Health  

Advancing plans for local vaccines, polio eradication

Dr. Faisal Shuaib

Dr. Faisal Shuaib, a medical doctor and public health specialist, is the Executive Director (ED)/ Chief Executive Officer (CEO) of the National Primary Health Care Development Agency (NPHCDA) Abuja. Before his appointment in 2016 and resumption of duties at NPHCDA in January 2017, by President Muhammadu Buhari, he was a Senior Programme Officer (Africa) for the Bill and Melinda Gates Foundation (BMGF) at Seattle, United States (U.S.). Prior to joining the foundation, Shuaib coordinated Nigeria’s successful response to the outbreak of Ebola Virus Disease (EVD) as the Incident Manager of the Ebola Emergency Operations Centre in 2014. He was also a member of the six-man panel established to assess the response of the World Health Organization (WHO) to the global Ebola outbreak in 2014 and provided technical advice to the Federal Ministry of Health (FMoH) and NPHCDA in areas of immunization and polio eradication activities between 2012 and 2015. Shuaib had in the past also worked as a research associate at the University of Alabama at Birmingham. Shuaib in this interview with The Guardian among other things said there is no threat to the Biovaccines project and plans for local manufacture of vaccines. The public health specialist said Nigeria has gone 25 months now without a case of the most virulent strain Wild Polio Virus type one (WPV1) but the critical challenges in the fight to end polio remain the insecurity in the North East Zone (NEZ) and funding. The medical doctor also said the Community Health Influencers, Promoters and Services (CHIPS) programme is a major effort towards reducing high mother and child deaths and the vision would translate to improved maternal and infant indices in the country. CHUKWUMA MUANYA writes.

Nigeria has gone 25 months without any case of most virulent WPV1 strain
CHIPS programme would translate to improved mother, child care outcomes

I learnt that the Federal Government (FG) has signed a new 10-year agreement with Global Alliance for Vaccines Initiative (GAVI) for vaccine sufficiency at highly subsidised rate and a grant of S1.9 billion. Please throw more light on this?
Actually, the FG has not yet signed the 10-year agreement with GAVI, due to required documentation that is being finalized.

GAVI, the Vaccine Alliance is a public–private global health partnership committed to increasing access to immunisation in poor countries.

Also, the agreed grant to Nigeria from GAVI will be $1.03 billion over the 10-year period and not $1.9 billion as stated.

It is noteworthy that as part of the agreement, the Nigerian Government has committed to provide $1.9 billion for co-financing vaccine procurements over the 10-year period. Also, the new 10-year Nigeria-GAVI agreement, which extends the planned GAVI exit from 2021 to 2028, is an exceptional feat no country has ever achieved under the GAVI alliance. This is the first of its kind in the history of GAVI.

It is also worthy to note that this multi-billion dollar achievement that Nigeria attained is in global recognition and acknowledgement of the unprecedented commitment and demonstration of President Buhari’s Administration, the Federal Ministry of Health and the current leadership of NPHCDA to ensure transparency, due process, accountability and zero tolerance for corruption.

It is feared that this new GAVI agreement will negatively affect the takeoff and profitability of the Biovaccines project and plans to locally manufacture vaccines. What is your take on this?
There is no threat to the Biovaccines project and plans for local manufacture of vaccines. Rather, we have an extended time to better plan for it. The pledge of $2.9bn made by the Federal Government and GAVI is a rare and special opportunity given to Nigeria by GAVI to adequately prepare for country ownership of immunization service delivery and to source domestic financing of immunization and Primary Health Care (PHC).

You may be aware that the initial plan was to graduate Nigeria from GAVI by 2021 but bearing in mind the potential enormous challenges Nigeria will face in funding immunization services, especially procurement of vaccines and devices, GAVI extended its support to enable us gather reasonable momentum within the ten year extension period for Local Vaccines Production (LVP). Other services include cold chain capacity, good mechanisms for vaccines distribution and adequate skills to handle them and provide adequate services to our teaming population. We have started engaging several stakeholders including GAVI, BMGF, the Clinton Health Access Initiative (CHAI), United Nation Children Fund (UNICEF) and World Health Organisation (WHO) on the business plan and we are getting promising results.

How far with the plans to eradicate polio? What are the challenges and achievements?
The plans to eradicate polio are well on track. Nigeria has gone 25 months now without a case of the most virulent strain Wild Polio Virus (WPV), even though we are having some polioviruses being detected from certain environmental sites in some States (Gombe, Jigawa, Sokoto and Yobe) in Nigeria, for which we have jointly mounted a robust response with our development partners. The environmental component is key to Polio Eradication and therefore we are not resting on our oars to stop the transmission of all forms of Polio Viruses in Nigeria.

The fact that we have been able to stop the circulation on WPV for over two years now is to us an encouraging achievement. The last WPV case was in August 2016, from the security challenged areas in Borno, the North East Zone (NEZ). We have been able to achieve this through effective collaboration with our development partners, stakeholders, guardians and parents in the NEZ, by developing strategies such as the RES – Reaching Every Settlement and RIC – Reaching Inaccessible Children initiatives that will expand and guarantee polio vaccination in areas that are inaccessible to vaccinators, due to insecurity. Through these strategies, we have been able to vaccinate close to five hundred thousand (500,000) children since inception in early 2017.

We are also collaborating very effectively with Lake Chad basin countries to mitigate the risk of transmission across these boarders, we have jointly established a Lake Chad working group with our partners, led by a very senior government official from our agency, based in Borno to fast track the implementation of the Lake Chad basin countries action plan for Polio Eradication Initiative (PEI) to work together with the Lake Chad basin PEI Task Team (LCTT) based in Ndjamena

The most critical challenges in our fight to end Polio remain the insecurity in the NEZ and funding. These challenges are being addressed by the Military as they tackle the issues of insurgency, in the NEZ of the country. Regarding the funding gaps in 2018, the government is exploring avenues to provide additional funding for PEI.

Despite efforts, Nigeria is still one of the countries with worst health indices especially in maternal and child health. Why? What are the latest efforts to address this?
Addressing maternal and child health interventions requires comprehensive implementation of several PHC interventions and involve a wide range of stakeholders, as well as considerable financial investment. At the NPHCDA, we have taken steps to improve the coordination of Mother and Child Health (MNCH) programmes, especially those being delivered at PHC facilities and to households. Currently, the Top Management Team is aimed at improving the coordination of Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH+N) activities being carried out at the PHC level in the country. The aim is to minimize duplication of efforts by partners, identifying gaps to be addressed, and optimize available resources. NPHCDA hopes a similar platform will be replicated at the State and Local Government Area (LGA) levels.

The Midwife Service Scheme (MSS) is still one of the critical programmes being implemented by the current administration with the mobilization of one thousand, one hundred and eighty one (1,181) basic midwives to various rural PHCs across the country between February and March this year (2018). These midwives are currently providing skilled delivery and other services to mothers and children in different PHCs across the country, thus reducing maternal, child and newborn deaths and sicknesses.

The Federal Government rolled out a special programme called Community Health Influencers, Promoters and Services (CHIPS) as one of the efforts to address these challenges. It is structured to stimulate and support households in communities to seek and obtain primary health care services through interventions at the community level (the demand side). President Muhammadu Buhari flagged off the CHIPS programme in Lafia, Nasarawa State in February 2018.

We are working with the States, LGAs, wards, communities, development partners and the private sector. Our goal is to have over 100,000 CHIPS agents across the country, 10 per ward, with special consideration for hard-to-reach areas. We aim to reduce barriers to access by taking services closer particularly to pregnant women, women of childbearing age, newborn and children. The agents will also promote health by avoiding delays in the decision to seek medical care, in reaching care and in receiving adequate healthcare.

The CHIPS Programme complements the effort to revitalize 10,000 PHCs across the country to address the supply side challenges. The Basic Health Care Provision Fund (BHCPF) is also a game changer that would address the overarching challenge of inadequate funds, thereby guaranteeing effective service delivery at the PHC level.

A minimum of 10 agents are selected per ward to provide the following services: counseling and Referral of pregnant women for Antenatal and postnatal care; health education on essential care of the newborn; educate, provide basic care and refer as appropriate for malaria, diarrhea and fast breathing for children; identify, counsel and refer for child health services including nutrition and immunization; and counsel on community Water, Sanitation and Hygiene (WASH).

It is pertinent to note that the CHIPS programme is a multi-sectorial approach in collaboration with a plan for Federal Ministry of Education to provide adult literacy to CHIPS agents, Ministry of Budget and National Planning (MBNP), Federal Ministry of Health (FMOH) and development partners

Our vision at the NPHCDA is to make PHC services available to all in Nigeria as a first step to achieving Universal Health Coverage (UHC) in Nigeria. The CHIPS programme is a major effort towards this vision and would translate to improved maternal and child indices in the country.

You recently kick started a new programme on PHC. What is it all about?
Yes, precisely on 17th July 2018, the Honorable Minister of Health Prof. Isaac Adewole launched one of our several innovations in leveraging PHC services in the country. It is called Technical Support Programme (TSP) as highlighted in the previous response. We carefully and critically reviewed our mandates as an Agency and realized that all the mandates stated in the Act that established NPHCDA require substantial technical capacity especially at the State and Local Government levels, the arms responsible to provide the service delivery.

We realized that over the years, the technical support given to the implementers have been fragmented and mostly circumstantial and activity based like during polio campaigns. So we felt we should devise a more structured and coordinated strategy for supporting States and LGAs.

We started with establishing a unit called Technical Support Unit (TSU) with full time officers that will coordinate technical support based on identified needs. The unit will identify skilled personnel within and outside the agency to provide the support. This will involve identification of training needs from States, process them, prioritize them and identify the people that could respond to the need. We intend to do all these in a judicious manner, starting with a Leadership Development Academy (LDA) within the Agency in which committed and talented officers will be selected and given adequate training in circles of 20-30 people. Then we will scale up to include officers from States and the Academia until we eventually establish a Public Health Institute where people can receive adequate trainings and skills to practice public health anywhere in the globe.

The rainy season is here again and it comes with flooding and cholera outbreaks. How prepared is NPHCDA to tackle the situation? Or what are you doing to contain the situation?
The response effort is being implemented by NPHCDA in collaboration with Federal Ministry of Water Resources (FMWR), Federal Ministry of Environment (FMEnv), Médecins Sans Frontières/ Doctors Without Borders (MSF), UMB, UNICEF, African Field Epidemiology Network (AFENET) and WHO through the established Emergency Operation Center. The National Rapid Response Team (RRT) through case management, WASH activities, oral cholera vaccination etc is supporting all affected States.

Active case search is ongoing in affected States and cases are being line-listed daily with high risk States mapped for intensified surveillance. LGA, sex and age group to serve as criteria for International Crisis Group (ICG) request for Oral Cholera Vaccine (OCV) and subsequent vaccination regularly contact all affected States for outbreak line-listing, epidemiological history.

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