Dr Ado Muhammed, Executive Director of National Primary Healthcare Development Agency(NPHCDA), in an exclusive interview with Time Nigeria speaks on the milestone covered by the agency, the implication of the country’s exit out of polio endemic countries, the immense possibilities offered by such remarkable feat to the nation state in the global health index as well as the agency’s resolution on monitoring and surveillance of poliomyelitis. Excerpts
How did you receive the news of the One-Year-Polio-free Nigeria?
Let me start by also appreciating gentlemen of the media for the support that has taken us to where we are in terms of primary health care in Nigeria. Nigeria is about 14 months now without a case of polio virus. For us as a country, it’s no mean achievement because what it has demonstrated is that no child has been paralyzed by wild polio virus for 14 months. It is a fulfilment for us as a programme and also fulfilling for the country because Nigeria is being removed from that club of disgraceful nations that has poliomyelitis.
We’ve been able to redeem the image of the country by removing the country from that committee of nations that has polio virus. Its fulfilling for us as a country that no child in Nigeria again will ever be paralyzed by wild polio virus.
Achieving success is one thing but managing it is more tasking, how prepared are you to start managing this success?
We need to sustain the tempo; we need to sustain the gains to be able to really get to our destination. The destination of the programme is to eradicate polio from the shores of Nigeria. It’s not just interruption. For us to be able to attain that eradication goal we need to sustain the gains. Interruption is just a milestone on the journey towards eradication. There are number of milestones and we have achieved a critical milestone which is interruption that is more than a year without wild-polio virus.
Between interruption and eradication, there are a lot of things that are needed to be done. We need to continue with those things we are doing that has made us achieve this much. We need to continue with quality campaigns so that each and every child irrespective of wherever he/she is, and irrespective of the security issues in any part of the country, we must access that child and ensure that we immunize that child with oral polio vaccine.
Secondly we also have to ensure that we continue with our routine immunization in such a way that we will continue to provide facility based services so that when parents take their children to facilities, those children and wards are really immunized with oral polio vaccine amongst other antigens that that will be administered in those facilities.
Thirdly, we also have to continue to intensify our surveillance system in such a way that if there is any case of wild polio virus anywhere in Nigeria that the programme should pick that case. So that it is not just a case of undetected polio virus being transited within our society without us really knowing. We must be able to beam our searchlight in such a way that any case anywhere is picked and we also carry out the protocol that we put in place in managing such detected cases.
Above all, it calls for commitment, it calls for dedication, and it calls for support from everybody in the society, because the fight against polio is not that of Dr. Ado alone, it’s not that of NPHCDA alone, it’s not that of Ministry of Health alone and it is not that of Mr. President alone. It’s a collective responsibility that we all have to support the Federal Government of Nigeria in realizing. That is where journalists like you also come in, parents and other care givers also coming in and other stakeholders to support the programme to sustain that gain.
This includes funding, mobilization and sending out positive messages out there that the only way to prevent this disease in the country is through immunization and we have a platform that happen and already progress has been made with polio and we need to sustain it beyond 2017 so that by then Nigeria will attain certification.
With this achievement, what is the position of Nigeria with regards to countries like Pakistan and Afghanistan?
Before July 24th 2015, Nigeria belonged to the same league of countries that are being tagged as polio endemic countries-Nigeria, Pakistan, and Afghanistan. But with this unprecedented progress we‘ve made and achievement that we recorded on July 24th which was a year without the case of wild polio virus, Nigeria has really exited the polio endemic countries.
I was just informed few minutes ago that even pending samples in the labs have been cleared and they are negative. Nigeria has exited polio endemic countries leaving behind Pakistan and Afghanistan. The import of this is that no child in Nigeria has been paralyzed in the last one year and if we sustain the tempo no child will ever again be paralyzed
Secondly, we’ve also redeemed our image before the global community that we are a country that our health system is responsive to tackling any public health emergency, responsive in tackling issues to do with the health of our people.
When it comes to public health, globally before now, when Nigerians travel to some countries, Nigerians are being asked of Certificate of Immunization against polio. Adults are being asked to be immunized before they are allowed to enter such countries but with this achievement, nobody has any right anywhere in the world to ask Nigerians to open their mouth to receive two drops of oral polio vaccine before you get into that country because the progress we have achieved has taken us away from polio endemic countries. So, Nigeria is no longer a threat to the world in case of transmission of oral polio virus.
President Muhammadu Buhari said he was looking forward to the formal declaration of Nigeria as polio-free country in 2017 as against Global Polio Eradication Initiative (GPEI) stipulated year of 2018. What do you make of this?
We are committed to making that happen, we are committed to achieving polio eradication by 2017 which will translate to receiving polio-free certificate that same year. Already, the programme is on course. The quality of campaigns are very good. In most of the states and local government areas we have attain over 85% coverage in terms of polio immunization. The quality of the campaign is also very good in most of the clusters and we are sustaining the gains through routine immunization, and we are also intensifying surveillance systems and the government of Nigeria just as Mr. President has said he would continue to provide resources to continue with these efforts.
Partners have also reassured us that they will continue to support the programme. All these would add up to maintain the momentum to sustaining our gains, and then to taking Nigeria to 2017 and beyond with the zero-polio case status of the country. By the time we sustain the gains and with support from all stakeholders, by 2017 Nigeria will receive the polio free status certificate which Mr. President has said is not negotiable. Even for us as technocrats and as program officers, we will make sure that we get that certificate by 2017 to sustain the gains that we have made.
The global target of 2018 is because it is being deemed that other countries should be able to interrupt by 2016 and that it will take those two years again to get certification but we have interrupted in 2015 and two years plus will take us to 2017.
How have you been able to carry governors of flash areas along in the fight against polio?
The war against polio is approached from a united front. We approach it from a family point of view and we had different levels of arrangement that we put in
place. We have the Presidential Taskforce which is chaired by Mr. President which has the governors from the polio endemic states as members, where we carefully sit down quarterly to review the progress that has been made and to also identify the challenges that we do have and to work out modalities toward tackling those challenges.
We also have at the state level, the State Taskforce on Immunization where the governors are the chair and that taskforce also has the same mandate that the presidential taskforce has. But as a programme, we have in place what is known as the Emergency Operations Centre that provides tactical and operational guidance to the eradication of polio emergency plan in Nigeria.
All these platforms add up to the current and has contributed immensely to the progress that we’ve witnessed in polio eradication in Nigeria. So there is a regular interface between us and the governors at presidential taskforce level. There is also the governors and the local government chairmen at the state level and then there is also regular interface between the local government chairmen and the councillors and then the ward heads at the local government level and we carry out regular high level advocacy visit to keep them continuously engaged so that at every point in time the issue of polio eradication is a priority.
Achieving this milestone definitely requires a lot of financial resources, we are equally aware of Financial Resources Requirements jointly prepared by WHO, UNICEF and national governments. Is Nigeria keeping up with her obligation in this respect?
The fund for global polio eradication is a basket funding arrangement that has partners pooling some resources and the government counterpart-funding. For us as a country, the Federal Government has been consistent in terms of meeting their own obligation as regards to the portion that has to do with counterpart funding. In the last four-five years consistently the government of Nigeria has been discharging her obligation in terms of paying their own portion of the basket fund arrangement. Partners have also been redeeming their own pledges in terms of funding.
When we look at other polio endemic countries, Nigeria has been much more committed in terms of providing resources. From domestic resource, Nigeria has really supported the programme more than any other polio endemic country and that has been acknowledged and commended by the global committee.
With the current security situation in the country, how do you ensure that IDPs are covered in this fight against polio?
As part of our programmes planning and part of our pro-activeness, we don’t just reduce ourselves to facilities to provide services. We don’t limit ourselves to during campaigns that we move from house to house. But for any new settlement which the IDPs also constitute we put in place an ad-hoc arrangement to service the need of that population. Because whether IDPs or household they are all Nigerians and our mandate is to reach every Nigerian irrespective of where they are.
We are working with NEMA to ensure that for any new IDPs camp that is established we are informed and in partnership with them we reach children in those IDPs camps and we also reach other eligible Nigerians that require our services in those facilities.
I receive weekly updates on regular basis, in terms of number of women, children and other services that are being provided across all IDPs camps in Nigeria. As I am talking to you now I know what services, how many has benefited from our services in all IDPs camps in Nigeria. As new IDPs camps are established NEMA gets across to me and then we provide services.
Public awareness campaign is key to polio eradication in Nigeria. Are you raising necessary awareness to reach the target audience?
The public awareness is still in the wider framework of programme management that we put in place and we don’t feel that simply because we have interrupted that we should soft pedal with the aggressiveness of our public awareness. We want to achieve certification between now and 2017, what we are targeting is two years. Two years of hard work, two years of redoubling our efforts, two years of progressiveness in terms of awareness. Besides it is not only polio that the agency is handling we have other disease that we are handling. We have health promotions that are preventing people from getting ill health; we also have other vaccine preventable disease that we are tackling. All these requires public awareness, it requires sensitizing the public so we have a roadmap that we are implementing in terms of ensuring that we pull the public fully in tune as to how to prevent diseases and what needs to be done to sustain the gains and with what is needed to be done to control the diseases. So we do that with public awareness.
How do you ensure that the pressure of polio eradication does not affect other programmes of the agency?
We operate an integrated approach. The polio progrmame is just one programme we treat as integrated platform of service delivery of the entire programme that the agency is leading. The polio programme speaks for other programmes that the agency is implementing. It speaks to programme communications, it speaks to community health services, it speaks to other mandate that the agency has. At any point in time we, are using the structure we have to run the polio progrmame and our structure in the community that speaks to other diseases. Polio programme is also speaking to others so it is a complimentary approach to service delivery within the public health arena.
Is the agency taking any step towards developing or manufacturing vaccines locally?
Looking at the back to hut which is about 7.2 to 7.5 million annually and looking at the eligible Nigerians that require vaccines when we carefully analyze it we see it as a veritable platform for us to earn foreign exchange for the country and to also conserve the scarce foreign exchange. Already we have constituted a small team working on the possibility of a local production of vaccines that will not only service the need of Nigerians but also service the needs of West African sub-region and it will earn us foreign exchange and also create opportunities for our teaming youths while also building the capacity of our local pharmaceutical industry in terms of competing with other pharmaceutical industries all over the world.
Yes we are working toward local production of vaccines in Nigeria.
There can never be a success without challenge. What are those challenges?
As usual the challenges are numerous but it is not all about challenges but what really are we doing also to contain those challenges to turn around challenges into opportunities that is what we have been doing as a programme. Funding is a challenge; insecurity is a challenge that has limited our capacity to access children in security compromised areas and then provide services in security challenged areas. We also have issues that have to do with attitude on the part of the health worker, on the part of the healthcare seeker, both ways. All these we are trying to handle and we have been managing through health education and interpersonal communication that we do have. All these are things that we are handling.
Yes, we do have challenges but the good thing about it is that we are turning around the challenges into opportunities so that we can move the programme forward.