Nigeria makes history in polio eradication initiative

Muhammad

Nigeria, in line with global commitment launched the Polio Eradication Initiative (PEI) in 1996. This was eight years after the World Health Organization (WHO) launched the initiative in 1988. The launch of the global initiative was to attain global eradication of the poliovirus by the year 2000. While many countries achieved the aspiration without much constraint, the road leading to the interruption of the transmission of indigenous wild poliovirus (WPV) in Nigeria was not an easy one. It was fraught with a lot challenges. However, with perseverance, innovations and commitment, the nation overcame these challenges and was formally delisted as a polio-endemic country by the WHO Director-General on 24th September 2015.

Nigeria commenced battling the polio scourge in 1996 with the formal inauguration of the Polio Eradication Initiative (PEI) in the country; and over 350,000 cases reported globally in several countries. As at 2014, only three countries remained in the world that have never interrupted indigenous transmission of the WPV; these were Pakistan, Afghanistan and Nigeria. Nigeria is now out of that list.

Our country has had several challenges, ranging from unfounded rumours on the Oral Polio Vaccine (OPV), suspension of the polio eradication efforts in some States; to the killing of innocent vaccination team members in the course of trying to prevent our children from getting paralyzed. But we were never deterred by these unfortunate events; indeed we grew in our collective resolve as a country, developed innovative strategies to surmount these challenges and built a formidable programme, which subsequently provided a platform to tackle other public health challenges like the Ebola Virus Disease epidemic of July 2014.

Despite the historical public health feat achieved by Nigeria in PEI, however the programme and the nation must sustain the tempo and maintain the momentum, as our ultimate goal is to achieve eradication in the next 17 months. In the interim, a lot of emphasis will be placed on improved surveillance system for the acute flaccid paralysis (AFP), the proxy for the detection of the poliovirus; maintaining high quality of our routine immunization (RI) and the polio campaigns by sustaining and scaling up innovative strategies; but above all, re-positioning of our Primary Health Care (PHC) system for delivery as the critical platform to improve the health outcomes of Nigerians, a key stimulant for national development.

To achieve polio eradication in the next 17 months, surveillance would continuously be improved, while maintaining high quality polio campaigns and also scaling up innovative strategies such as health camps, deepening of partnership with Traditional and Religious Leaders as well as deploying the polio infrastructure to strengthen routine immunization and the broader health system.

The programme therefore needs sustained funding. The commitment of all stakeholders – Local Government Areas (LGAs), health workers, Civil Society Organisations (CSOs), communities etc., is critical to achieving certification by 2017. While also requiring functional PHC system to deliver on essential services, optimize results and provide a platform for improved health system and health outcomes not only for polio but other vaccine-preventable diseases and non-communicable diseases (NCDs). This is a gift Nigerians and indeed the entire African region deserves.
In the last three decades, PHC has consistently remained the cornerstone of our national health system, and a veritable platform for the attainment of Health for All Nigerians. While key achievements have been attained, there are significant systemic challenges of PHC implementation ranging from the governance arrangement to service delivery. These account for suboptimal service delivery at the PHC level with concomitant inefficiency resulting into not too impressive health outcomes. Programme implementation is hamstrung by weak co-ordination within and between the three levels of government. These challenges are further compounded by limitations in coverage and access.

There is the need to institutionalize provision of essential package of care at the PHC level, increase geographical and financial access to health care services, improve the quality and increase demand of the services, and provide financial protection for the vulnerable groups.
The Federal Ministry of Health (FMoH), working with the States and PHC stakeholders is addressing the challenges of the huge out-of-pocket expenses (OPE), which currently stands at over 60 per cent among others, and have made concerted efforts to make the National Health Act operational. Stakeholders are upbeat with optimism that provision for the Basic Health Care Provision Fund (BHCPF) in the Act, has the potential to significantly increase the resource envelope for PHC and ensure some predictability in the availability of funds.

There is also the National Strategic Health Development Plan 2009 – 2015, which is the overarching policy framework for Health Sector programmes, being supported by all stakeholders in the sector. In addition, there is the Ward Minimum Health Care Package, which serves as guidelines for implementation of PHC focusing on making one PHC facility functional in each of the 9572 political wards in the country with a view to scaling up Universal Health Coverage in the country; and also addressing the huge OPE.

At the macro level, there have been concerted efforts towards having one authority coordinating PHC system at the State level in order to enhance efficiency, thus the Primary Health Care Under One Roof (PHCUOR) initiative. This has resulted in the establishment of 32 PHC Agencies.

The National Primary Health Care Development Agency (NPHCDA) is currently assisting in the functionality of these boards. It is expected that the State PHC Agencies will ensure that all the essential components of PHC will be integrated under the new governance structures: the State Primary Health Care Development Boards/Agencies at the State level and the Local Government Health Authorities at the local government level.

The Agency under the oversight of the FMoH has now embarked on PHC revitalization with a vision of building a resilient health system on the principle of equity and social justice through functional PHC systems. We therefore call on all stakeholders, particularly States and LGAs to own and drive the implementation of PHC services in their various localities, as this is critical to our current effort to reposition PHC as the platform to improve health outcomes of all in Nigeria.
*Dr. Ado J.G. Muhammad (OON), is the Executive Director/CEO of the National Primary Health Care Development Agency (NPHCDA)