Upload
core-group
View
558
Download
0
Tags:
Embed Size (px)
Citation preview
Lora ShimpLora ShimpSenior Technical Officer – ImmunizationSenior Technical Officer – Immunization
John Snow, Inc / MCHIPJohn Snow, Inc / MCHIP
Learning from Polio Eradication: Community involvement in
reaching under-immunized in northern Nigeria
Acknowledgement of slides from: Nigeria NPHCDA; USAID’s JSI/ TSHIP project
Wild poliovirus situation and NigeriaWild poliovirus situation and Nigeria
• Continuing transmission of WPV in endemic countries (including Nigeria: 21 WPV cases in 2010; 10 WPV cases as of 1 June 2011)
• Identification and further analysis of high risk and under-served populations
Communication Communication responseresponse
• Country prioritization & analysis
• Global communication indicators developed by UNICEF, WHO, Communications Initiative, MCHIP, BMGF, and others: used for reporting in priority countries to improve measurement within and across countries.
• Refined strategies to reach under-served and non-compliant communities: system improvements and community-oriented approaches
Nigeria exampleNigeria example
• Continually increasing government commitment to polio eradication and immunization (through National Primary Health Care Development Agency), including mass media and advocacy plans and ensuring ongoing engagement of subnational and traditional leaders.
• Involvement of partners like JSI/TSHIP (Targeted States High Impact Project – USAID funded) in high risk and lower performing states: Bauchi and Sokoto. Building on experience from previous USAID-funded projects, COMPASS and IMMUNIZATIONbasics
• Women’s groups, traditional birth attendants (TBAs), and religious/traditional leaders participate in identifying and tracking missed children, non-compliant, pregnant women and newborns -- utilizing communication and PEI indicators.
Sokoto and Bauchi states; multiple MCH interventions
Nigeria national data: cumulative routine immunization Nigeria national data: cumulative routine immunization coverage for all antigens 2005-2010coverage for all antigens 2005-2010
Source: Routine Administrative Reports
2005 = 32%2007 = 59%2006 = 49%
2005-2010 Routine OPV3 performance at state level2005-2010 Routine OPV3 performance at state level
Source: Routine Administrative Reports
<50%
50-79.9%
80-90%
>90% 2008 = 57%2010 = 69%
2009 = 63%
Intensified Ward Communication Strategy Intensified Ward Communication Strategy
Phase 1 (since Nov)
Phase 2 (from Jan)
Phase 3 (from Feb)
Repeat
for each
round
Example: progress in resolving persistent non Example: progress in resolving persistent non compliance with a tailored package of interventions compliance with a tailored package of interventions
Source: IPD Tally Sheet data
Trend of children immunized with OPV during IPD Trend of children immunized with OPV during IPD Rounds by month in Sokoto State (Jan – Mar 2011)Rounds by month in Sokoto State (Jan – Mar 2011)
Note: Field reports showedvaccine shortage during Immunization Plus Days (IPDs) in January, resulting in lower coverage compared to February and March.
However, the state has been immunizing children above target (857,167 estimated children < five in 2011) in every IPD round since the beginning of the year.
LGA # Children referred & immunized (never been vaccinated)
# of defaulters tracked &
immunized
# of newborns
seen
# of newborns
referred for OPV0
# of newborns receiving
OPV0
# households
visited
# of missed children
Dange Shuni 769 0 0 0 0 660 159
Goronyo 1239 275 101 101 101 320 138
Gwadabawa 2563 589 399 399 399 1320 143
Illela761 244 73 73 73 240 109
Sabon Birni 811 0 0 0 0 400 86
Sokoto South
2145 128 85 85 85 2800 334
Wamakko 1095 84 0 0 0 660 1331
Wurno 1323 0 0 0 0 240 147
Total 10706 1320 658 658 658 6640 2447
TBA monthly tracking and referral of newborns and defaulters to TBA monthly tracking and referral of newborns and defaulters to HFs, by LGA in Sokoto - HFs, by LGA in Sokoto - Jan to March 2011Jan to March 2011
ource: TSHIP monthly data collection
MonthNumber of
Sultanate/Emir in the LGAs
Number of Sultanate/Emir involved during
this round of IPD
Number of district head in the Ward
Number of district head
involved during this
round of IPD
Number of Village head in the Ward
Number of Village head
involved during this
round of IPD
Number of Settlement head in the
Ward
Number of Settlement
head involved during this
round of IPD
January 1 0 21 17 177 162 2020 1012
February 1 0 21 18 177 163 2020 1497
March 1 0 21 14 177 132 2020 921
Average 1 0 21 16 177 152 2020 1143
Summary of traditional leader involvement in monitoring SIAs in Summary of traditional leader involvement in monitoring SIAs in Sokoto – Jan to March 2011Sokoto – Jan to March 2011
Total # Wards in state: 244
Total infants < 12 months: 171,433
Source: TSHIP Record
Settlements, households and children involved in non-compliance Settlements, households and children involved in non-compliance during IPD rounds in Sokoto from January-March 2011during IPD rounds in Sokoto from January-March 2011
The chart beside shows the number of children involved and resolved in non-compliance during IPD rounds in Jan - March 2011
(Source: TSHIP record – Eight LGAs only)
Who helped to resolve non-compliance cases?Who helped to resolve non-compliance cases?
Month
# of traditional leaders involved
# of LGA task force involved
# of Women leader
involved
# of Community Influencer involved
# of political leaders involved
# of Religious
leader involved
January 663 18 67 77 33 172
February 692 17 17 140 24 131
March 755 25 17 213 27 286
Total 2,110 60 101 430 84 589
N= sub-sample of 360
Activities January February March Total
# of ward coordination meetings planned 105 85 104 294
# of ward coordination meetings Held 89 75 88 252
# of community meetings planned 97 62 85 244
# of influencers’ meetings planned 30 22 42 94
# of influencers’ meetings held 23 18 32 73
# of mosque/church announcements planned
1004 1026 1013 3043
# of mosque/church announcements held 773 821 924 2518
# of RI sessions planned 480 469 468 1417
# of RI sessions supported 194 185 196 575
Activities conductedActivities conductedJan-Mar 2011 Jan-Mar 2011
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Bauch
i
Borno
Katsin
a
Soko
toYobe
Zam
fara
Gombe
Jigaw
a
KadunaKan
oKebbi
Niger
Oct-10 Nov-10 Jan-11
SIA Quality in Polio High Risk States SIA Quality in Polio High Risk States Proportion of wards with >10% Missed ChildreProportion of wards with >10% Missed Children
Source: Enhanced Independent Monitoring15
States with reduction in number of under-immunized States with reduction in number of under-immunized (DTP3) – comparison of 2009 and 2010(DTP3) – comparison of 2009 and 2010
No
of u
n-im
mun
ized
Results and lessons learnedResults and lessons learned
• Preliminary results show improvements in reaching special populations and increases in timely routine immunization.
• Use of these indicators in Nigeria benefiting polio and immunization and demonstrating the potential role of community influencers for other programs.
• 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.
Thank you!Thank you!