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Kano, Kaduna, Sanctuary

POLIO | Contents

Kano State

Kaduna State

POLIO | 1 Challenges, Actions and Outcomes discussed at the June IMB Report (1/4)

Challenges Reasons for Actions taken Responsible Timeline Outcomes challenges 1. Persistent • No felt need: •Formation of State •LGA 9 Oct ’12. •Proportion of pockets of 25% and LGA Rapid Chairmen missed children non- •No caregiver Response Teams to •LGA due to compliance consent: 16% address Technical noncompliance areas with 34% •Too many noncompliance Teams reduced to 26% missed SIAs rounds: 9% •Conduct of •Communit in Oct SIPDs children due Intensified Ward y leaders compared to to non- Communication •VCMs Jul (34%) round compliance in Strategies (Film show (Unicef) Jul ‘12 SIPDs , community •20% of WPV dialogues, compound infected LGAs meetings) had coverage •Use of Voluntary accepted with Community mobilisers >90% by LQAS (VCMs) to mobilise coverage caregivers in compared to households 0% in Jul SIPDs •Sensitization of 26,000 religious leaders during every round of IPDs POLIO | Challenges, Actions and Outcomes discussed at the June IMB Report (2/4)

Challenges Reasons for Actions taken Responsible Timeline Outcomes challenges

2. Poor micro •Non- •Intensive review of •Vaccination Sept 2012 •Workload planning in all involvement of micro plans in 21 VHR team rationalized for the 44 LGAs community LGAs supervisors all teams in the leaders in •Conduct of physical & 21 LGAs micro planning walkthrough with full Community •Non conduct support of TL in 21 leaders •630 New of physical LGAs supervised settlements verification of •Rationalization of by 3 levels of identified & Microplans. team workload supervisors included in •Poor maps •Conduct of cross from Zonal, micro-plan •Irrational border meetings State, LGA & vaccination •Verification & Partners team workload validation of all 21 LGA •No border micro plans meetings •Surge capacity •Not enough personnel for supervision

POLIO | Challenges, Actions and Outcomes discussed at the June IMB Report (3/4)

Challenges Reasons for Actions taken Responsible Timeline Outcome challenges 3. Weak •Lack of •Advocacy to •State TFI •9th Oct 2012 • Executive programme accountability deputy Governor •State & LGA Teams governor pledged to ownership in some •Poor appreciation and State task force reward and sanction LGAs of the current on accountability 3 best and 3 worst emergency status framework performing LGAs of polio eradication respectively •Poor •Executive governor oversight/monitor persuaded to meet •Conduct of State ing by State LGA chairmen twice Flag off by H. E. the authorities on accountability for Governor PEI •71% of LGA •Sensitization of Chairmen LGA chairmen on supervised PEI and regular implementation review meetings. • 80% of LGA •Daily monitoring of Chairmen chaired dash board evening review indicators (pre- and meetings intra-campaign)

POLIO | Challenges, Actions and Outcomes discussed at the June IMB Report (4/4)

Challenges Reasons for Actions taken Responsible Timeline Outcomes challenges 4. Under- •Lack of systematic •Provision of •Kano Emirate •14th Sept 2012 •80 % of District heads engagement of engagement of TLs guidelines on roles & Council /TFI supervised traditional leaders responsibilities, implementation accountability frame •93% of District heads work and supervisory attended evening checklist for review meetings traditional leaders

5. Poor Routine •No budget line for •Advocacy to LGA •State/LGA •On-going •79% of planned fixed immunization with routine leadership for routine Teams sessions implemented OPV3 & DPT3 immunization in the immunization support (Jan –Aug 2012) Coverage (Jan-Aug LGAs to support •>80% of tOPV & ‘12) of 33% and logistics (vaccine •Supportive DPT have been in stock 36% respectively distribution, supervision and since 2nd quarter of the supervision and application of abridged year outreach services) checklist •Frequent vaccine stock outs •On the job training of •Poor community personnel linkage •Inadequate trained •Regular feedback manpower meeting with LIOs

POLIO | Challenges, Actions, and Outcomes arising AFTER the IMB meeting (1/3)

Challenges Reasons for Actions taken Responsible Time frame Outcomes challenges

1. Poor quality •Poor planning •Early •Ward Focal 5th Oct 2012 •98% of training trainings at •No conducive preparations for persons, Team venues were ward levels training venues training supervisors and conducive •Overcrowded •Staggering of level 3 •95%of training training venues training sessions supervisors sessions had •Inadequate •Segregation of practical practical/demo participants demonstration nstration according to roles •97% of sessions •Emphasis on participants •Poor demonstration attended training monitoring of and field work training sessions •Surge capacity & use of checklists to monitor trainings

POLIO | Challenges, Actions, and Outcomes arising after the IMB meeting (2/3)

Challenges Reasons for Actions taken Responsible Time frame Outcomes challenges

2. Poor team •Not adhering to • Sensitization meeting •State TFI 9th Oct ‘12 During Oct SIPDs: performance selection criteria with LGA chairmen on •State Taem •Only 6% of missed (e.g. teams not the negative impact of •LGA Teams children were visiting •Politicization of politicization of team •LGA Chairmen unvaccinated due to households, not team selection / selection •Community households not reporting Weak/nonfunctio •Printing and distribution leaders visited by teams: noncompliance nal ward selection of team selection criteria •96% of supervised and revisit committees to all LGAs and wards teams reported households, poor •Ward selection noncompliance IPC skills and not •Poor quality committees reactivated in •92% % of asking key training all LGAs supervised teams questions in the •Printing and sharing of asked 5 key households) •No feedback to key questions to be asked questions community in households to leaders on the vaccinators performance of •Replacement of erring personnel ward focal persons (e.g. Gwale LGA) found •Weak supportive flouting selection criteria supervision •Training of vaccination teams on work ethics •Lack of accountability POLIO | Challenges, Actions, and Outcomes arising after the IMB meeting (3/3)

Challenges Reasons for challenges Actions taken Responsible Timeline Outcomes

3. Weak supportive •Weak ownership •State and LGA senior supervisors •State Team 9th Oct ‘12 •93% of supervised supervision briefed on supervision during SAIs •LGA Team teams were supervised •State and LGA senior prior to deployment by senior supervisors supervisors not trained on supervision •State and LGA senior supervisors provided with supervisory •Supervision without use of checklists checklists •LGA senior supervisors giving •No forum for feedback by State feedback during evening review senior supervisors meetings

•Advocacy to the State for a forum of feedback by State senior supervisors

•Surge capacity ensures adequate supervision 4. Surveillance gaps •Lack of logistics support for •Provision of 60 motorcycles to •WHO •77% of LGAs meeting identified during surveillance at State and LGA DSNOs •State Team •On going two key surveillance rapid levels indicators assessments/review •Inadequate number of reporting •Regular feedback meeting with • Annualized NP AFP s and supervisory sites and community informants DSNOs rate of 8.5 (Jan –Sep visits •Inadequate active case search 2012) and clinician sensitization •On the job clinician sensitization

POLIO | Next Steps…

The remaining 23 LGAs be taken up for revised HH based Microplan, LGA level trainings scheduled for 22nd Oct’12

Tally sheet analysis (TSA) new format explained to all cluster consultants & LGA Facilitators at the state level

Cluster level FV’s orientation is ongoing for TSA format understanding with a timeline to complete TSA by 23rd Oct’12

The 21 LGAs will review & update their Micro plans on the basis of TSA findings along with field validation as per requirement.

POLIO | Contents

Kano State Katsina State

Kaduna State

POLIO | 10 Summary of WPV cases, Katsina

WPV distribution, Kastina

▪ Intensive WPV1 outbreak in northern half of the State (40% in Katsina LGA) ▪ 60% had less than 4 doses ▪ 59% of WPVs are in villages (rural/semi rural) and 29% in urban slums ▪ 40% of the cases are children of farmers residing in villages ▪ Those in villages (mostly farmers) did not get the vaccine because their houses were not visited by teams ▪ Major reasons for refusals during SIAs were “No caregiver consent”, “No felt need” and “Reason not given”

POLIO | Characteristics of WPV cases, Katsina State – Sep 2012

Age Sex

1 2 4 4% 8% 16% 2 <12 mths 8% 12-23 mths 4 24-35 mths 16% 36-47 mths 48-59 mths 60+ 12 48%

OPV doses Location

POLIO | Major reasons for missed children

Non compliance : Reasons for NC: No felt need, Religious belief, No caregiver consent and Reason not given. ▪ Katsina LGA (38%), ▪ LGA (40%), ▪ (62%), ▪ Dutsinma (41%),

Household not visited/Failure of team to seek for all eligible children: ▪ Katsina LGA (40%), ▪ Danja (78%), ▪ (67%), ▪ (54%), ▪ Mani (63%), ▪ (80%), ▪ (50%), ▪ (50%), ▪ (49%) and ▪ Kankia (48%).

Source: Outside monitoring data, Oct IPD

POLIO | Challenges and actions taken – Katsina State

SN] Challenges Corrective actions Responsible Timeline Remarks Person

1. High percent missed children a)Involvement of Traditional State Task 4th Quarter More than 70% >10% due to Non Compliance and religious leaders: force / State 2012 of the NC and child absent. Emirate Council Committees team/SSMC resolved with 15 LGAs out of 34 (44%) on Polio eradication the recorded >10% of wards with constituted by the Emirs. intervention of more than 10% missed children Carried out sensitization of Traditional in 2/4 IPDs rounds between Trad. Leaders, RLs and Leaders. Feb and July 2012 (Katsina LGA Communities. Evening had 100% of wards with >10% Review Meetings held at MC in 3 consecutive rounds) District Head’s palace b) IWCS activities in high risk wards (Majigi film show , CDs, CMs, Sensitization meetings) c) Involvement of VCMs

2. Weak political commitment at Continuous advocacy, Chairman October/No Exemplary LGA LGA level Governor meeting with State Task vember 2012 leadership in - Only 12 out of 34 LGA LGA chairmen. Force , Chairmen (35%) chaired - High level advocacy (HCH, Ingawa and evening review meeting in Oct- HC MLG/CA ) conducted to Mai’adua has 12 SIPDs WPV infected LGAs led to - Meeting of the Emergency improved Committee headed by HE LQASPOLIO coverage | Deputy Governor with LGA >=90% (Oct-12 Chairmen of WPV infected IPDS) LGAs

Challenges and actions taken – Katsina State

SN Challenges Corrective actions Responsible Timeline/Dea Person (s) dline for implementati on

3. Micro planning issues/ Team Household-based Walk State and October/Nove performance through microplan LGA team mber 2012 66% of missed children in July /Training and due to Child absent and 11% selection sub due to HH not visited. commitees

12 of the 25 cases of WPV .Reactivation of ward (48%) are under vaccinated selection committees and (less than 3 doses of OPV). 7 strict adherence to selection (28%) of them are zero dose guidelines children. .Work load rationalisation, Training, Scaling up IPC skills .Concurrent monitoring

POLIO | Challenges and actions taken – Katsina State – Cont’d

SN Challenges Corrective actions Responsible Timeline/Deadline Person (s) for implementation

4. Poor program Mass multi media campaign SSMC/STATE TASK October/Novemb visibility FORCE er 2012

5. Supervision Training and deployment of State/ LGA teams 4th quarter of 2012 more supervisors

6. Insufficient Advocate at all levels for State/ LGA teams 4th quarter of 2012 motivation of increased motivation of teams. personnel

7. Low RI Promoting ownership of RI State/ LGA teams 4th quarter of 2012 performance services , REW & 123 strategy, Involvement of community leaders,

POLIO | Comparing LQAs July 2012 and LQAS Oct 2012 Results

July LQAS Oct LQAS

Kaita Mai'Adua

Katsina Daura Kaita Mashi Mai'Adua Zango Dutsi Mani Sandamu Katsina Jibia Daura Rimi Zango Dutsi Baure Batagarawa Mani Sandamu Kurfi Rimi Batsari Baure Ingawa Bindawa Kurfi Kankia Charanchi Ingawa Safana Dutsin Ma Kusada Kankia Safana Dutsin Ma Kusada Matazu Dan Musa Musawa Kankara Malumfashi

Faskari Kafur Kafur Bakori

Funtua Dandume Danja Funtua Dandume Danja Sabuwa

• ≤ 3 unvaccinated: LGAs accepted with >=90% Coverage • 4 to 8 unvaccinated: LGAs rejected >80% and <90% Coverage • 9 to 19 unvaccinated: LGAs rejected >60% and <80% Coverage • > 19 unvaccinated: LGAs rejected <60% Coverage

POLIO | Contents

Kano State Katsina State

Kaduna State

POLIO | 18 Details of Polio Cases, Kaduna, 2012

EPID No LGA, Ward Community Profile OPV Doses Planning gaps

BNG-001 , MG III Nomadic & H2R 1 dose M/c Plan , Team performance

BNG-002 Birnin Gwari, MG III Nomadic & H2R 0 Dose M/c Plan , Team performance

KAR-004 Ikara, Paki Urban, Non Compliance 0 Dose Team performance

BNG-006 Birnin Gwari, MG II Urban, Non Compliance 2 Doses No gaps

KAR-004 Ikara, Paki Urban, Non Compliance 0 Dose Team performance

KAR-006 Ikara, Rumi Rural,Nomadic, NC 2 Doses Team performance

KAR-007 Ikara, Sayasaya Rural, Non compliance 3 Doses M/c Plan , Team performance

ANC-003 Kubau, Karogi H2R Isolated 2 Doses Team performance

TRK-005 Igabi, Birnin Yero H2R Isolated 8 Doses Team performance

TRK-008 Igabi, Sabon Birnin Rural, H2R, Non compliance 2 Doses M/c Plan , Team performance

ZAR-002 , Tukur tukur Hausa, Urban slum, NC 4 Dose M/c Plan , Team performance

ZAR-003 Zaria, Tukur tukur Hausa, Urban slum, NC 2 Dose M/c Plan , Team performance

NKR-010 Makarfi, Gagara Rural, H2R, Non Compliance 2 Dose M/c Plan , Team performance

ZAR-005 Zaria, Kawarbaia Hausa, Urban slum, NC 0 Dose M/c Plan , Team performance

NB: M/c Plan: micro-plan, H2H: House to House , H2R: Hard to reachPOLIO | Compliance with June IMB Report

Challenge Activity to address challenge Responsible Timeline Data showing person for activity outcome

Inadequate 1. State TFI re-invigorated, with Deputy SMOH/SACI End of 2 State TFI meetings Program Governor directly in charge as Chairman, quarter 2 chaired ownership at with the full support of the Executive State & LGA Governor levels ( Only State TFI July 2012 100% LGAs released 52% LGA 2.Basket funding for the programme – Commissioner of funds 3 days prior to chairmen ensuring that LGAs contribute their quotas Health implementation & participated for program financing – especially for 100% LGA Chairmen at LGA purchase of add-ons (pluses) attended at least 2/4 Evening Advocacy to Ministry of Local Government Evening Review Review for Counterpart Funding for implementation Meetings Meetings, of Sept IPD Non release Office of the July 2012 11/13 reports submitted of Funds, 3. Progress reports on PEI now mandatory Executive at executive council Lack of at weekly State Executive Council meetings Governor meeting progress tracking at 4. State Task Force on Immunization has Office of the July 2012 Reward System State level) been expanded for greater impact Executive instituted by State to Governor the best performing LGAs by end of Oct Now all State Executive Council members and all LGA Chairmen are members POLIO | Activities addressing challenges

Challenge Activity to address challenge Responsible person Timeline for Data showing activity outcome

Excessive Team 1. Household-based microplanning and State technical team August 2012 11/23 LGAs with Work-load rationalization of team work-load in 11 High- H2H based micro risk LGAs plans, and 1916 State Team /NPHCDA From Sep 2012 new settlements Inadequate Chairman State TFI IPDs identified team compared to performance July IPD ( poor quality of data, lack of State Team Highest ever IPC skills) documentation of NC since PEI 2. Introduction on new (HH-based) teams tally inception sheet to improve data capturing & minimize recorded in Sept data falsification July –Dec 2012 IPDs (From 0.3% in July to 1% in Sep)

POLIO | Activities addressing challenges

Challenge Activity to address challenge Responsible person Timeline for Data showing activity outcome

Poor IPC skills 3. 3703 FAQs for H2H team printed and State & LGA teams distributed for improving IPC Oct-Dec 2012 State Report of meetings with members of WSC and line-list 4. Ward Team Selection committees constituted SACI of members in 23 LGAs with active support/Monitoring by October, 2012 state team in VHR LGAs

Inadequate Increased access to SACI/State August-Dec 2012 reporting of mobile/nomadi 5.Collaboration with National Commission for team/NCNE immunization in c populations Nomadic Education(NCNE) for line-listing all LGAs and and mapping of fulani settlements in 12/23 mapping of selected LGAs with high nomadic stock routes and populations grazing reserves

POLIO | Activities addressing challenges

S/no Challenge Activity to address challenge Responsible Timeline for Data showing person activity impact

4 Increasing Non- Scaling up of Intensified Ward State & LGAs Jul-Dec 2012 Drop in Sept IPD to Compliance “Strategy in High-Risk LGAs & wards. In Soc Mob 6% due to OPV (21.9% due to tandem with other activities targeted at Working Safety & 15% due to OPV Safety & improving team performance, it is Groups Religious Belief 19.7% due to expected that the necessity for multiple Religious Belief) “redos” & “revaccinations” will be reduced

5 Poor supervision Deployment of 100 Senior Supervisors SACI July to October 54% Teams were of teams by by the State 2012 supervised by Senior Senior Supervisors Supervisors in Sept IPD (<10%)

POLIO | Activities addressing challenges

S/ Challenge Activity to address challenge Responsible Timeline for activity Data showing no person impact

6. High Number of 1. REW Micro plan was conducted and SACI/LGA April 2010-Sept 2012 unimmunised finalized. technical Birnin Gwari (-379) Children from RI* 2. Plan document for 1 fixed session per team Zaria(244) Birnin week with 2 outreaches per month in 2 Makarfi(788) Gwari(2,319) Health facilities at wards with the highest Igabi (1,823) Zaria (3,637) unimmunized children. Ikara(-2,198) Makarfi(1,422) 3. On going compilation of profile of Kubau (88) Igabi (4,109) chairmen of VDC and WDC Ikara (1,783) 4. Planned State-wide meeting with Kubau (2,473) Chairmen of WDC . 5. A template has been developed by WHO * Data as on Sept to aid RI supervision by LIOs, WFP and FV 2012 6. The state technical supervisors (STFs) also double as the first level state RI supervisors, were instructed to integrate both IPDs and RI supervision by completing the abridged checklist and the pre- implementation checklist in their LGAs of posting, to compliment the one filled by Cluster Consultants.

POLIO | Emerging Results

POLIO | Improving trend in LQAs and OPV status of n-polio AFP cases Kano, Katsina, Jigawa and Kaduna States

Wild Polivirus cases, Kano, Jigawa, Katsina + Kaduna states

WPV and cVDPV cases October 2011 to September 2012

Environmental surveillance results, Kano sampling sites

LQAS survey results by SIA

Proportion of non-polio AFP cases 6-35 mo by OPV status

POLIO | POLIO |