nigeria-based Television (NTA Network Stations across Nigeria, Amuludun Telly on Hitv, Mitv Station in Lagos). The production of the documentary will start in March 2012.

The Governor commits to release more funds for polio eradication in Kebbi

(c) UNICEF Nigeria/2012/Panchanam

On the occasion of the Polio-Free Torch event in Kebbi State, the Governor commits to release more funds for polio eradication programmes in the state until the end of the year. He commits to double the allowance of the community workers.

TRADITIONAL LEADERS

Northern Traditional Leaders Committee commits to forge a strong partnership in the fight against polio
Under the leadership of the National Primary Health Care Development Agency (NPHCDA) and the Northern Traditional Leaders Committee, an advocacy session on Polio Eradication Initiative took place in Kebbi on February 12th, in the presence of more than 25 Emirs from the most high risk Northern states of Nigeria. Traditional and Religious leaders renewed on this occasion their commitment to support the Polio Eradication Initiative and especially, to address communities refusals to polio immunization in their respective states and LGAs. Participants committed themselves to forge a strong partnership in the fight against polio as well as improving primary health care issues. His Eminence, the Sultan of Sokoto reaffirmed his commitment to advocate for a systematic partnership with the Northern Traditional leaders. According to the latest data analysis, traditional leaders play a crucial role in resolving caregivers refusals to polio immunization in Nigeria.
(c) UNICEF Nigeria/2012/Andriamasinoro

In Magami Ward, Gusau LGA, Zamfara State, the District Head (community traditonal leader), Alh Adamu Faraumana, has resolved almost all the non-compliance cases identified in his village during the February Immunization Plus Days. Traditional Leaders play a key role accross the country in resolving refusals of polio immunization and addressing missed children.

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The Challenges GOVERNORS FORUM

March 2012

Advocacy

Nigerian Governors sign up to Immunization Leadership Challenge

(c) UNICEF Nigeria/2012/Andriamasinoro

February data analysis revealed that 55% of the decisions for immunization were taken by the husbands while 30% by the mothers. Photo taken in the village of Yarbachaka during the February Immunization Plus Days.

Nigerias 36 Executive Governors and the Federal Capital Territory have signed up to the Nigeria Immunization Challenge launched by the Bill & Melinda Gates Foundation last year. Renewed political resolve and accountability are critical to stopping polio in Nigeria and we find it encouraging to witness both through the support expressed by every Executive Governor across the country for this initiative said Jeff Raikes, Chief Executive Officer of the Gates Foundation. By collectively signing up to this challenge, they are sending a very clear message about their commitment to lead the fight to eliminate polio in Nigeria. Announced in October 2011, the Challenge was initiated together with the Nigeria Governors Forum to recognize those Executive Governors whose states pass a pre-defined threshold to improve routine immunization coverage and end polio. The announcement followed a visit by Bill Gates, co-chair of the Gates Foundation and Jeff Raikes, during

which President Goodluck Jonathan expressed his hope that Nigeria would have close to zero cases at the same time in 2012 and be finished with polio soon after. Nigeria made great progress in 2010, reducing polio by 95%, said Mr. A.B. Okauru, Director General, Nigeria Governors Forum. But that pressure was not sustained in 2011, and as a result the polio virus was able to make a comeback this year. In 2012, Nigeria will need to redouble its efforts to finally get rid of this devastating disease. The Nigeria Immunization Challenge sets specific objectives that need to be met during each quarter of 2012. If met, Nigeria will significantly improve its chances of stopping polio and protecting more children against vaccinepreventable diseases such as measles and whooping cough. The sooner we end polio, the sooner we can ensure that our children, and the children of the world, stop suffering from this debilitating disease,

said Hon. Chibuike Rotimi Amaechi, Governor of Rivers State and Chair, Nigeria Governors Forum. Meeting this Challenge will enable us to focus on other health priorities and also help Nigeria to join other countries that have eliminated this disease.The states that meet all the necessary threshold criteria by the end of 2012 will be awarded a $500,000 grant from the Bill & Melinda Gates Foundation to support their top health priorities. This could include priority initiatives in public health, such as malaria and tuberculosis, improving immunization, HIV prevention and treatment, or safe drinking water and hygiene promotion. As of December 30, 2011, 51 cases of wild poliovirus had been reported in eight Nigerian states, compared with 21 cases in 2010. Polio virus from Nigeria is also genetically linked to transmission in Chad, Niger and Mali, making it critical to stop the spread of the disease to neighboring countries.

Press Release issued by BMGF in January

UNICEF QUARTERLY ON THE SITUATION OF CHILDREN IN MADAGASCAR 11 UNICEF NEWSLETTER NEWSLETTER ON POLIO ERADICATION INITIATIVE IN NIGERIA

The Challenges CAPACITY BUILDING

March 2012

Capacity Building

Improving interpersonal communication skills to resolve persistent non-compliance

(c) UNICEF Nigeria/2012/Andriamasinoro

(c) UNICEF Nigeria/2012/Andriamasinoro

Murtala Aliyu, Health Educator of the LGA of Gusau, Zamfara State, is practicing his interpersonal communication skills in the village of Sabon Gida (Gusau)

UNICEF has initiated an interpersonal communication training sessions aiming at strengthening the capacity of health educators, vaccination team supervisors and ward focal persons to convince caregivers to have their children immunized against polio. After Kano, Zamfara and Sokoto States, the training session has now been completed in Kebbi, which is one of the highest risk states in Nigeria. We are planning to start a cascade training to target all actors at community level including the vaccination teams. After that, we hope our vaccination teams will be able to better interact with non-compliant households and convince them to get their children immunized, said Murtala Aliyu, Health Educator of Gusau LGA, in Zamfara State. Different assumptions, different points of view, misunderstanding of language, use of difficult words, lack of attention, poor clarity of speech, conflicting body

language, discouraging feedback, cultural differences, lack of trust, etc., these are the barriers raised by the participants to convince communities in Zamfara during the training. After the session, the vaccination teams should know exactly what they want to communicate. They should think: How is it possible for someone to misunderstand their message? and ensure they are able to resolve non-compliance and refusals to polio immunization, continued Murtala Aliyu. Also, they should be able to ask if there are any children under 5 years who have never taken polio vaccine, advise vaccination of all children under 5 years during every polio round for added protection, advise routine immunization of all children under 1 year at local health center, answer basic questions about polio and vaccine, use simple, clear, local language to ensure caregiver understanding, he concluded.

At State and LGA levels, UNICEF team has conducted pilot IPC skills training session for Health Educators and a pilot training for Ward Focal Persons and Team Supervisors in at least two (2) High Risk LGAs of the States. Those sessions will be followed by a cascade training - in local language - for all the high risks LGAs. In total, this training will cover a total of 2,000 beneficiaries. We need to keep in mind that interpersonal communication skills need to be consistently and appropriately practiced. Otherwise, non-compliance in accepting polio vaccine is likely to occur, concluded Paryss Kouta, UNICEF Polio Communication Adviser. The Interpersonal communication skills training will cover in total seven (7) high risks Northern states of Nigeria: Kano, Zamfara, Sokoto, Kebbi, Jigawa, Yobe and Borno. The next session will take place in Jigawa State.

12 UNICEF QUARTERLY ON THE SITUATION OF CHILDREN IN MADAGASCAR NIGERIA UNICEF NEWSLETTER NEWSLETTER ON POLIO ERADICATION INITIATIVE IN

The Challenges MEDIA

March 2012

Media

A Media Award for best reporting on Polio Eradication Initiative in Nigeria

(c) UNICEF Nigeria/2012/Andriamasinoro

Polio Eradication Initiative Partners will launch this year a special Polio-Free Nigeria Media Awards. The idea of this award is to encourage and motivate journalists, producers and media outlets to report on polio eradication initiative and mobilize their respective audiences around polio immunization in order to increase demand for and acceptance of oral polio vaccine, said Tommi Laulajainen, UNICEF Chief of Polio Communication. The awards honour journalists for excellence in reporting on Polio Eradication Initiative in print, television, radio and online media; and celebrate media contributions to the eradication of polio in Nigeria. The entries are judged on journalistic merit, with emphasis on promotion of community awareness and understanding of polio eradication initiative in Nigeria. Another key factor for entries is how well they inspire stakeholder and community interest in and action for polio eradication.

TV journalists covering the ceremonial launching of the Polio Free Torch Event in Kaduna on February 11th

Traditional and Emergent media are playing key roles in raising awareness around polio issues, encouraging the

community to be mobilized around polio eradication efforts and reducing refusals to polio immunization. NPHCDA and

NEW TECHNOLOGY

A new dedicated website for the Polio Eradication Initiative in Nigeria - www.poliofreenigeria.com
The National Primary Health Care Development Agency (NPHCDA) and Polio Eradication Initiative (PEI) Partners have launched a new website focusing on the Polio-Free Torch Campaign and the Polio Eradication Initiative in Nigeria. This site was designed not only for the Polio-Free Torch Campaign but also to ensure a permanent online presence of the Polio Eradication Initiative in Nigeria. We are inviting all actors and development partners including media professionals - to feed this new website with information to demonstrate the impact of our joint interventions on the health and well-being of communities, said Tommi Laulajainen, UNICEF Chief of Polio Communication. Developed and powered - free of charge - by Flash IT Solutions Company, www. poliofreenigeria.com provides updates on the latest social data related to polio and the communication efforts that are carried out in the field. Stories from the field will be featured on the site showing the human face behind the data, and the difficulties faced in some high risk areas to address non compliance, missed children and low demand for vaccination. The site will also feature a selection of communication materials used to motivate various stakeholders to support polio eradication efforts in Nigeria as well as materials to promote OPV acceptance amongst caregivers. Flash IT Solutions is among the corporate companies responding to the call for support issued by PEI partners, by designing and hosting free of charge this dedicated website. Private sector companies need to be more committed and have the moral responsibility to support the Polio Eradication Initiative and to make Nigeria free from polio, stated Jide Owolabi, CEO of Flash IT Solutions.

13 UNICEF QUARTERLY ON THE SITUATION OF CHILDREN IN MADAGASCAR NIGERIA UNICEF NEWSLETTER NEWSLETTER ON POLIO ERADICATION INITIATIVE IN

The Challenges FEBRUARY IMMUNIZATION PLUS DAYS

March 2012

From the Field

Yarbachaka settlement: the reality on the ground in one of the most high risk areas of Zamfara State

Bala is a town announcer in the village of Yarbachaka, Wanke Ward, Gusau LGA in Zamfara. He starts his day at 7 a.m. to inform the communities on IPDs. Town announcers play a key role within the communities. According to the February data analysis, 51% of the caregivers were informed about Immunization Plus Days by town announcers, followed by radio/TV (25%), and traditional leaders (12%).

Vaccinators and Mobilizers started their work at 6.00 a.m. The team has immunized during the day 193 children. Street teams are also deployed in order to reduce missed children.

UNICEF polio communication team on the ground making sure that the system is working well and to monitor the IPDs. Dr. Ogu Enemaku, Communication Officer, is encouraging the Vaccination team in the village of Yarbachaka.

Aisha is an independent supervisor, and is part of the House-to-House immunization team. She is doing a housemarking after visiting each household, to ensure that not a single household is missed.

February data analysis revealed that 55% of the decisions for immunization were taken by the husbands while 29% by the mothers. Photo taken in the village of Yarbachaka during the February 2012 Immunization Plus Days.

14 UNICEF QUARTERLY ON THE SITUATION OF CHILDREN IN MADAGASCAR NIGERIA UNICEF NEWSLETTER NEWSLETTER ON POLIO ERADICATION INITIATIVE IN

The Challenges FEBRUARY IMMUNIZATION PLUS DAYS

March 2012

From the Field

Yarbachaka settlement: the reality on the ground in one of the most high risk areas of Zamfara State

Abdul Rasheed, 4 years old, has been immunized against polio in the February Immunization Plus Days, in the village of Yarbachaka.

Aminus Household is one of the non-compliant families in the village of Yarbachaka. A special committee has been constituted during the evening meeting to convince him.

Children without fingermark are considered as non-immunized children. Fingermarking is essential to make sure that not a single child under five is missed.

Kick polio out of Nigeria, Nigeria is not heading for success according to the latest Independent Monitoring Board report. The country needs to redouble its efforts to end polio by the end of the year.

Immunization Fixed Post at the Primary Health Care of Wanke Ward. Polio Immunization services are free all over the country.

I want to be a doctor, to help my communities and children said Umar, 16 years old, in the village of Yarbachaka. UNICEF Nigeria/2012/Andriamasinoro

15 UNICEF QUARTERLY ON THE SITUATION OF CHILDREN IN MADAGASCAR NIGERIA UNICEF NEWSLETTER NEWSLETTER ON POLIO ERADICATION INITIATIVE IN

(c) UNICEF Nigeria/2012/Andriamasinoro

FOR MORE INFORMATION

TOMMI LAULAJAINEN Chief of Communication (Polio) Mobile: +234 706 401 9646 tmlaulajainen@unicef.org UNICEF Nigeria Country Office www.poliofreenigeria.com Facebook page : Polio Free Nigeria

Nigeria CO March 2012

UNICEF QUARTERLY NEWSLETTER ON OF CHILDREN IN MADAGASCAR 20 UNICEF NEWSLETTER NEWSLETTER ON POLIO ERADICATION INITIATIVE IN NIGERIA 16 UNICEF QUARTERLY ON THE SITUATIONPOLIO ERADICATION INITIATIVE IN NIGERIA