nigeria addressing communication challenges 2011 - PolioInfo

UNICEF Nigeria /2011/Morgan
NIGERIA
ADDRESSING
POLIO COMMUNICATION
COMMUNICATION
2011
CHALLENGES
S U M M A R Y R E P O R T

UNICEF Nigeria /2011/Morgan
F A C T S A N D F I G U R E S
As of November 25, 2011, Nigeria has recorded 43 cases of wild
poliovirus (WPV) in eight States compared to 14 cases in seven
States for the same period in 2010. Four (4) States of North
Eastern part of Nigeria recorded 28 WPV cases. Kano has so far
14 WPV cases followed by Kebbi (8), Jigawa (6), Borno (5),
Sokoto (5) and Yobe (3), whereas Katsina and Zamfara
experienced one case each.
In January round, non-compliance as a reason for missed
children was 27% and it finally reached 28% in September
Immunization Plus Days.
Total number of circulating vaccine derived poliovirus (cVDPV2)
is 25 in six States compared to 25 cases in eight States for the
same period in 2010. Jigawa has the highest number of cVDPV
cases (11) followed by Kano (9), Borno (2) and one in Katsina,
Zamfara and Yobe States.
In 2011, Nigeria conducted eight national and sub-national IPDs
in January, February, March, May, June, July, September and
November. There will be another Special Immunization Plus
Days in 12 high-risk States in December. In line with the 21 st
Expert Review Committee (ERC) recommendations, Nigeria also
conducted mop-up campaigns in the polio-affected States. The
proportion of missed children during these campaigns has
fluctuated.
In January Immunization Plus Days, the percentage of missed
children was 6% while in September it rose to 6.5% in the
northern high-risk States. Non-compliance as a reason for
missed children also showed a similar wavy trend.
Fig 1: Trend of missed children (MC) and non-compliance (NC)
in 2011 IPDs.

UNICEF Nigeria /2011/Morgan
THREE
TIMES
HIGHER
THAN
IN 2010
Nigeria continues to experience a surge of polio cases,
following a dramatic reduction of cases in 2010. The
country remains the only polio-endemic country in
Africa. Significant progress has been achieved in
Nigeria, with the number of cases collapsing by more
than 95% in 2010. However, as of end of November,
Nigeria recorded 43 cases of wild poliovirus compared
to 14 cases in the same time period in 2010.
In the first nine months of 2011, Nigeria has already
reported more cases than in the whole of 2010. The
States of Borno, Kano, Jigawa and Kebbi account for
85% of all cases nationally. Continued community
resistance to the programme is profoundly impacting
progress. Caregiver refusals, or non-compliance, to
immunize their children still make up a significant
proportion of the total number of children missed during
campaigns, and refusals are on the rise in some highrisk
States.
This upsurge of polio cases is also due to higher
number of under-immunized population groups and
pockets of non-compliance in a few northern States.
Routine immunization coverage remains below 80%
nationally, with sub-optimal performance by northern
States.
Over the past months, Nigeria conducted a series of
national and sub-national Immunisation Plus Days
(IPDs) as well as mop-up campaigns in the polioaffected
States. During mopping-up, vaccine is
delivered house-to-house to children to ensure that all
children are vaccinated. However, the proportion of
missed children has shown a slightly increasing trend.
Child absent was found as the main reason for missed
children. According to Independent Monitoring data,
one quarter of all missed children are missed due to
refusal, with 68% of missed children due to „child
absent‟.
The biggest challenges facing the Nigerian programme
are to find ways to overcome the operational
challenges, as well as the increasing numbers of
missed children due to resistance. Experts opine that
the eradication of polio from Nigeria in 2012 is feasible
if all children under five years of age receive two drops
of the oral polio vaccine during Immunization Plus Days
campaigns and during routine immunization sessions at
the health facility irrespective of their previous
immunization status.
Nigeria has made a lot of progress in reducing the
number of polio cases in the country. More than ever
before, the Federal Government, State Governments,
Traditional and Religious Leaders and other Partners
are committed to stopping polio completely in Nigeria
by end of 2012. In September 2011, the Federal
Government and the Nigeria Governors‟ Forum signed
a re-confirmation of the Abuja Commitments, pledging
to reach at least 90 percent of children with polio
vaccine with the goal of wiping out polio from the
country and improve routine immunization.
To achieve the target of Polio eradication requires
multiple high quality rounds of Immunization Plus Days
Campaigns that reach more than 90% of children under
five in all villages.

UNICEF Nigeria /2011/Morgan
P R O G R E S S
Sustained high awareness of polio immunization
According to independent monitoring data, the level of prior
awareness of caregivers about polio campaigns is 98% in all
rounds of 2011. According to the September 2011 IPD
independent monitoring data, 45% of the caregivers were
informed about IPDs by town announcers followed by radio/TV
(23%) and traditional/religious leaders (19%). IPD data also
revealed that about 75-80% of the decision to immunize the
child was taken either by the father or the mother.
Consequently, community dialogues involving men and
compound meetings with women have been intensified so that
caregivers‟ high awareness level can be effectively turned into a
positive decision about polio immunization by caregivers.
Nationally, the level of awareness about polio immunization has
increased from 65% (2009 KAP) to 75% (2010 KAP) with a wide
variation among States (25% in Kano to 94% in Bauchi). The
milestone target is to bring the awareness level to 85% by the
end of 2011. Effort is underway to increase awareness through
community dialogues, compound and town hall meetings, Majigi
film shows, the use of IEC materials and mass media.

Reduced proportion of noncompliance
Communication activities to address non-compliance have
produced promising results. The proportion of missed children
due to non-compliance has declined in comparison to 2010. In
2010 non-compliance as a reason for missed children ranges
from 47% (2010 January IPD) to 35% (2010 November IPD) in
high risk States where as it came down to 27% in January
2011 and 28% in September 2011 IPDs. However, the
number of non-compliant wards varies greatly from round to
round and is difficult to predict.
Involvement of community in PEI
UNICEF piloted few community-based communication
initiatives in three northern States. Neighbor to Neighbor (N2N)
in Sokoto, Dattawa & Abokai (Respected elderly women and
youth) in Zamfara and Household Adoption Strategy in Kebbi
States showed encouraging results by reducing missed
children and non-compliance through active community
participation.
The 22 nd Expert Review Committee meeting recommended
scale-up of participatory and community-based communication
initiatives. UNICEF is now rapidly scaling up communitybased
communication initiatives in three priority States.
The main objective is to reduce the percentage of missed
children during IPDs through targeted interventions to
generate demand for and acceptance of Oral Polio Vaccine in
Kano, Sokoto and Kebbi States. This project is funded by the
Bill and Melinda Gates Foundation.
Decreased immunity gap
The proportion of zero doses NP-AFP cases at national level
fell from 3% in 2010 to 2% in 2011. As of 18 November 2011,
Borno has more than 12% zero dose children followed by
Kano (7%), and Katsina (5%). Three high-risk States namely
Gombe, Jigawa and Yobe have 0% zero dose children.
Nationally, 22% children among NP-AFP cases received 3 doses which was
68% in 2010. However, four States Borno (61%), Kano (63%),
Yobe (64) and Sokoto (68%) have lower coverage.
Implementation of intensified
ward communication strategy
“Intensified Ward Communication Strategy” was implemented
vigorously in 2011 as recommended by 21 st ERC and was
found to be effective. While 86 wards were identified as very
high risk in January IPDs, only 59 remained high risk in
September round. This indicates that evidence-based
communication planning at ward and LGA level has produced
promising results. However, States like Borno, Kano, Jigawa
and Yobe still have high number of LGAs with persistent noncompliance
(>300 households).
As Nigeria approaches the last phase of polio eradication, data
driven communication activities and interventions which
empower communities to take action will be of high importance
to reduce missed children and non-compliance.
UNICEF Nigeria /2011/Morgan
The objective of the intensified ward communication strategy is
“to reduce the percentage of missed children due to noncompliance
of more than10% in the targeted wards through
intensified communication activities”.
Selection of the high-risk wards is based on the following
criteria:
• with more than 20% missed children and more than 30%
non-compliance
• with more than 50% missed children,
• presence of WPV or cVDPV in the last six months

ADDRESSING
CHALLENGES
It is 10.00 a.m. at the health facility of Dawakin Tofa, one of the villages in Kano State with several polio cases this
year. Outside of the health facility, a group of women – health educators, community mobilisers and vaccinators -
are preparing to start a house-to-house polio immunization “mop-up” activity to reach every last child. Among this
group, Ms. Hafsat, vaccinator, and her team were assigned to cover a remote village of Yansalmo, where block
resistance to polio immunization by the community is still persisting.
“Why is the polio vaccine given round after round when there is no health care nor clean water in our village
There are so many other diseases like malaria, cholera and meningitis that kill our children; drugs are either
unavailable and we cannot afford to buy them,” a representative of the village asked when the team arrived.
In Kano State, continued community resistance to the polio eradication programme is profoundly impacting
progress. Caregiver refusals, or non-compliance, to immunize their children still make up a significant proportion
of the total number of children missed during campaigns, and refusals are on the rise in some high-risk areas.
According to the latest data analysis, non-compliance accounts for more than four (4) out of ten (10) of missed
children in Kano State and in ten (10) Local Government Areas (LGAs), non-compliance accounts for fifty percent
(50%) of missed children.
“It is difficult to convince families under these circumstances, especially when they are facing multiple
deprivations. But, through compound meetings and community dialogues, we were finally able to convince
villagers to accept the oral polio vaccine. We have been successful in turning around their resistance by
increasing their threat perception of polio,” Ms. Hafsat said.
To address the issue of resistance to polio immunization, local government and polio eradication partners
organize regular community dialogues with the support of traditional leaders. In fact, according to the latest data
analysis, almost eight out of ten of resolved non-compliance cases were due to traditional leaders‟ interventions.
UNICEF also initiated an interpersonal communication training to strengthen the capacity of health educators,
supervisors and ward focal persons to convince communities to be immunized against polio. By the end of the
year, all these actors - in the States of Kano, Kebbi, Zamfara and Sokoto which account for the majority of all
cases nationally - will be trained. Piloted in Kano State, these training sessions will be followed by a cascade
training aiming to target all actors at community levels.
Media professionals have joined communication efforts to raise awareness around polio issues in some high risks
States. Through the Journalists against Polio networks, radio programs with appropriate messages and healthrelated
FAQs are periodically on air for mass awareness. “Journalists are playing and have to play an important
role in communication for social and behavior change. This is why we decided to join our forces and support polio
eradication initiative in Nigeria,” said Sani Zango, chairman of the Journalists against Polio network in Kano State
“With all the challenges we are facing, we just have to do more to eradicate this disease, and the most important
contribution is to strengthen the health system to improve Routine Immunization coverage” Ms. Hafsat concluded.
Several pilot projects which have engaged and empowered community volunteers in the efforts to reduce missed
children and non-compliance have also shown encouraging results in Nigeria. With the support of Bill and Melinda
Gates Foundation, UNICEF is planning to scale up these volunteer community mobilizer initiatives in three priority
States as recommended by the 22 nd Expert Review Committee.
“This project will contribute to reducing the percentage of missed children during IPDs through targeted
interventions to generate demand for and acceptance of Oral Polio Vaccine in Kano, Sokoto and Kebbi States.
Over 900 settlement level volunteer mobilizers will be recruited, trained and deployed in these settlements where
refusals have been a persistent problem,” says Tommi Laulajainen, UNICEF Chief of Polio Communication.
Nigeria continues to experience a surge of polio cases, following a dramatic reduction of cases in 2010. As of
November 25, Nigeria recorded 43 cases of wild poliovirus compared to 14 cases in the same time period in 2010.
In the first nine months of 2011, Nigeria has already reported more cases than in the whole of 2010. This upsurge
of polio cases is also due to higher number of under-immunized population groups and pockets of non-compliance
in a few northern States. Routine immunization coverage remains below 80% nationally, with sub-optimal
performance by northern States. The country remains the only polio-endemic country in Africa.
A national and state level raise awareness and advocacy campaign – Polio-Free Torch campaign - was recently
launched in the country to reinforce advocacy efforts and to mobilize wide support from a variety of stakeholders
at all levels for the last lap of the polio eradication efforts in the country.

UNICEF Nigeria /2011/Morgan
C H A L L E N G E S
Lack of commitment of health
workers
In principle, health workers need to be in the forefront and
spearheading the polio eradication effort in Nigeria. However,
the contribution of the health workers in communication activity
has been found very minimal and that may indicate lack of
commitment from them. In 2011, the contribution of health
workers as a source of information and influencer has been
found below 5% in all rounds. Interpersonal Communication
(IPC) skills training as part of the IPDs training packages was
found to be ineffective. Knowledge of health workers about
polio, the vaccine efficacy and safety is poor. Health workers
also hardly make efforts to resolve non-compliance and track
child absence.
Considering the importance of involving health workers in a
more effective manner, UNICEF has started IPC Skills training
in high-risk States. Training of trainers on IPC Skills has
already been completed in Kano and Sokoto and by
December, in two other States.
2011 national election and
security situation
With the 2011 national and state level elections, the
government at different levels gave its priority and focus on the
election campaigns for a certain period. Likewise, the mass
media was also preoccupied for extended period of time by
election coverage.
Tracking of the implementation of Abuja commitments
(Governors‟ and LGA Chairmen involvement in IPDs) shows a
downward trend with the new faces of leaders at national,
State and LGA levels. However, it is expected that the ongoing
advocacy efforts and Polio-Free Torch campaign will
increase the commitment level of Governors and LGA
chairmen in the high risk States.
The August 26, 2011 bomb attack at the UN House in Abuja
was also a big blow to the normal functioning of UNICEF and
other partners like WHO. Several staff of UNICEF and WHO
died in that incident and many were injured. The situation was
very stressful and still there are threats of more bomb blasts.
However, UNICEF was able to rapidly recover from this
incident with renewed commitment to polio eradication in
Nigeria.
States like Borno, Bauchi, Yobe, Kaduna and Plateau also
have faced repeated outbursts of violence in 2011. Sectarian
carnage erupted a number of times this year in Plateau,
Kaduna and Bauchi while abduction, bombing and killings
have become common in Borno.

POLIO-FREE TORCH
AWARENESS
AND ADVOCACY
CAMPAIGN
The Federal Government of Nigeria with the support of the Polio Eradication
Initiative partners launched a new communication campaign on September 24 th ,
2011, entitled Polio Free Torch Campaign.
Supported by the Nigerian Olympic Committee (NOC) and a number of Nigerian
Olympians, this campaign is designed to overcome resistance to polio immunisation
and to mobilize wide support from a variety of stakeholders at national and State
levels for the last lap of the polio eradication efforts in Nigeria.
“This is a war. Not
a war on killing
people, but a war
for the survival of
people”
His Royal Highness,
The Emir of Kano State, Nigeria
“The Polio- free Torch will serve as a reminder to all Nigerians that a healthy
Nigerian child can grow up to be an Olympian and win laurels for the country,” said
the Vice-President of the Federal Republic of Nigeria, Namadi Sambo, on behalf of
the President, Goodluck Jonathan.
As the world heads for the London 2012 Olympic Games, the Polio Free Torch
illustrates the determination of the Nigerian Polio Eradication Initiative to make the
year 2012 the last year that Nigeria witnesses a case of Polio.
The campaign kickoff at the federal level has already initiated a series of State level
launches in the Northern States which are still considered at very high risk from the
wild polio virus. Olympic Icons in each State carried the Polio Free Torch during a
public Polio Rally to sensitize the public and engage their support.
In Niger State, the Governor commits to release funds for polio eradication
programmes in the state until the end of the year. He also instructed all local
government chairmen to rise up to the task of eradicating polio from the State. In
Kano, one of the highest risks States in the country, the torch campaign serves as a
symbol of renewing the commitments of all the main stakeholders.
The State tour joined by Nigerian Olympians featured lighting of the torch by the
Governor to symbolize the State‟s commitment to eradicate polio by the London
2012 Olympics. Governors decorate a number of key influencers as „Polio
Ambassadors’ with the Polio free lapels.
“We are racing against time with the global goal of eradicating polio from the world
by 2012. UNICEF believes that partnerships and collaborative relationships with all
stakeholders at all levels are critical to deliver results for children and to ensure that
not a single Nigerian child will be victimized by this crippling disease,” said Dr.
Suomi Sakai, UNICEF Representative in Nigeria.
Private sector companies have also expressed their interest to support this special
advocacy campaign. Flash IT Solutions is among the corporate companies
responding to the “call for support” issued by PEI partners, by designing and hosting
free of charge a dedicated website for the campaign. The telecommunication
company, Visafone, also supported the campaign by financing print advertisement
in the newspapers.

COMMUNITY MOBILIZERS NETWORK
TARGETED
INTERVENTIONS
TO GENERATE
DEMAND FOR
AND ACCEPTANCE OF
ORAL POLIO VACCINE
Neighbour to Neighbour
communication approach to reduce
non compliance
Makwabci to Makwabci (Neighbour to Neighbour) aims to
reduce non compliance and child absent in high risk
settlements. Neighbour to Neighbour is a community-based
approach delivered by volunteers and strengthens community
ownership and action for addressing local health issues with
special focus on Routine Immunization and polio eradication.
Volunteers serve as „champions‟ for their neighbours, families
and friends. The purpose of volunteers is to conduct informal
conversations with their neighbours in community settings.
Volunteer training was designed to provide key facts about
aims of this project, polio updates/risk, Routine Immunization,
Wild Polio Virus, Polio Eradication Initiative, Oral Polio
Vaccine, sanitation and hygiene. Volunteers conduct individual
conversations with their neighbours. Reasons given for
holding individual conversations were to encourage open
conversations, as people are more likely to query rumours and
vocalise doubts on a one-to-one basis, expectations of groups
include pluses.
Several pilot projects which have engaged and empowered community
volunteers in the efforts to reduce missed children and non-compliance
have shown encouraging results in Nigeria. In October 2011, 22 nd
Expert Review Committee recommendations clearly emphasize the
need to strengthen community empowerment through up scaling
community based innovative approaches following intensified ward
communication strategy (IWCS). Some community based innovative
strategies were piloted at High Risk settlements at various polio
endemic States. Case studies were submitted with before and after the
intervention data analysis, and some very positive trends of reduction
in non-compliance and missed children were noticed.
Over 900 settlement level volunteer mobilizers
With the support of Bill and Melinda Gates Foundation, UNICEF is
starting to scale up these volunteer community mobilizer initiatives in
three priority States as recommended by the 22 nd Expert Review
Committee. This project will contribute to reducing the percentage of
missed children during Immunization Plus Days through targeted
interventions to generate demand for and acceptance of Oral Polio
Vaccine in Kano, Sokoto and Kebbi States. All high risks LGAs, Wards
and Settlements will be identified. Over 900 settlement level volunteer
mobilizers will be recruited, trained and deployed in these settlements
where refusals have been a persistent problem: 557 settlements in
Kano, 200 in Kebbi and 200 in Sokoto. Through this extensive Social
Mobilization efforts and increased House-to-House behavior change
communication, Polio Eradication Initiative aims to achieve the goal of
immunizing missed children and making Nigeria Polio Free.
House-to-house mop-up at the village
of Kashirmo in Kano State
UNICEF Nigeria /2011/Morgan
Hafsat, the vaccinator, uses her interpersonal skills to engage
with a nervous mother clutching her child close to her. She
explains about prevention of childhood diseases and the
importance of Routine Immunization to the mother who draws
closer, listens and looks carefully at the picture of the child with
polio.
Hafsat shares more pictures and information on vaccinepreventable
diseases and a quick lesson on health hygiene and
sanitation and care of her baby. The mother‟s face is
transformed with a smile as she vaccinates her child with oral
polio vaccine. Hafsat is confident that this mother has
understood the importance of giving her child the oral polio
vaccine drops. Before she steps out of the household, she
explains where and when to take her child to the health facility
for Routine Immunization.
FOR MORE INFORMATION, PLEASE CONTACT
Tommi Mika Laulajainen
Chief of Communication (Polio)
+234 706 401 9646
tmlaulajainen@unicef.org
UNICEF Nigeria Country Office
www.poliofreenigeria.com
Facebook page: Polio Free Nigeria
UNICEF Nigeria /2011/Mendes