CHALLENGES AND PROSPECTS OF IMMUNIZATION IN NIGERIA BY

CHALLENGES AND PROSPECTS OF IMMUNIZATION IN NIGERIA BY DR ADEIGA. A. A HEAD OF IMMUNOLOGY AND VACCINOLOGY RESEARCH GROUP 2 ND WORLD IMMUNIZATION WEEK: FIRST SYMPOSIUM FOR THE WORLD IMMUNIZATION WEEK AT NIGERIAN INSTITUTE OF MEDICAL RESEARCH YABA LAGOS NIGERIA. . 22 ND-30 TH APRIL 2014

OUTLINE OF PRESENTATION • • • Background Expectation Challenges Consequences of challenges. Way forward.

History of Immunization Programme • It was introduced in 1956, but was found to be characterised by intermittent failure and successes. • Re-launched as Expanded Programme of Immunization in 1979 to provide Immunization services to children <2 years of age. • It was re-launched in 1984 due to limited successes.

History of Immunization contd. • Restructured in 1997 and renamed as National Programme on Immunization (NPI) and was established as Parastetal of FMOH by decree 12 of 1997 for effectiveness. • Merged with National Primary Health care Development Agency in May 2007. • The agency is now charged with responsibility of controlling the programme.

Expectation From Immunization Programmes • World Health Assembly in 2010 recommended full Immunization of children by one year of age to be 90% coverage nationally and at least 80% coverage at districts. • This requires good funding for vaccine procurement, well developed cold chain facilities, good logistics, materials for immunization and capable personnel

EXPECTATIONS • Reach target groups: children of 0 -11 months 0 -59 months, women of child bearing age 15 -49 years. • Vaccines to be made available: BCG , OPVo at birth, Pentavalent (DPT, HBV &Hib) OPV 1, OPV 2, OPV 3 at 6 wks, 10 wks , 14 wks. Measles and Yellow fever at 9 months. • Tetanus toxoid for pregnant women.

CHALLENGES • Barriers to Immunization become significant when expectations are not met and there is rising incidence of vaccine preventable diseases. • Barriers grouped as follows: 1. Barriers from the 3 tiers of government— finance 2. From healthcare provider-inadequate staff, staff attitude, inadequate capacity.

CHALLENGES CONTD. • Barriers from logistics: supply and distribution of vaccines, vaccine storage capacity, cold chain maintenance, electricity. • Parent barriers: failure to present the children due to fear of safety of vaccine, lack of transportation, long waiting at clinic, inconvenient clinic hours. • Child barriers: when child is sick, when child is malnourished. • Vaccine barrier: genetic change in causative agent, vaccine potency, management of vaccine that are in large doses, leading to missed opportunities.

CHALLENGES CONTD. • Barrier from service delivery: PHCs with low standard leads to diminished immunization demand. Frequent unavailability of vaccine. Focus on Immunization days, poor integration of Immunization services into PHC system.

CHALLENGES CONTD. • As at February 2013, challenges for routine Immunization highlighted at Lafia meeting of stakeholders include: • Increasing number of Unimmunised children from 2. 5 million in 2011 to 3. 2 million in 2012. • Huge disparities in Immunization coverage within and between states and regions and between rich and poor. • Increasing trends in disease outbreaks such as measles, polio, meningitis, pertusiss and diphteria.

Challenges : Finance

CONSEQUENCES OF CHALLENGES

CONSEQUENCES OF CHALLENGE AS OBSERVED FOR IMMUNIZATION DAYS PRACTICE.

CONSEQUENCES OF CHALLENGE • Effect of malnutrition

STATES PERCENTAGE OF CHILDREN FULLY IMMUNIZED AT ONE YEAR OF AGE OGUN 49. 5% 4. 05% LAGOS (SOUTH WEST) 49. 5% 9. 92% ENUGU (SOUTH EAST) 49. 95% 8. 7% EDO (SOUTH) 49. 45% 5. 7% KWARA (NORTH CENTRAL) 49. 4% 4. 17% KADUNA(NORTH WEST) 49. 4% 3. 45% TARABA (NORTH EAST) 49% 0% Source: National Immunization Coverage Survey Report 2010

WAY FORWARD • Governance- Continuous advocacy to political leaders to give child health a priority in their budget, especially at States and LGAs. • Advocacy approach to private companies to discharge their social responsibilities in area of health. • Continuous health education of mothers to allay the fear of vaccine adverse events. • Continuous training of health workers to reduce adverse events and manage vaccine to avoid missed opportunities.

WAY FORWARD CONTD. • Continuous community engagement to remove resistance. • Making community members as part of planners and implementation of routine immunization. • Form Immunization education group in the community. • Form Immunization action coalition in the community and make members as community volunteers. • Subsidise the transport fare of mothers to travel for immunization.

WAY FORWARD CONTD. • Federal government should implement strategic plan with the state and local government to the letter. • At federal level, monitoring and evaluation team must be formed to assess on continuous basis and establish performance indicators. • Involve political leaders for buy in at State and LGA levels.

CONCLUSION • Federal government is showing leadership on Immunization. • Commitment of the States and the LGAs has been epileptic. This has to improve to avoid epileptic immunization coverage we are having. • There must be a feedback from the community on the quality of service they receive. • In any strategy Federal government is planning, the research component must be strengthened and involve people within.

• THANK YOU FOR LISTENING.