APPLYING LESSONS LEARNED TO APPLYING LESSONS LEARNED TO FOLLOW-UP CAMPAIGNS, NIGERIAFOLLOW-UP CAMPAIGNS, NIGERIA
A presentation @ 8th Annual Meeting of Partners for Measles Advocacy. Washington DC, USA
By
FMOH/NPHCDA- Dr. Emmanuel. I. Odu
Nigeria Political MapNigeria Political Map
• .Country
State
LGA
Ward
CommunityNorth West
North East
North Central
South East
South West
South South
Admin Levels
Administrative coverage results of measles Catch-up Administrative coverage results of measles Catch-up Campaign, 2005/2006; Nigeria.Campaign, 2005/2006; Nigeria.
Overall coverage; 95.3%< = 84%
85 – 94%
95 – 100%
Overall coverage; 83%
North – Dec 2005 South – Oct 2006
SUMMARY FEATURES OF MEASLES CATCH-SUMMARY FEATURES OF MEASLES CATCH-UP CAMPAIGN, NIGERIA; 2005/2006UP CAMPAIGN, NIGERIA; 2005/2006
Parameter North South
Implementation dates
06-12 Dec. 2005 03-09 Oct. 2006
Age Category involved (Measles Vaccine)
9months-15YRs 9months-15YRs
# of States &
(T-Population)
19
(29,877,057)
17
(31,630,011)
Reported Coverage 95% 83%
LGAs with => 95% Coverage.
211/419 138/355
Key Challenges
Measles trends, 2005-2008, NigeriaMeasles trends, 2005-2008, Nigeria
0
5000
10000
15000
20000
25000
30000
Jan-
05Feb M
ar AprM
ayJu
ne July
Aug Sep Oct NovDec
Jan-
06Feb M
ar AprM
ayJu
ne July
Aug Sep Oct NovDec
Jan-
07Feb M
ar AprM
ayJu
ne July
Aug Sep Oct NovDec
Jan-
08Feb
Mar
cApr
il
Northern States
Southern States
2005 2006 2007
Measles catch up campaign
in Northern states
Measles catch up campaign
in Southern states
2008
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Missing (1). Less than 9months
(2). 9 to 11months
(3). 12 to 23months
(4). 24 to 59months
(5). 5 to 14 Years (6). 15 Years -Over
Missing 0 Doses >=1 dose
Age & vaccination status of confirmed measles cases, Age & vaccination status of confirmed measles cases, Nigeria, Jan – Jul 2008 (n=8,887)Nigeria, Jan – Jul 2008 (n=8,887)
SurveillanceSurveillance
• Measles case-based surveillance implemented in all states.
• Good performance– rate of suspected measles cases reported with blood
specimens >3 / 100,000 population, of which – >95 have had blood specimen collection, and results
available.
Zonal location of Measles Labs; NigeriaZonal location of Measles Labs; Nigeria
Measles lab
Lesson learned – Lesson learned – 11
• Government Funding. Readiness of government to provide funds.
• Phased Implementation ensured optimum use of limited skilled personnel
• Partnership. Technical resources in-country partners & Support international partners, including Measles Partnership – Valuable.
• Involvement of other Ministries, Religious, Traditional & Community leaders – helpful.
• Use of Volunteers helpful.
Lesson Learned – Lesson Learned – 22::
• Controversial population estimates• Planning. Commenced late; more time needed for
micro-planning and verification •
• Procurement of vaccine not ‘bundled’ created logistic problems.– Delays in clearing & forwarding
• Training. Quality decreased on cascading to operational levels.
• Duration of implementation. Five days were not sufficient.
Lesson Learned – Lesson Learned – 33::
• Timing of implementation. Rainy season in the south; affected vaccination activities & quality of supervision.
• Late release of funds by partners.• Mobilization messages not focused on fixed post vaccination.• Coordination. Weak coordination capability at LGA level.
• LLINs Integration; concept and practice need to be managed well.• Mop-up Plans. Necessary to have contingency (Mop-up) plans.
• Gains registered after the catch-up campaign were not sustained throughout the country due to failure to achieve reasonable RI
coverage levels.
2008 Follow-up Campaigns2008 Follow-up Campaigns
• Goal– Contribute to Measles Mortality reduction by by
building on the gains of 2005 and 2006 catch-up campaigns
• Objective– to Vaccinate 95% of all children aged 9 – 59, months in
Nigeria, against Measles (regardless of their previous immunization status) by December 2008.
– To use the opportunity to deliver other CS interventions.
• Scope: 36 states plus FCT
Goal and ObjectivesGoal and Objectives
InterventionsInterventions
• Measles Vaccine: Children aged 9-59 months
irrespective of previous immunization status (target
coverage 95%): target population 25,348,212.
• Oral Polio Vaccine (OPV): Children aged 0-59 months
irrespective of previous immunization status (target
coverage 95%): target population 29,821,426.
• Vitamin A Supplementation: Eligible Children aged 6-
59 months (target coverage 95%): target population
26,839,285.
Roles & Responsibilities; Key Stakeholders.Roles & Responsibilities; Key Stakeholders.
Stakeholder Responsibility Area Remarks
FGN/NPHCDA Procurement of vaccines (‘Bundled’) 50% & Operational funds.
Payment made, order placed.
States/LGAs Cold Chain Strengthening,Injection Safety/AEFIMonitoring & SupervisionProvision of AEFI kits, Buckets for running water, Soap, Cups and hand towels, Waste Management.
Funding available
Partners; WHO, UNICEF, etc.
Social Mobilization, Logistics/CC, Monitoring & S
Funding available
Measles Partnership.
Advocacy/Mobilization, Funding Support.
2 visits conducted
PlanningPlanning
• Commenced early, 2006 Census figures used.• National POA developed > 1year ahead• National Budget prepared > 1 year ahead• Partners mobilized• International Support; MP
Activity Timelines, IMC 2008; Nigeria.Activity Timelines, IMC 2008; Nigeria.
S/N Date Activity Responsible Comments
1 16-8 Sept. Zonal Level Training of Trainers (TOT) on Micro-planning
National Trainers and Partner agencies’ Zonal Consultants
2 23-24 Sept. State TOT on Micro-planning State Officials, consultants, partners.
3 07-08 Oct. Ward level Training on Micro- planning
LGA Team, WFPs
4 13-17 Oct. Development of Ward Micro-plans.
LGA Team, WFPs
5 20-22 Oct. National TOT for Implementation NMC, National
Trainers
6 27-29 Oct. Zonal Level TOT for Implementation National Trainers and Partner agencies’ Zonal Consultants
7 03-05 Nov State Level TOT for Implementation State Officials, consultants, partners.
8 13-15 Nov Ward Level training on Implementation
State & LGA Teams, WFps.
9 19-24 Nov
10-14 Dec
Implementation North
South
Timing of Implementation & EvidenceTiming of Implementation & Evidence
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2500
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Suspected & total confirmed & lab-confirmed measles cases by monthFrom 01/05/2007 to 31/05/2008
Num
ber
of
cases
Month of date of onset2007_05 2007_06 2007_07 2007_08 2007_09 2007_10 2007_11 2007_12 2008_01 2008_02 2008_03 2008_04 2008_05
1-Suspected 2-Total confirmed 3-Lab confirmed
Communication/IECCommunication/IEC
• POA distributed to stakeholders • States informed• Consultative Meetings – North & South
– Information sharing– Views/inputs
• IEC materials finalized.• Mobilization messages address fixed posts.• social mobilization messaging for the different target
groups clarified
TrainingTraining
• Training materials and schedules are standardized for the operational levels to ensure that content and messages do not get diluted while cascading,
• Lessons from previous measles SIAs are incorporated at all training levels
• Mapping – part of the training and micro-planning exercises, – vaccination teams understand the operational use of these maps
• to delineate their catchment areas, • for community mobilization purposes and• For Monitoring & Supervision
• National & Zonal TOT for Micro-planning - conducted
Logistics/Cold Chain Logistics/Cold Chain
• Procurement of Vaccines (MV, OPV) by FGN. – ‘Bundles’ MV, Sufficient quantities ordered
– Expected Date of Delivery • 15/10 (for North)
• 24/10 (for South)
• Vitamin A – available.• Syringes/Needles being cleared at the ports.• Cold Rooms & Dry Stores (National, Zonal States, LGAs).• Waste Mgt options being explored and included in Micro-plans.• Distribution Plan – in place.
M & EM & E
• M & E tools finalized and harmonize for the various interventions at different levels – With instructions on their use.
• Training on supervision and operational support for supervision duly included in implementation training.
• Strategy in place for monitoring of zero dose measles vaccine recipients outcome for – advocacy– programmatic use for strengthening RI
• Planning, Implementation & Monitoring/Supervision Templates/Forms - finalised.
ImplementationImplementation
• Phased. Duration – 5 days.• Scheduled for Dry Season (Nov/Dec) in both North &
South.• Intervention to delivered at fixed Posts.• Supervision highly prioritized. To be addressed during
implementation training. Active participation by LGA team
• Supervisors/Monitors to be used extensively. • Nationwide Distribution of LLINs suspended, possibility
of distributing in 2-3 States, final decision to be reached.
ConclusionConclusion
• The Catch-up campaign implemented in Nigeria 2-3 years ago achieved significant impact on measles morbidity & mortality, in view of low disease incidence post-SIA.
• Outbreak events affected unvaccinated Children < 5 Yrs.– Gaps in routine vaccination of recent birth cohorts – Gaps in campaign coverage.
• Campaign coverage gaps to be eliminated with mop-ups.• Follow-up campaign to contribute to RI Strengthening.• We so value and count on your support & advice for
which we ‘say thank you’.
