APPLYING LESSONS LEARNED TO FOLLOW-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 Map . Country State LGA Ward North West North East Admin Levels Country State LGA Ward Community . North West North East North Central South East South West South South

Administrative coverage results of measles Catch-up Campaign, 2005/2006; Nigeria. North – Dec 2005 South – Oct 2006 Overall coverage; 83% Overall coverage; 95.3% < = 84% 85 – 94% 95 – 100%

SUMMARY FEATURES OF MEASLES CATCH-UP CAMPAIGN, NIGERIA; 2005/2006 Parameter North South Implementation dates 06-12 Dec. 2005 03-09 Oct. 2006 Age Category involved (Measles Vaccine) 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, Nigeria Measles catch up campaign in Southern states Measles catch up campaign in Northern states 2007 2008 2005 2006

Age & vaccination status of confirmed measles cases, Nigeria, Jan – Jul 2008 (n=8,887)

Surveillance 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; Nigeria

Lesson learned – 1 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 – 2: 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 – 3: 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 Campaigns

Goal and Objectives 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

Interventions 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. Responsibility Area Remarks FGN/NPHCDA Procurement of vaccines (‘Bundled’) 50% & Operational funds. Payment made, order placed. States/LGAs Cold Chain Strengthening, Injection Safety/AEFI Monitoring & Supervision Provision 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 Measles Partnership. Advocacy/Mobilization, Funding Support. 2 visits conducted

Planning 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. 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. 5 20-22 Oct. National TOT for Implementation NMC, National Trainers 6 27-29 Oct. Zonal Level TOT for Implementation 7 03-05 Nov State Level TOT for Implementation 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 & Evidence

Communication/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

Training 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 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 & 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.

Implementation 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.

Conclusion 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’.

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