CHALLENGES AND PROSPECTS OF IMMUNIZATION IN NIGERIA BY DR ADEIGA .A.A HEAD OF IMMUNOLOGY AND VACCINOLOGY RESEARCH GROUP 2ND WORLD IMMUNIZATION WEEK: FIRST SYMPOSIUM FOR THE WORLD IMMUNIZATION WEEK AT NIGERIAN INSTITUTE OF MEDICAL RESEARCH YABA LAGOS NIGERIA..22ND-30TH 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) OPV1,OPV2,OPV3at 6wks,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 2.5million in 2011 to 3.2million 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

Source: National Immunization Coverage Survey Report 2010 STATES PERCENTAGE OF CHILDREN FULLY IMMUNIZED . PERCENTAGE OF CHILDREN FULLY IMMUNIZED AT ONE YEAR OF AGE OGUN LAGOS (SOUTH WEST) 49.5% 4.05% 9.92% ENUGU (SOUTH EAST) 49.95% 8.7% EDO (SOUTH SOUTH) 49.45% 5.7% KWARA (NORTH CENTRAL) 49.4% 4.17% KADUNA(NORTH WEST) 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.

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