National Primary Health Care Development Agency Research Articles

Revealing the challenges and efforts of routine immunization coverage in Nigeria.

Nigeria adopted the expanded program on immunization (EPI) in 1978, which aimed at offering children under 2 years old routine immunization (RI). Early accomplishments with the program resulted in a decrease in childhood mortality. As of 2018, Nigeria accounted for about 4.3 million out of over 13 million unvaccinated children globally. Therefore, this study revealed the challenges and efforts associated with RI program in Nigeria and the way forward. In this perspective article, I conducted searches and extracted relevant information from publicly available sources such as Google Scholar, Pubmed, and grey literature. I employed RI, challenges, efforts, and Nigeria as the keywords. The 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey reports revealed weaknesses in the program, with a national average coverage of 36%. The primary barrier to EPI across various zones is the challenge of reaching marginalized areas that were cut off from vaccination services due to operational and sociocultural issues. Some of the obstacles, such as restricted access to medical facilities, weak cold chain systems, and COVID-19 containment strategies had a great impact on the RI program. To scale up the RI program, the Nigerian government, through the National Primary Health Care Development Agency (NPHCDA), collaborated with the World Health Organization (WHO) and Gavi, the Vaccine Alliance, to optimize the "Big Catch-up campaign" and increase immunization coverage nationwide. By 2028, 80% of the projected zero-dose populace is expected to be covered, reaching these eligible children with life-saving vaccines. Nigeria still has a long way to go in making significant progress in the RI program. To further strengthen the immunization coverage, the country needs to maintain data on their achievements, as this will help identify gaps that need to be addressed in the immunization program.

Paediatric Association of Nigeria (PAN) Immunization Guidelines: An Update (2023)

The Paediatric Association of Nigeria (PAN) Guidelines for Childhood Immunisation were first published in 2012 as a follow-up to a position paper submitted to the Nigerian government in 2008. These guidelines are long overdue for updating since their lifespan has exceeded the recommended five years. New evidence and information have accrued, and new vaccines have emerged to prevent old and new diseases. The updated guidelines, while ensuring compliance with international best practices, are intended to guide the use of vaccines in the country as a whole (both within the national guidelines and outside the national guidelines) as well as ensure that the use of vaccines is timely, comprehensive and in tandem with empirical evidence. The updated guideline is intended for use by the Federal Ministry of Health, the Nigerian Immunization Technical Advisory Group (NITAG), the National Primary Health Care Development Agency (NPHCDA), Paediatricians and other healthcare workers in private and public institutions, parents, other key policymakers and vaccine funders.

Moving the needle for COVID-19 vaccinations in Nigeria through leadership, accountability, and transparency.

The first set of vaccines arrived in Nigeria in March 2021. The National Primary Health Care Development Agency (NPHCDA) set out to vaccinate at least 70% percent of Nigeria's eligible population, i.e., 111,776,503 people, by December 2022. As of June 2021, only 3% had received at least one dose of the vaccine. This presented a threat to the achievement of NPHCDA's goal. Nigeria Solidarity Support Fund (NSSF) went into a partnership with NPHCDA to accelerate the uptake of COVID-19 vaccinations across Nigeria over 3 months. Across Nigeria's 6 geopolitical zones, 6 states were selected, namely: Adamawa, Edo, Imo, Katsina, Nasarawa, and Ogun states based on performance, political will, and absence of external resources. A two-pronged approach was implemented: unrestricted funding to the sub-national level and providing technical support at the national level. 5 out of 6 states received unrestricted funding to ramp up vaccination coverage. They also received adequate vaccine supplies. A total of 12,000 healthcare workers were trained on safe immunization practices and multiple communities were engaged across the 133 local government areas (LGAs) through religious and community leaders. After 6 months, there was an average of 35% increase in the uptake of COVID-19 vaccines in the 5 states. An indicator tracker was developed for weekly reviews at the national level and the total population vaccinated in Nigeria increased from 6,186,647 to 11,985,336 at the end of the partnership. Unrestricted funding, though not without its risks, can yield a significant impact on health. The intervention was co-designed with stakeholders and had leadership buy-in, accountability mechanisms, with unrestricted funding. These techniques produced an increase in the vaccination rates in the 5 states and across the country. These elements should be explored for application to other program designs such as routine immunization.

Improving Program Outcomes Through Responsive Feedback: A Case Study of a Leadership Development Academy in Nigeria.

In 2018, the National Primary Health Care Development Agency (NPHCDA), under the Nigeria Federal Ministry of Health, recognized that inadequate personnel competencies limited its ability to provide technical assistance to state primary health care development boards (SPHCBs). In response, NPHCDA instituted a cohort-based leadership development academy (LDA) to develop its staff's leadership and management skills. A baseline assessment identified critical gaps in leadership and management competencies. Agency leaders and midlevel staff aligned on the gaps and approaches to bridge them. Participants in the LDA were selected across headquarters and zones to ensure equitable spread. The NPHCDA adopted a mix of capacity-building approaches that prioritized 6 core leadership and management skills with the application of the 70-20-10 learning philosophy to ensure participants learn and apply skills. Responsive feedback (RF) mechanisms were key in program design and implementation. NPHCDA collaborated with development partners through an iterative cocreation process to design and revise for implementation. The program embraced information and communication technology to collate qualitative and quantitative data across activities in real-time and used insights to drive continuous improvement. Incorporating feedback from the first cohort led to an increase in the proportion of trainees acquiring intermediate to advanced competencies in target skill areas from 41% to 57% in the second cohort. The trainees have taken on more challenging roles at NPHCDA, delivering technical assistance to SPHCBs and bolstering the agency's ability to independently execute activities such as the COVID-19 vaccine introduction. The agency continues to adopt RF mechanisms in the coordination and delivery of advanced technical training for staff and institution of a capacity-building and acculturation program for new hires. RF has demonstrated that identifying and engaging key stakeholders to participate in continuous learning and adaptation is critical to achieving program effectiveness and sustainability.

Web Mapping for Nigeria Covid-19 Testing and Vaccination Site Finder Application

This study aimed to describe the development and implementation of COVID-19 vaccine and testing center’s location finder portal for Nigeria. Names, locations, coordinates, pictures and other relevant information related to the health centers were obtained from the Naational Ccenter for Ddisease Control and the National Primary Healthcare Development Agency. The data was used to create a database which was used to connected to the Google API. The portal contains sections like Nearest Centers, Vaccination Centers, Testing Centers, All Centers, FAQ, Survey and COVID News. The objective of the study is to improve access to COVID-19 testing site, enhance access to COVID-19 vaccination centers across the country and educate Nigerians about COVID-19. The research suggest the active participation of religious and community leaders would improve access and willingness of their subjects to be vaccinated

Assessment of service readiness for maternity care in primary health centres in rural Nigeria: implications for service improvement.

Introductionseveral scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and personnel. This study was designed as part of an intervention program with the goal to improve the access of pregnant women to skilled pregnancy care in rural Nigeria. The specific objective of the study was to determine the nature and readiness of Primary Health Centres (PHCs) in two Local Government Areas (LGAs) in rural parts of Edo State, Southern Nigeria to deliver effective maternal and child health services.Methodsthe study was conducted in 12 randomly selected PHCs in the two LGAs. Data were obtained with a semi-structured questionnaire administered on health workers and through direct observation and verification of the facilities in the PHCs. The results obtained were compared with the national standards established for PHCs in Nigeria by the National Primary Health Care Development Agency (NPHCDA). Descriptive statistics were used to analyze the data.Resultsthe results showed severe deficits in buildings and premises, rooms, medical equipment, essential drugs, and personnel. Only 40% of items recommended by the NPHCDA were available for buildings; 41% of the PHCs had facilities available in the labour ward; while less than 30% had the recommended facilities in the antenatal care rooms. Only one PHC had a laboratory space, with only one item (a dipstick for urine analysis) identified in the laboratory. None of the PHCs had ambulances, mobile phones, internet or computers. There was no nurse/midwife in 4 PHCs; only one nurse/midwife each were available in 8 PHCs; while there was no Environmental/Medical Records Officer in any PHC. About 26% of the essential drugs were not available in the PHCs.Conclusionwe conclude that PHCs in Edo State, Nigeria have severe deficits in infrastructural facilities, equipment, essential drugs and personnel for the delivery of maternal and child health care. Efforts to improve these facilities will help increase the quality of delivery of maternal and child health, and therefore reduce maternal and child mortality in the country.

Implementation strategy of primary health care in Ovia communities

Primary health care is the essential health service provided at the grassroot level. Over the years the implementation of Primary Health Care (PHC) programmes in Edo state are bedeviled with associated challenges such as limited community participation, great communication gap that limit evaluation processes of PHC programme and slow pace collaboration among stakeholders. These challenges need to be averted through effective and people oriented strategies to ensure the implementation of primary health care. A descriptive research design with a population of the study comprised 1,024 primary health care stakeholders in Edo state. Multi-stage sampling technique was used to select 180 respondents for the study. The study found that intersectoral collaboration involving partnerships with community health agencies such as village health committees and ward health committees significantly influenced the implementation of PHC. Intersectoral collaboration, community mobilization strategy and community feedback mechanism are effective and efficient strategies for improved implementation of PHC programmes. The study recommended among others that National Primary Health Care Development Agency (NPHCDA) and State Primary Health Care Development Agency (SPHCDA) should strengthen partnership with international health organizations such as WHO, UNICEF, GAVI, UNDP and boost confidence and trust of these international organizations.

What is the Unemployment Situation of Nurses and Midwives in Nigeria?

Background: The quacking controversy that trailed the Nursing & Midwifery Council of Nigeria’s (N&MCN) release of a “License Community Nurse (LCN)” circular (Ref No. N&MCN/SG/RO/CIR/24/VOL.4/152 dated March 3, 2020) which conveyed the intention of the council to lower the existing standard of nursing education for the LCN programme that will take secondary school leavers at least a credit in English and Biology to be admitted into and two years to complete, and inter alia blamed the crude situation and abysmal performance of the Nigerian Primary Healthcare (PHC) system in the community settings on mass migration of Nurses & Midwives to urban areas and to other countries prompted UGONSA to initiate this survey to empirically determine whether there are indeed a shortage of Nurses & Midwives to fill the manpower need of the Nigerian PHC system in the community settings or not, or whether the shortage is as a result of the deliberate age-long policy of attrition and displacement of Nurses & Midwives from the PHC system in the community settings and their replacement with Community Health Extension Workers (CHEWs) [who do not have nursing education, training, skills or the ethical leaning to be responsible and accountable for nursing & midwifery services] by the National Primary Healthcare Development Agency (NPHCDA). Objective: The main aim of the study was to determine if there is a shortage of nurses that could fill the nursing needs of the PHC system in the community settings. The study also sought to compile the list of unemployed and underemployed Nurses & Midwives and to find out if unemployed Nurses & Midwives are willing to work in the community settings if the opportunity to serve the PHC system in the community setting is offered to them by the NPHCDA. The study further sought to determine the ratio of unemployed Nurses & Midwives in relation to the possible number of graduates that can be licensed by the N&MCN in a session. Methods: Using Google forms an online compilation was carried out from March 7 to April 08, 2020, in a descriptive survey of unemployed Nurses & Midwives that could be reached online within the timeline. Names, Phone numbers, State of Residence, Year of Graduation, Qualification(s), and how long they have remained unemployed after graduation were compiled. In addition, two questions were asked about the objective of the study. Analysis of data was done via Google forms statistical tools. Results: A total of 3317 unemployed Nurses & Midwives responded to the survey. Among these unemployed Nurses & Midwives – 38% holds RN only, 19% holds both RN & RM, 15.4% holds RM only, while 27.6% holds BNSc plus another qualification. For the year they have remained unemployed after graduation 57.1% have spent 0–2 years, 29.9% have been unemployed for 3–5 years, 7% have been unemployed for 6 – 8 years and 6.1% have been unemployed for more than 8 years. To the question, “Do you think there is a shortage of Nurses and Midwives in Nigeria?” – 47.5% said yes, 43.5% said no whereas 9% were undecided (said maybe). Furthermore, the result showed that while 95% of the unemployed Nurses & Midwives are willing to work in the rural community settings, 1% was not willing to work in the rural community settings and 4% were undecided (.i.e. said maybe) on whether they will work in the rural community settings or not. The result also revealed that the 3317 unemployed Nurses & Midwives captured in the survey represents graduates of 66 Nursing & Midwifery schools per session out of a total of 162 schools that are currently accredited by the N&MCN. This represents 41% of the possible number of graduates that can be turned out of the accredited Nursing & Midwifery Schools (excluding Post-basic schools) in a session. Conclusion: Despite the reported migration of Nurses to urban areas and other countries, at least 41% of Nigerian Nurses & Midwives produced in a session remain unemployed and 95% of them are willing to work in the rural community settings if given the opportunity. These unemployed Nurses & Midwives can bridge the Nursing & Midwifery manpower needs in the Primary Healthcare System should the NPHCDA engage their services with a commensurate or higher payment to what their employed counterparts receive in Federal Government-owned establishments and hospitals. There is no current shortage of Nurses that necessitates the lowering of the existing standard of nursing education. Nurses & Midwives are not responsible for the design, implementation, and delivery of healthcare services at the PHC level and therefore are not culpable for the deplorable condition and abysmal performance of the Nigerian PHC System.

Comparing data Reported Using the National Health Management Information System and data Declared Validated on the PBF Declaration Forms in Funding Health Districts in Nasarawa State

The National Health Management Information System (NHMIS) Was Designed To Provide Timely And Reliable Health Service Delivery Information. The Efficiency And Effectiveness Of Health Service Delivery Is Assessed By The Availability Of Quality, Complete And Timely Data. The NHMIS Policy Review Was Initiated By A Consortium Of Relevant Stake Holders Led By The Department Of Planning, Research And Statistics (DPRS) Of The Federal Ministry Of Health (FMOH) And The National Primary Health Care Development Agency (NPHCDA). The Emphasis Of The NHMIS Is To Strengthen The Health Information System-HIS In The Country And Promote The Use Of Quality Information For Evidence-Based Decision-Making At The Community, LGA, And National Levels. In Spite Of Substantial Investments, The Health Sector In Nigeria Has Made Slow Progress In Improving Its Health Indices. Thus The Nigeria State Health Investment Project(NSHIP), Through Support From WHO, Introduced The Performance-Based Financing –PBF Currently Rolled Out In Three States- Adamawa, Nasarawa, And The Ondo States To Deliver A Result-Based Approach To Improve Quantity And Quality Of Health Services Especially In The Area Of Maternal Health. Health Centers Receive Funds Directly Based On The Number Of Essential Services They Delivered And The Improved Quality Of Care. This Encouraged Health Centers To Focus On Delivering Results, And The New Funds Enabled Them To Improve Their Services. This Study Compared Data Reported Using The NHMIS And Declared Validated On The PBF Declaration Forms In Funding Health Facilities In Nasarawa State For Quarter 1 (Jan.- Mar.)2018 And Quarter 2 (Apr. – June) 2018.

Improving access, quality and efficiency in health care delivery in Nigeria: a perspective

Providing equitable access to health care for every Nigerian is central in the country´s National Health Act. But the Nigerian Health System ranks poorly in terms of access and quality just as the country also ranks poorly on Transparency International’s Corruption Perception Index. The problem of lack of access to quality health care stems from wasteful use of primary care services at referral centres. In the rural communities where the burden of morbidity and mortality is high, efficient health expenditure and service utilization is plagued by the absence of adequately functioning Primary Health Centers (PHC), cost sharing schemes and corrupt practices in the health sector. In order to curb these issues, policy options such as revamping the PHC and prioritizing the delivery of a basic minimum package of health care are useful to consider. Furthermore, implementation of strong actions to curb corruption in the health sector will improve access to care and health outcomes and it does not incur extra financial investment. This is achievable through improvement in public financial management and limiting corruption by making right choices in resource allocation towards pro-poor interventions. Similarly, well designed package of services and prioritization of primary care making best use of human resource will be beneficial. This is relevant to the Nigerian health system, leveraging on the country´s decentralized administration and strengthening Community Health Committees’ role in ensuring accountability and transparency at the PHCs. Finally, considering the role community health committees play in driving demand at the communities, the National Primary Health Care Development Agency (NPHCDA) can coordinate the development of a joint action plan for health care delivery, between a committee and each respective PHC facility. This will promote efficient use of resources and facilitate access to quality health care at each facility.

Nigerian Results-Based Financing Fellowship: A Strategic Approach for Sustaining Results-Based Financing in Nigeria.

There is an emergency in the Nigerian primary health care (PHC) system. Majority of PHC facilities are in a sordid and lugubrious state (1). Despite substantial government spending and policy initiatives toward revitalizing the PHC system, it remains largely deplorable across the World Health Organization (WHO) health system building blocks (2). To this end, the government of Nigeria in collaboration with the World Bank launched a Results-Based Financing (RBF) project under the Project Name: Nigeria State Health Investment Project (NSHIP) with the goal of improving service utilization and quality of healthcare services in Nigeria (2, 3). Due lack of in-country capacity, Oxford Policy Management (OPM) was contracted by National Primary Health Care Development Agency (NPHCDA) in 2014 to provide technical assistance to NSHIP for the implementation of RBF in Nigeria. In order to bridge the capacity gap at the exit of OPM in 2018, Nigerian Results-Based Financing Fellowship was conceptualized jointly by OPM and NPHCDA to train 14 Nigerians to a level whereby they are able to take on technical assistance roles in NPHCDA for continued implementation and possible scale-up of RBF in Nigeria (4). This paper describes the 10-months RBF fellowship, the competencies acquired and its usefulness as strategic approach for the sustainability of RBF in Nigeria.

Primary Healthcare on Utilization of Insecticide Treated Nets among Pregnant Mothers and Carers of Children in South –South Nigeria

One of the strategies of Primary Health Care (PHC) is the use of insecticide treated nets (ITNs) against malaria among pregnant mothers and care givers of children under five years. The agency for PHC in Nigeria is the National Primary Health Care Development Agency (NPHCDA). The objective of this narrative review is to identify the role of PHC providers in promoting the use of ITNs among pregnant mothers and care givers of children under five years. Method was by review of 30 published literatures on PHC; as it relates to use of ITNs. Findings indicate that most pregnant mothers and care-givers of children under five years in Nigeria are aware that the best option to prevent malaria infection is by use of ITNs. Healthcare providers participate in mass distribution of ITNs. There is increase nets ownership in households. Supervisory guidance influences use of ITNs. However, there is evidence of slow uptake of ITNs due to resistance to behavioural change. Also, the knowledge of pregnant women concerning ITNs use was good, but the attitudes and practices were poor. The implication is that health promotion need to be enhanced among both PHC workers and community leaders on use of ITNs. Primary healthcare workers may need to be motivated to do their job in terms of promoting the use of ITNs among pregnant mothers and carers of children under five years.

NIGERIAN NURSES AND MIDWIVES UNEMPLOYMENT SURVEY

Background: The quacking controversy that trailed the Nursing & Midwifery Council of Nigeria’s (N&MCN) release of a “License Community Nurse (LCN)” circular (Ref No. N&MCN/SG/RO/CIR/24/VOL.4/152 dated March 3, 2020) which conveyed the intention of the council to lower the existing standard of nursing education for the LCN programme that will take secondary school leavers at least a credit in English and Biology to be admitted into and two years to complete, and inter alia blamed the crude situation and abysmal performance of the Nigerian Primary Healthcare (PHC) system in the community settings on mass migration of Nurses & Midwives to urban areas and to other countries prompted UGONSA to initiate this survey to empirically determine whether there are indeed a shortage of Nurses & Midwives to fill the manpower need of the Nigerian PHC system in the community settings or not, or whether the shortage is as a result of the deliberate age-long policy of attrition and displacement of Nurses & Midwives from the PHC system in the community settings and their replacement with Community Health Extension Workers (CHEWs) [who do not have nursing education, training, skills or the ethical leaning to be responsible and accountable for nursing & midwifery services] by the National Primary Healthcare Development Agency (NPHCDA).
 Objective: The main aim of the study was to determine if there is a shortage of nurses that could fill the nursing needs of the PHC system in the community settings. The study also sought to compile the list of unemployed and underemployed Nurses & Midwives and to find out if unemployed Nurses & Midwives are willing to work in the community settings if the opportunity to serve the PHC system in the community setting is offered to them by the NPHCDA. The study further sought to determine the ratio of unemployed Nurses & Midwives in relation to the possible number of graduates that can be licensed by the N&MCN in a session.
 Methods: Using Google forms an online compilation was carried out from March 7 to April 08, 2020, in a descriptive survey of unemployed Nurses & Midwives that could be reached online within the timeline. Names, Phone numbers, State of Residence, Year of Graduation, Qualification(s), and how long they have remained unemployed after graduation were compiled. In addition, two questions were asked about the objective of the study. Analysis of data was done via Google forms statistical tools.
 
 Results: A total of 3317 unemployed Nurses & Midwives responded to the survey. Among these unemployed Nurses & Midwives – 38% holds RN only, 19% holds both RN & RM, 15.4% holds RM only, while 27.6% holds BNSc plus another qualification. For the year they have remained unemployed after graduation 57.1% have spent 0–2 years, 29.9% have been unemployed for 3–5 years, 7% have been unemployed for 6 – 8 years and 6.1% have been unemployed for more than 8 years. To the question, “Do you think there is a shortage of Nurses and Midwives in Nigeria?” – 47.5% said yes, 43.5% said no whereas 9% were undecided (said maybe). Furthermore, the result showed that while 95% of the unemployed Nurses & Midwives are willing to work in the rural community settings, 1% was not willing to work in the rural community settings and 4% were undecided (.i.e. said maybe) on whether they will work in the rural community settings or not. The result also revealed that the 3317 unemployed Nurses & Midwives captured in the survey represents graduates of 66 Nursing & Midwifery schools per session out of a total of 162 schools that are currently accredited by the N&MCN. This represents 41% of the possible number of graduates that can be turned out of the accredited Nursing & Midwifery Schools (excluding Post-basic schools) in a session.
 Conclusion: Despite the reported migration of Nurses to urban areas and other countries, at least 41% of Nigerian Nurses & Midwives produced in a session remain unemployed and 95% of them are willing to work in the rural community settings if given the opportunity. These unemployed Nurses & Midwives can bridge the Nursing & Midwifery manpower needs in the Primary Healthcare System should the NPHCDA engage their services with a commensurate or higher payment to what their employed counterparts receive in Federal Government-owned establishments and hospitals. There is no current shortage of Nurses that necessitates the lowering of the existing standard of nursing education. Nurses & Midwives are not responsible for the design, implementation, and delivery of healthcare services at the PHC level and therefore are not culpable for the deplorable condition and abysmal performance of the Nigerian PHC System.

Assessment of resources for primary health care: Implications for the revitalization of primary health care in Akwa Ibom, Nigeria

Context:Primary health care (PHC) is the cornerstone of the Nigerian National Health Policy. The national policy on PHC under one roof is undergoing implementation nationwide as a means of strengthening the PHC system. Akwa Ibom State (AKS) is set to commence full implementation of the policy.Aims:The aim of the study was to assess the existing human resource and infrastructure in PHC facilities in AKS.Settings and Design:A descriptive cross-sectional study was carried out in 18 facilities selected from the three senatorial zones of AKS, Nigeria.Subjects and Methods:A rapid assessment of selected PHC facilities based on a checklist adapted from the minimum standards for PHC as provided by the National PHC Development Agency. The results were analyzed using Excel and presented in tables.Results:A total of 18 health facilities were included in the study. Human resources available were 276 full time core health workers, of which 48 (17.4%) were volunteer workers. There was inequitable distribution in district and facility type as 122(44.2%) work in Ikot Ekpene Senatorial district and 242 (87.7%) of them work in the Operational Base. Basic lifesaving equipment such as resuscitation sets was unavailable in more than 50% of the health facilities.Conclusions:There are absolute deficit and inequitable distribution of available human resources in AKS PHCs. Basic-lifesaving equipment is grossly inadequate. There is an urgent need for more health workers to be employed and provision of basic equipment for the PHCs.

Time delays in the response to the Neisseria meningitidis serogroup C outbreak in Nigeria - 2017.

BackgroundNigeria reports high rates of mortality linked with recurring meningococcal meningitis outbreaks within the African meningitis belt. Few studies have thoroughly described the response to these outbreaks to provide strong and actionable public health messages. We describe how time delays affected the response to the 2016/2017 meningococcal meningitis outbreak in Nigeria.MethodsUsing data from Nigeria Centre for Disease Control (NCDC), National Primary Health Care Development Agency (NPHCDA), World Health Organisation (WHO), and situation reports of rapid response teams, we calculated attack and death rates of reported suspected meningococcal meningitis cases per week in Zamfara, Sokoto and Yobe states respectively, between epidemiological week 49 in 2016 and epidemiological week 25 in 2017. We identified when alert and epidemic thresholds were crossed and determined when the outbreak was detected and notified in each state. We examined response activities to the outbreak.ResultsThere were 12,535 suspected meningococcal meningitis cases and 877 deaths (CFR: 7.0%) in the three states. It took an average time of three weeks before the outbreaks were detected and notified to NCDC. Four weeks after receiving notification, an integrated response coordinating centre was set up by NCDC and requests for vaccines were sent to International Coordinating Group (ICG) on vaccine provision. While it took ICG one week to approve the requests, it took an average of two weeks for approximately 41% of requested vaccines to arrive. On the average, it took nine weeks from the date the epidemic threshold was crossed to commencement of reactive vaccination in the three states.ConclusionThere were delays in detection and notification of the outbreak, in coordinating response activities, in requesting for vaccines and their arrival from ICG, and in initiating reactive vaccination. Reducing these delays in future outbreaks could help decrease the morbidity and mortality linked with meningococcal meningitis outbreaks.

Evaluating scenarios of locations and capacities for vaccine storage in Nigeria

Many developing countries still face the prevalence of preventable childhood diseases because their vaccine supply chain systems are inadequate by design or structure to meet the needs of their populations. Currently, Nigeria is evaluating options in the redesign of the country’s vaccine supply chain. Using Nigeria as a case study, the objective is to evaluate different regional supply chain scenarios to identify the cost minimizing optimal hub locations and storage capacities for doses of different vaccines to achieve a 100% fill rate. First, we employ a shortest-path optimization routine to determine hub locations. Second, we develop a total cost minimizing routine based on stochastic optimization to determine the optimal capacities at the hubs. This model uses vaccine supply data between 2011 and 2014 provided by Nigeria’s National Primary Health Care Development Agency (NPHCDA) on Tuberculosis, Polio, Yellow Fever, Tetanus Toxoid, and Hepatitis B. We find that a two-regional system with no central hub (NC2) cut costs by 23% to achieve a 100% fill rate when compared to optimizing the existing chain of six regions with a central hub (EC6). While the government’s leading redesign alternative – no central three-hub system (Gov NC3) – reduces costs by 21% compared with the current EC6, it is more expensive than our NC2 system by 3%. In terms of capacity increases, optimizing the current system requires 42% more capacity than our NC2 system. Although the proposed Gov NC3 system requires the least increase in storage capacity, it requires the most distance to achieve a 100% coverage and about 15% more than our NC2. Overall, we find that improving the current system with a central hub and all its variants, even with optimal regional hub locations, require more storage capacities and are costlier than systems without a central hub. While this analysis prescribes the no central hub with two regions (NC2) as the least cost scenario, it is imperative to note that other configurations have benefits and comparative tradeoffs. Our approach and results offer some guidance for future vaccine supply chain redesigns in countries with similar layouts to Nigeria’s.

Transforming vaccines supply chains in Nigeria

Nigeria is the most populous country in Africa and in 2012 was suffering some of the lowest vaccination rates in the World. A combination of factors had resulted in a dysfunctional immunization cold chain and supply chain. Recognizing that the number of unimmunized children contributed to high levels of under-5-mortality, and that health MDGs would not be attained, Minister of State for Health Mohammed Pate launched a vaccines transformation project in 2013. In partnership with BMGF, GAVI, UNICEF, WHO, other donors and implementing partners the transformation journey has so far taken three years and achieved impressive results. It has though faced challenges along the way and with the financial burden of GAVI graduation facing Nigeria, the economic downturn and the decentralized funding of health services, the results are far from sustained. This paper documents the work undertaken at the Federal level and then highlights specific work undertaken in partnership with Lagos State Government. It identifies the importance of taking an end to end approach and looking at the root causes of weak system performance. The strategy combined simple innovations in how data was captured, recorded and used to drive decision making. It included a comprehensive and systematic approach to cold chain procurement, installation and maintenance with a shift to a culture of active cold chain maintenance that is performing with higher levels of uptime. It also included supply chain redesign at both the Federal and State level. Finally, it involved an institutional transformation at the National Primary Health Care Development Agency (NPHCDA) to establish a data driven Department of Logistics and Health Commodities (DLHC) to manage the many challenges in immunizing 7.5 million children annually. While results have been impressive, there have been many challenges and lessons learned on the way. As Nigeria gets ready for its graduation from GAVI, a robust agile performing cold chain and supply chain will be essential for the good health of Nigeria’s children and its economy. The necessary transformation journey has only just begun.

VP159 Strengthening Primary Health Care In Nigeria By Patient Involvement

INTRODUCTION:The Health system in Nigeria is structured into three tiers which include tertiary health care, secondary health care and primary health care (PHC). The latter forms the grassroots system of delivering basic health services to communities in both rural and urban centers. However PHC in Nigeria have been affected by poor service delivery. This has resulted in underuse of PHC due to the acceptance and utilization of health services delivered through this system. This research seek to bridge the gap of inequality, reaffirm that implementing PHC is a human right/duty and fosters patient and consumer involvement for economic, social and environmental sustainability of PHC.METHODS:A qualitative method of research was adopted using a participatory research model. The relative data was sourced secondarily from recent findings (July 2015) carried out in seventy-three primary health centers across Anambra State, Benue State, Kaduna State, Plateau State and Federal Capital Territory (FCT) of Nigeria. Issues that were examined included: client perspective and community involvement, status of available services, utilization and service delivery, and infrastructure and human resource capacities. The respondent of 294 client/service user population from interview were recorded and analyzed.RESULTS:The assessment showed client dissatisfaction to services being provided. In most centers, National Primary Health Care Development Agency (NPHCDA) requirements like availability of basic functional equipment, well trained health workers, patient record system, and access to water and sanitation were not met. Most of the facilities visited reported to be disconnected from the health system due to supportive supervision.CONCLUSIONS:Conclusively, the interest of the underserved Nigerian could be advocated for through local committees of consumer organizations. Their involvement will have an impact in PHC evaluation, policy making, and implementation of action plans aimed at improving PHC services.

Strengthening HR for SCM in the immunization supply chain in Nigeria through stakeholder engagement

Background Nigeria is the most populous country in Africa with an estimated population of 176 million people and employs the largest number of health workers on the continent. The availability of human resources is at optimal levels however the human resource capacity remains a challenge in Nigeria’s health sector. National Primary Health Care Development Agency (NPHCDA) leadership has moved ahead in addressing these challenges by engaging international partners, traditional and religious leaders nationwide, and donors to be leaders and change agents in strengthening HR for SCM at all levels. This focus is aimed to improve the efficiency and effectiveness of the immunization supply chain.

Pneumococcal Infection in Nigeria: Preparing for the vaccine

Background: The Pneumococcus is the most common cause of community-acquired pneumonia (CAP), sporadic bacterial meningitis, and bacteremia worldwide. It is an important public health concern throughout the world with global burden in causing disease and deaths comparable to that of human immunodeficiency virus (HIV), malaria, and tuberculosis. Nigeria accounts for 5% of the total global burden. Many of these morbidity and mortality could be averted with the use of pneumococcal vaccine, which is shown to be highly effective. This review is set out to highlight the burden of pneumococcal infection (PI) in Nigeria, its attendant mortality, antibiotic resistance, and the rational for the need to introduce routine pneumococcal vaccination. Materials and Methods: Relevant literatures were reviewed from medical journals, library search, and internet source. Other relevant websites like Global Alliance for Vaccines and Immunisation (GAVI), WHO were also visited as source for information. The key words employed were: pneumococcal infection, Nigeria, and vaccine. Results: Several studies have shown high burden of PI and high prevalence of antibiotic resistant Pneumococcus in Nigeria. Mortality rate has also been shown to be high and the need for effective implementation of pneumococcal vaccine into routine childhood vaccination program has been underscored. Conclusion: Prevention of pneumococcal disease and death is achievable only if efforts to deliver and implement prevention in regions with the greatest burden of disease are successful. National Primary Healthcare Development Agency (NPHCDA) should introduce either pneumococcal conjugate vaccine (PCV)-13 or PCV-10 through GAVI support to eligible children and at risk adult all over the country. As these new vaccines are introduced, it is imperative that we conduct surveillance to document changes, positive or negative, which occur in disease epidemiology. This entails continuing surveillance pre- and post-vaccine introduction, assessing resistance, changes in invasive PI (IPI), serotypes, and any replacement.