Dr Anis Siddique is UNICEF Nigeria’s Chief of Communication for Development/Polio Section at the Country Office. He joined the UNICEF team in Nigeria in 2016, at the time the country was taking stringent steps to eradicate polio. And in 2019, Nigeria marks three years without a single case of wild polio virus. He spoke to Saturday Sun on what it took for Nigeria to be free of polio, his favourite Nigerian food, among others.
Congratulations to you and your partners for the milestone, three years without a case of polio virus in Nigeria
Congratulations to all Nigerians. The government of Nigeria and thousands of vaccinators who work day and night, succeeded in reaching this milestone of three years without a case of wild polio virus. It’s an historic achievement not only for Nigeria but for the entire African sub-continent.
Why has it been difficult to eliminate polio in Nigeria? Can you share some of the challenges faced these past years?
I see two parts in this. There was long-term difficulty caused by unsubstantiated rumours that were circulating, that the vaccine was unsafe. There might be a number of motives behind the creation and spread of these rumours, however, once any rumour takes hold, they become firmly entrenched in the community psyche and these rumours reflected in wide scale vaccine avoidance and subsequent boycott of polio campaigns in the north of Nigeria. Another reason why it has been so hard is high numbers of missed children due to child absence for several reasons at the time of vaccination and sometimes the vaccinators did not re-visit the household to try again. We worked hard to improve such team performance over the years.
In early 2009 the support of local leaders boosted our achievements as we renewed our efforts from the local governments to the national level, and a change of leadership at the National Primary Health Care Development Agency further enhanced our success.
In February of the same year, Bill Gates visited the country for the first time and met with national and state political representatives including His Eminence, the Sultan of Sokoto, to encourage more involvement. The Sultan soon addressed northern traditional leaders with a direct request for their heightened support for polio eradication, and these leaders responded by inaugurating the Northern Traditional and Religious Leaders Forum for Primary Healthcare and Polio Eradication. District, Village and Ward heads—representatives of the Emirs—are now seen walking the dusty streets of northern Nigeria, working to ensure polio teams reach every house in their community while also helping families to understand, trust and accept the vaccine through facilitation of community dialogues and public meetings.
In the evenings, many traditional leaders attend the debriefing meetings at local health facilities, something that was unheard of just a few years ago. Formation of the national polio emergency centre is another innovation in the Nigeria polio eradication programme, which addressed weaknesses in campaign implementation and has ensured high quality polio campaigns.
In the last three years, the focus has been mainly in Borno where the last four Nigerian wild polio virus cases were found in 2016. There are major challenges in Borno, including reaching every single child in inaccessible areas where there are both geographic and security challenges that prevent vaccination teams from reaching eligible children. This is coupled with the need of maintaining high quality campaigns in the rest of the country. These challenges, however, have resulted in the development of many creative strategies to ensure eligible children are vaccinated.
What are some of the challenges that might make it difficult to certify Nigeria polio-free?
Certification is a process; Africa regional certification committee will award certification not only to Nigeria but to a bunch of African countries together. The entire process is time consuming and it is a technically heavy process. While on the ground sustaining the gain by vaccinating every single child is important so that complacency won’t set in, it also requires constant vigilance to ensure that no importation takes place.
How has the conflict in the North East impacted polio elimination efforts?
It has resulted in remarkable creativity by the Borno state team as they have come up with multiple innovative solutions to ensure every child is reached.
What are some of the ways the health workers who are at the heart of the polio programme build trust in the communities they work in?
Health workers, vaccinators and VCMs (Voluntary Community Mobilisers) work hand in hand, and the core of their work is building alliances within their community. Traditional and religious leaders have a significant role to play as educators and advocates, in partnership with governments and public health organizations. The experiences of working with local leaders in Nigeria could be used by any public health programme as a model of partnership, and a demonstration of the criticality of ensuring underserved populations take ownership for the health of their own communities.
I hear that you work locally with people in the communities who serve as volunteers, can you tell us more about that initiative by UNICEF?
UNICEF supports “Volunteer Community Mobilizers” — or VCMs, as they are known, are 18,000 in total, with 99 percent of them being females, each of whom is responsible for anywhere from 350 to 500 households in their settlements. This network is often referred to as the gold standard in polio eradication. These volunteers are primarily recruited from areas experiencing a high number of polio vaccine refusals. The women are typically between 20 to 50 years old, well-known, and well-respected in their communities, some of whom can read and write in the local language, Hausa. Beyond polio, these volunteers now cover a wide range of health topics during their household visits to keep families safe and healthy. They educate households on sanitation and hand washing, the importance of prenatal care, the advantages of breastfeeding, and how to treat child malnutrition with therapeutic foods. They’re even trained to spot signs of emerging health threats in the community. These volunteers also help UNICEF and the government of Nigeria track vital statistics like births and deaths in their communities, which can help authorities and agencies better understand and plan for the health care needs of a particular community — information that is crucial to understanding gaps as well as gains in health care access.
As the polio eradication in Nigeria comes to a close, how do you see the future?
On the polio front, the future is promising yet challenging. The country has a long way to go to improve its routine immunization system and improve indices for neonatal health and maternal health services. The country needs to address harmful social norms and the crises of malnutrition, open defecation etc. However, a day when polio eradication will come is not easy to predict but we have good start. The Nigerian government’s National Primary Health Care Development Agency started a new programme called CHIPS (Community Health Influencers, Promoters and Services Programme), the aim of which is to improve access to and equitable coverage for health services, especially those relating to maternal, infant, and child survival. We see a smooth transition of VCMs to CHIPS that will extend the polio legacy into broader child survival interventions. To reach these goals requires strong community-based healthcare.
The health workers, do they face stigma on the job?
I am not aware of any stigma that health workers are facing in Nigeria, they are respected in the community.
Can you share some of the challenges that health workers face?
First of all, there are shortages of health care workers at different levels. I have talked about CHIPS implementation; we are working closely with National Primary Health Care Development Agency, Abuja (NPHCDA) to develop a strong community health care platform. Health workers’ motivation is critical, and their salary/ honorarium must be in timely manner.
What’s your perception of the average Nigerian?
As a development worker I am not a perception-oriented person. Perception is a process to gain knowledge. I am more of a knowledge-oriented person. I try to understand people through a different lens. Around me whom I interact daily either for work or other purposes, they are hardworking, and kind hearted. Even on the weekend when I go for a walk, every single known or unknown Nigerian greets me. I have never come across such courteous people.
Which Nigerian cuisine do you enjoy most?
My favourite food is moi-moi with fish. I am a fish loving person and, in my country, Bangladesh, our food culture is fish oriented. So, moi-moi with fish is a great combination. I also enjoy goat and chicken pepper soup and suya.
Do you like Nigerian music? If yes which genre do you like the most?
Unfortunately, I have little time to explore music or movies. I am a bit dry on this.
What’s your general perception of Nigeria, our dressing?
I think Nigeria is one of the most diverse countries. Culturally, people are so different and peacefully co-existent. I see people with modern and dress next to people with religious attire. Every Friday I see men and women wear colourful dresses and look so festive. Even now, I wear Nigerian dresses on Friday, representing both south and north. Culturally, it’s probably the most vibrant country in the world.
What are your experiences living here, do you enjoy your stay here or not?
Honestly, for work I have lived in a couple of cities in different countries; in Bangladesh, in India, in Afghanistan and in Nigeria. But the city I live now is Abuja, which is the most planned and modern city I have ever lived in. The wide roads, the greenery, walkways and serene nature all I love, and another attraction of the city is that every single house is an example of modern architecture. Different, but picturesque.
What are the challenges you face daily compared to situations in your country, what will you like Nigeria to do differently?
I think my country Bangladesh and Nigeria have lots of commonalty, except we are oil importing country, Nigeria is big five times bigger than Bangladesh but population size is same. Bangladesh eliminated polio in 2001 and routine immunization coverage is more than 80 percent. I wish Nigeria to achieve high routine immunization coverage soon. We have same values with various similarities. The city itself, Abuja is not comparable to the city I grew up in, Dhaka. Abuja is the most beautiful city I ever lived with wonderful people.
How many states have you visited and what fascinates you the most about those states?
I visited all the states in the north, and in the south I have visited Ondo, Lagos and River states. The diversity between those states fascinates me the most. One state is different from the other and traditional hierarchy and systems differs. Nigeria is all about respect. People respect each other and there is an order in it.