After suffering a nail-biting miss in 2016, Nigeria is almost set to be certified as a polio-free nation. In this interview, the Executive Director, National Primary Healthcare Development Agency, NPHCDA, Dr Faisal Shuaib, provides insight on this milestone and nation’s battle against other preventable, but deadly diseases responsible for high maternal and child mortality rate in the country.
He also speaks on the allegation that healthcare providers have now resorted to paying passive attention to other major health issues following the outbreak of Covid-19 in the country, among other major health issues.
The report of Nigeria getting certified as a polio-free nation is no doubt an elating one. What is the story behind this good news?
It is indeed an elating news. It is the result of decades of hard work by government at all levels and our partners both locally and internationally over three decades. The resurgence of Wild Polio Virus (WPV) in 2016 was a huge setback programmatically and financially. Going the last mile to end Polio is the story of resilience and of government commitment at the highest level. Recall that rather than lose motivation after the setback, President Muhammadu Buhari pledged (in 2015) to ensure that Nigeria is certified polio free during his tenure and he backed the pledge by the release of N9.8billion needed at that time for Nigeria to sustain its response which was further coupled with the good support from partners. This good news is also the story of effective coordination by government through the Presidential Task Force chaired by the Vice President, the state task force on immunization chaired by deputy governors, and LGA task force on immunization chaired by LGA chairmen. It is the story of effective local and international partnership and collaboration with stakeholders, including traditional and religious leaders, donors, and developmental partners. The setback attracted a lot of sympathy and support from our donors and partners who rededicated themselves to achieving polio eradication in Nigeria. It is the story of synergy between all arms of government. When we came in 2017, we realized that we had to do things differently for us to win this protracted war against polio. We expanded the span of collaboration by including the security agencies to help deal with challenges of insecurity in some sections of Nigeria which had limited access to polio vaccinations. However, we took it in our strides which thereby led to a story of accountability, transparency, and effective incident management approach. It is a story of dedication by frontline health workers and house-to-house vaccinators who went house-to-house to ensure that every eligible child is vaccinated with the life-saving two drops of the oral polio vaccine. Above all, it is the story of sacrifice, including paying the supreme price. Some people lost their lives in this onerous battle of polio eradication in Nigeria. Recall the harmless women vaccinators in Kano and Borno (13 in Kano) who were murdered in cold blood by unknown gunmen just because they volunteered to protect children and their communities from the scourge of poliomyelitis. Others lost their lives in line of active duty either due to road traffic accidents. Their memories will remain indelible and we dedicate this feat to them. We are here today savouring the joy of a WPV free Nigeria because of these heroes.
Nigeria suffered a near-miss in 2016. What were the lessons learnt from the experience and how did these lessons impact on the fight against polio?
The polio eradication efforts in Nigeria suffered a setback in 2016 when we had an outbreak of the wild polio virus after about two years without a case of WPV and WHO had delisted Nigeria from the list of endemic country a year earlier. It is pertinent to state that the setback was due to insecurity in the Northeast, especially Borno State. As a country and indeed the health sector, we have learnt that multisectoral collaboration is key to dealing with public health issues. For example, because we needed to reach children that were trapped in areas of insurgency, we opened a window of collaboration with the military that enabled us have access to children in previously unreached areas. This also guaranteed a very sensitive water-tight Acute Placcid Paralysis (AFP) surveillance in these areas to improve our detection and reporting of the polio cases. We have learnt how to effectively collaborate with partners and donors, working as a team with a common goal. We have learnt from the polio programme how to effectively integrate health services and how to coordinate programmes using the incident management system. We also learnt how the effective engagement of traditional and religious leaders in building trust in the communities and households, could result to positive health outcomes.
For a very long time, the North proved to be a very hard nut to crack considering the disposition of the people of the zone to routine immunization. How were you able to overcome this challenge coupled with the more intractable challenge of insecurity in the zone?
We leveraged the influence of our traditional and religious leaders to build community trust and mentorship as the community gatekeepers became the voice of the programme. For this we are very grateful to His Eminence, the Sultan of Sokoto who brought on a fresh zeal in this battle against polio. The Northern Traditional Leaders Committee on PHC Delivery (NTLC) was set up in June 2009 to support government efforts to achieve polio eradication and improve routine immunization coverage. Membership of NTLC is made of one senior traditional leader from each Northern state and the FCT. For 10 years, NTLC members embarked on advocacy, role modeling, sensitization, and mobilization in their states to ensure all eligible children are vaccinated during polio campaigns. Consequently, the programme has engendered a lot of trust across the country, by using a multi-prong approach, including engagement of different stakeholders, to build trust. We also engaged over 20,000 volunteer community mobilizers that conducted daily home visits in high risk settlements and created awareness on the benefits of vaccination and key household practices. In addressing the challenge of insecurity, the polio programme has been very innovative with home grown initiatives and systematic collaboration with the military. Some of the innovative interventions include international border, market and hospital vaccinations, profiling, firewalling, reaching every child, reaching inaccessible children strategies, and engagement of community informants in inaccessible areas, among others. These innovations were complemented with an accountability framework, which holds people accountable for their actions and inactions.
It was estimated that an approximately 2,400 children and over 100 women of child-bearing age die daily from preventable diseases in Nigeria. How come Nigeria still has such frightening figures at this period and age?
As you know, primary healthcare forms the critical foundation for overcoming the scourge of preventable diseases. Sadly, primary health care has been neglected over the years. A special area of interest in dealing with preventable diseases is routine immunization. We were determined to change the narrative here and this informed a state of emergency on routine immunization in 2017. With the support of the president and the Federal Ministry of Health, we established immediately, drawing from the lessons learnt in the Polio Eradication Initiative Programme (PEI) what we called the National Emergency Routine Immunization Coordinating Centre (NERICC), and deployed a very strong and committed team from the agency and our partners to address the decline in routine immunization in Nigeria. I am happy to inform you that current statistics show that we are making progress. For instance, routine immunization coverage was 33 per cent in 2016, but as at end of 2018, it has increased to 57 per cent. I admit we are not there yet, but this progress is very encouraging and highly motivating for our donors and frontline workers. Based on the lessons from NERICC, we are paying attention to maternal and child health issues as well through the National Emergency Maternal and Child Health Intervention Centre (NEMCHIC) and I assure you we will not rest on our oars until our coverage is optimal. We are very hopeful.
Nigeria and indeed the world are currently battling a major enemy in COVID-19 with reports suggesting that healthcare institutions are now paying passive attention to other major health issues. How do we ensure the war against COVID-19 does not impact negatively on other major health issues?
Thank you for this question. The COVID-19 pandemic has brought about life-changing situations in the entire health systems and economies of nations, including Nigeria. This, therefore, calls for urgent measures to stop the ravaging effects of the COVID-19 infections in Nigeria. We have developed and disseminated to PHC facilities a COVID-19 preparedness and response guide and we followed it up with cascaded training of health workers and community resource persons across the country. This has resulted in our having a critical mass of over 260,000 frontline health workers equipped to deliver routine PHC services amidst COVID-19 outbreak. Also, we are advocating to all governors to saturate the PHC facilities with Personal Protective Equipment (PPEs) to further reassure the health workers of their safety. We are on the verge of disseminating to states the strategy they should adopt to ensure PHC services are being provided. That is on the supply side. On the demand side, we have continued our awareness creation to inform Nigerians that PHC centres are open for routine services, and the need to take personal responsibility to adhere strictly to COVID-19 preventive measures.
You were appointed as the head of NPHCDA in 2017. How would you assess the journey so far and what would you like to be remembered for as the head of the agency?
I must thank the President, His Excellency Muhammadu Buhari for the opportunity to serve my fatherland as the Chief Executive of NPHCDA. The journey so far has been tough, but fulfilling at the same time. I am very fortunate to have a crop of highly skilled and dedicated Nigerians as staff. We have achieved a lot in this past three years. As I said earlier, we have started seeing improvements in our routine immunization coverage, we have strengthened collaboration with all stakeholders, especially with other arms of government and our partners and donors. We have ensured accountability and transparency in our relationships which has rekindled trust in the agency and government, thereby attracting increased donor support. And the icing on the cake is the achievement of a WPV-free status. This is a dream come true for me. Remember I was in the polio team for some years. Ending polio affords us the opportunity to transit polio resources (both man and materials) to revitalize PHC and to leverage on the lessons learnt in polio eradication to tackle other diseases. I feel fulfilled! I will like to be remembered as someone that came, learnt and led a team, and with the support of partners and donors, added its bit to the work of heroes past, to get Nigeria through the last mile to be certified as a polio-free country.