Treezer Michelle Atieno
It is a Thursday morning, and Nafii Ibrahim is expecting a group of women at Kumbotso Local Government Hospital in Kano for training on how to administer polio vaccines in the community. The women begin to arrive and settle in the hall. Nafii, the World Health Organization Coordinator of the hospital, is familiar with activities like this.
“After a series of trainings, these women will join our list of Volunteer Community Mobilizers (VMCs) and be assigned to different areas for routine polio vaccination and general health surveillance in the community,” says Nafii.
Kano state and Polio
Kano, located in Northern Nigeria, is one of the 36 states in the country. The state has 44 Local Government Areas (LGAs), 484 wards, and 27,233 settlements. Kano was a major source of Wild Polio Virus (WPV) cases in Nigeria until 2015. In 2009, the state reported 168 WPV cases out of the 388 reported nationally.
From 2010 to 2015, a total of 65 confirmed WPV cases were reported in Kano State. Almost half of these cases were reported in 2012. The number of reported cases fell to 15 in 2013 and further decreased to 5 in 2014. No new WPV cases have been detected in Kano since 2015.
However, in 2021, circulating Vaccine-Derived Poliovirus 2 (cVDPV2) was detected in 18 states in Nigeria, including Kano, where four children had already been confirmed paralyzed by the disease. The first confirmed case of cVDPV2 in 2021 in Kano was a 63-month-old boy from Albasu LGA.
To interrupt the transmission of cVDPV2, the National Primary Health Care Development Agency (NPHCDA) is taking the lead in efforts to eliminate all forms of poliovirus.
This initiative is being supported by the World Health Organization (WHO) and partners of the Global Polio Eradication Initiative (GPEI) partners.
The aim is to strengthen immunization coverage by using both the fractional Inactivated Polio Vaccine (fIPV) vaccine and the novel oral polio vaccine type 2 (nOPV2). These efforts are specifically targeting 13 high-risk and security-compromised states, including Kano. To achieve this, VMCs and women in different other sectors in polio eradication are important.
Women are considered the backbone of global immunization efforts due to their strength in supporting their community. They overcome gender discrimination, stigma, and even violence to protect children against vaccine-preventable diseases. In Nigeria, women are at the heart of polio immunization efforts.
Sai;dat Ibrahim(Photo Credit: Treezer)
According to Sa’adat Ibrahim, the State Immunization Officer of Kano state, all the VCMs in Kano are female residents of the communities where they work.
Suleiman Issa, a member of the WDC in Chirin ward, explains why these requirements are important. “As part of the team responsible for selecting VCMs, we look for someone who is above 18 and has good interpersonal communication skills.”
After the selection process, the VCMs undergo two weeks of training. “We train them on various topics such as the importance of the Polio Eradication Initiative (PEI), routine immunization, Acute Flaccid Paralysis (AFP) surveillance, social mobilization and community engagement, the use of behavior change communication tools, and interpersonal communication skills,” says Nafii.
Hadira Bello is a VCM in charge of Maidinawa village, Kumbotso LGA, and this is her fourth year doing this work. “As a VCM, I am responsible for mobilizing households for polio and routine immunization. Through a community-friendly approach, I identify and report issues related to chronically missed children and non-compliant parents. Using flip charts, I also carry out door-to-door vaccination activities, providing interpersonal counseling on immunization and promoting key household practices, such as the treatment of diarrhea, prevention of malaria, and breastfeeding.”
At birth, VCMs also mobilize mothers and caregivers of newborns to ensure that they bring their babies to receive the Oral Polio Vaccine (OPV) within the first few critical day
While the VCMs are important in polio vaccination, they do not work alone during vaccination. They must be paired with an independent vaccine supervisor to ensure that all vaccines are administered to the children and to minimize wastage.
The directly observed polio vaccination strategy has improved the uptake of polio vaccines and population immunity in high-risk areas for polio transmission in the north.
Fatima Abdul from Rimin Gado local government area in Kano has been a polio vaccine supervisor since May 2014. Independent vaccine supervisors are selected from reputable partner civil society organizations, and Fatima is a member of the Muslim Women Association in Nigeria (FOMWAN).
FOMWAN is the umbrella body of all Muslim associations in Nigeria and has been in existence for over 40 years, with branches in 600 local government areas in Nigeria.
According to Fatima, convincing non-compliant households can be a challenge and can take up to an hour. To address this hurdle, some VCMs simply pour out the vaccines and mark the houses as fully vaccinated.
To ensure the integrity of the supervisors, they are assigned to different teams each day, sometimes even rotating between two teams in a single day. Despite the challenges of navigating unfamiliar areas, Fatima expresses her satisfaction at being involved in polio vaccination campaigns in Kano.
Aisha Ahmed, the Zonal Coordinator of FOMWAN in Northern Nigeria, explains that the organization has been actively engaged in polio eradication since 2012. In addition to providing vaccine supervisors, FOMWAN organizes door-to-door campaigns, community discussions, market campaigns, and even sponsors radio programs in northern states to increase awareness about the polio virus and the importance of vaccines. Aisha mentions that they also collaborate closely with the Ulama (Muslim Scholars) to dispel the misconception that the vaccine contains birth control elements.
As a VCM, Hadira is partnered with a village head who fulfills both traditional and religious leadership roles to address issues of vaccine non-compliance. In Kano, women must seek permission from their husbands and heed the opinions of traditional and religious leaders regarding the use of vaccines for their children. If non-compliance persists even after involvement from the village heads, the State Immunization Officer notifies the NPHCDA. Then, an officer is dispatched from the National Polio Emergency Operations Centre (EOC) in Abuja to collaborate with the traditional and religious leaders.
Initially, men were the primary polio workers. However, it quickly became evident that they were unable to reach children under the age of five because they were not permitted to enter homes according to cultural norms in Northern Nigeria. The involvement of women in polio eradication has proven to be the key solution to various challenges, including the widespread rejection of the oral polio vaccine, high levels of non-compliance, curbs child absenteeism during immunization campaigns, and a high rate of immunization dropouts. By going door-to-door, women are able to reach populations that were previously overlooked.
These women play a crucial role in tracking and resolving routine immunization dropouts, non-compliant families and defaulters as well as strengthening surveillance for Acute Flaccid Paralysis (AFP). Sa’adat affirms, “Without the critical participation of women as vaccinators, surveillance officers, and social mobilizers,
Nigeria would not have made such significant progress in the eradication of polio.”
Challenges
Misinformation is a big challenge here. “The notion that polio vaccines were contaminated was initially propagated by some Islamic preachers. These claims gained credibility when they were endorsed by the self-proclaimed Supreme Council for Shari’ah in Nigeria (SCSN), led by physician and one-time presidential aspirant Datti Ahmed,” says Dr. Ndeayo Lwot, the Coordinating Consultant for Development of Social Care Health Quality Assurance at the National Citizen Centre in Abuja, Nigeria, and former Director of Primary Healthcare Development Agency in Nigeria.
Despite their significant contributions to polio eradication in Nigeria, women hold only 25% of leadership positions in the health sector, which has impacted health efforts, including immunization.
In Nigeria, women face a ‘glass ceiling’ when it comes to reaching the most senior roles. While approximately one third of leadership positions in health organizations are held by women, the same cannot be said for national ministers or commissioners, where only 5 out of 30 are women, or for Directors of Federal Medical Centers, where only 1 out of 28 are women. This significant gender disparity in higher-level positions has resulted in poor treatment of women in polio vaccination.
To address gender barriers to immunization, the Global Polio Eradication Initiative (GPEI) launched its comprehensive Gender Equality Strategy in 2022. The strategy aims to address gender-related obstacles to immunization and improve the representation of women at all levels of the polio program.
This includes focusing on recruiting and training women for frontline eradication efforts, promoting a gender-responsive organizational culture, increasing ownership and accountability, ensuring a safe work environment, enhancing data collection and analysis, fostering partnerships, and allocating financial resources. The program seeks to involve women more actively while considering their specific needs and profiles, recognizing their crucial role in the delivery of polio vaccines.
#This reporting is supported by the United Nations Foundation Polio Press Fellowship.
