Learning from Polio Eradication: Community Involvement in Reaching Under-Immunized in Northern Nigeria

This presentation explores the role of community involvement in reaching the under-immunised in northern Nigeria, which at the time of writing was a polio-endemic country. Featuring slides from the Nigeria National Primary Health Care Development Agency (NPHCDA) and the United States Agency for International Development (USAID)'s Targeted States High Impact Project (TSHIP) project, the presentation looks at the wild poliovirus (WPV) situation in Nigeria and the communication response to it.

Lora Shimp explains that global communication indicators were developed by the United Nations Children's Fund (UNICEF), World Health Organization (WHO), The Communication Initiative, Maternal and Child Health Integrated Program (MCHIP), the Bill & Melinda Gates Foundation (BMGF), and others. These indicators were used for reporting in priority countries to improve measurement within and across countries. They helped inform the development of refined strategies to reach under-served and non-compliant communities through system improvements and community-oriented approaches.

Nigeria saw continually increasing government commitment to polio eradication and immunisation (through the NPHCDA), including mass media and advocacy plans and ensuring ongoing engagement of subnational and traditional leaders. There was also involvement of partners like JSI/TSHIP in the high-risk and lower-performing states of Bauchi and Sokoto. Utilising communication and Polio Eradication Initiative (PEI) indicators, women's groups, traditional birth attendants (TBAs), and religious/traditional leaders participated in identifying and tracking missed children, non-compliant people, and pregnant women and newborns.

Shimp shares data from Sokoto and Bauchi states, as well as Nigeria national data, also outlining the Intensified Ward Communication Strategy, which featured these steps: (i) identify high-risk wards each vaccination round and analyse reasons for missed children; (ii) supervise and assess quality of communication activities; (iii) identify and implement intensified communication activities; and (iv) monitor for change in missed children/non-compliant and knowledge, and refine strategies to improve outcomes. An example: progress in resolving persistent non compliance with a tailored package of interventions that included high-level traditional leader involvement (e.g., meeting with anti-polio religious sects) and re-engagement of Federation of Muslim Women's Associations in Nigeria (FOMWAN) in high-risk wards for revisit.

Next, Shimp presents data showing a trend of children immunised in increasing numbers with the oral polio vaccine (OPV) during Immunization Plus Day (IPD) rounds by month in Sokoto State (January - March 2011); one chart shows the number of children involved and resolved in non-compliance during those IPD rounds. She provides a summary of traditional leader involvement in monitoring Supplementary Immunisation Activities (SIAs) in Sokoto during that same time period. She asks, Who helped to resolve non-compliance cases? Traditional leaders played a central role. One slide displays the activities conducted during that time period, such as ward coordination meetings, community meetings, influencers' meetings, and mosque/church announcements.

Results and lessons learned:

• Preliminary results show improvements in reaching special populations and increases in timely routine immunisation.
• Use of these indicators in Nigeria have supported polio immunisation and demonstrate the potential role of community influencers for other programmes.
• Building upon experience and collaborating with partners within high-risk communities creates access to leaders trusted by and representative of local communities.
• Describing and quantifying this contribution can be challenging, given the need for social data that are nuanced.