EndPolio: eHealth Africa Supports Cross-Border Vaccination Tracking 

#Endpolio: eHealth Africa Supports Cross-Border Vaccination Tracking
#Endpolio: eHealth Africa Supports Cross-Border Vaccination Tracking

Moshood Isah

The ongoing transmission of the poliovirus in the Lake Chad Basin, the Sahel, and throughout West Africa poses a significant obstacle to achieving global polio eradication targets. This challenge informed the development of a cross-border coordination plan by the Global Polio Eradication Initiative (GPEI).

Amid harsh climatic conditions and insecurity, at least 55 million people are facing or expected to face food and nutrition insecurity in 2024, according to the GPEI. With consistent displacement and migration across the region, the risk of importing and exporting poliovirus and other diseases increases. This situation underscores the need for effective collaboration among countries to eliminate the spread of the Circulating Variant Polio Virus 2 (cVPV2)  in the subregion.

As part of the Polio Outbreak Response Campaign (OBR4) for October, eHealth Africa joined other stakeholders in an international cross-border synchronization initiative in communities along the Kebbi State-Niger Republic border. Led by the Kebbi State Primary Healthcare Development Agency, the Bill and Melinda Gates Foundation, eHealth Africa and other polio eradication partners, this initiative is vital for immunizing eligible populations in these critical areas.

During a cross-border supervisory visit to the Daitegi Kanta community in Kamba Kamba Ward, Dandi Local Government Area of Kebbi State, eHealth Africa’s project manager, Comfort Audu, stated that the coordinated campaign aims to ensure that children in border regions receive vaccinations simultaneously. This approach will minimize the risk of unvaccinated populations and help control the spread of cVPV2. Comfort emphasized, “eHealth Africa is happy to provide technical support, especially in deploying innovative technology to improve vaccination reach.”

Dr. Samuel Okiro, a Senior Program Officer at the Bill and Melinda Gates Foundation (BMGF), highlighted the importance of simultaneous vaccinations for children residing across borders. He noted that the poliovirus knows no borders and that constant migration means the virus can easily cross from one country to another. “While we cannot prevent people from traveling between border towns, the cross-border synchronization campaign provides an opportunity to immunize eligible children before they continue their journey,” he explained.

Praising the commitment of immigration officials to the polio eradication initiative, Dr. Samuel remarked, “The immigration officers clearly understand the importance of polio immunization. It is commendable that there is a fixed immunization post with various antigens at the border, ensuring that eligible children crossing either side are vaccinated.”

However, Dr. Samuel lamented the lack of sufficient cold chain equipment needed to freeze ice packs and maintain vaccines at the proper temperature. “One of the challenges I observed is that the cold chain system is inadequate, especially at the Local Government Area level, where they are unable to freeze enough ice packs for the following day.”

He also pointed out that the poor condition of roads leading to these communities may impact negatively on the cross-border vaccination campaign. “Some of the roads are in poor condition. When it rains, our teams struggle to reach the immunization sites,” he said.

Finally, he emphasized the importance of Western education in enhancing community knowledge about polio vaccination and other public health interventions. While commending the existence of functional public schools in the communities, he advised that local authorities should address the issue of poor road access to these schools.

With at least 83 cases of circulating variant poliovirus reported in Areas of Intractable Transmission (AIT), plus two states which include Kebbi, Katsina, Zamfara, Sokoto   Kaduna, and Niger, States. Kebbi state government, through the  Polio Task Force Committee, led by Deputy Governor Umar Abubakar Tafida, has consistently reiterated its commitment to supporting initiatives that will drive the final push to end polio in the state and beyond.

As a vital partner in polio eradication efforts throughout Nigeria and Africa, eHealth Africa has significantly contributed to establishing Emergency Operation Centers and integrating technologies such as Geographic Information System, and Planfeld. These advancements enhance the planning and execution of polio vaccination programs.

World Polio Day: Uniting for the Final Push to End Polio

Engagement with Traditional Institution in Sokoto to lead fight against polio

Moshood Isah


October 24th each year commemorates World Polio Day. This commemoration isn’t just an opportunity to reflect on the journey towards the eradication of the disease but also to remind all stakeholders of the seemingly unending battle to eliminate what has been described as a crippling and life-threatening illness.

The European Region was declared polio-free in 2002 and has maintained this status every year since. While the African region was declared polio-free in 2020, the emergence of circulating Variant Poliovirus type 2 (cVPV2) continues to be an important area of focus. This means other low- and medium-income countries, including Nigeria, continue to play catch-up.

With over 70 cases reported across 46 local government areas (LGAs) in 14 states, Nigeria is currently witnessing intense transmission of cVPV2. This is largely due to issues surrounding vaccine hesitancy, which has led to low vaccination coverage. Similarly, misinformation and distrust about the potency and intentions of vaccination have significantly contributed to the low rate of herd immunity against the disease.

Another major barrier that developing and underdeveloped nations face is political instability and ongoing conflicts. This severely restricts access to vaccination campaigns, making it difficult to reach underserved communities and leaving them vulnerable. The challenges posed by health supply chains, sometimes exacerbated by insecurity and logistics gaps, have also consistently impacted the availability of polio vaccines for effective distribution, especially in hard-to-reach areas.

Given the potential devastating effects of polio—such as paralysis and psychosocial impact—along with the speed at which this disease can spread, the urgency needed to end this scourge remains critical. While the progress made is impressive, nearly eradicating polio is not good enough. Locations with incomplete vaccination coverage may experience outbreaks that can rapidly escalate into fresh public health emergencies.

Funke Ibikunke, the EHA Project field Officer Sokoto State updating the data derived by the House to house mobilizers on the tracking devices December 11, 2023.
The Sokoto North LGA review meeting Sokoto North LGA Secretariat December 11, 2023.
Focus Group discussion LGA Cold Chain officers on effective Vaccine delivery
Vaccine Direct Delivery (VDD) in Sokoto captures the essence of efficient vaccine distribution. VDD ensures the seamless transfer of vaccines and dry commodities from the state cold store to ward-level health facilities. This image highlights the precision and dedication of VDD’s logistics, emphasizing its critical role in enhancing healthcare delivery.
A Ward focal person ties a box containing the vaccines he has received for the day as he get ready to begin his day’s work Bodinga LGA, Sokoto 13 December, 2023
A Ward focal person picking up tracking devices from the project field officer as they begin their day’s work Bodinga LGA, Sokoto 13 December, 2023

The coordination of efforts by the Global Polio Eradication Initiative (GPEI) over the years has been critical to the global effort to eradicate polio, involving significant investments of financial and human resources. This further underscores the importance of strengthening existing collaborations at all levels to accelerate the end of polio in the African region.

For instance, eHealth Africa is  working with key partners, such as the Sultan Foundation for Peace and Development, to engage traditional and religious institutions in leading the polio vaccination drive. The intervention led by the Sultan of Sokoto himself, His Eminence Dr. Muhammad Sa’ad Abubakar III, has  built trust within communities across northern Nigeria to increase vaccine uptake. To a significant extent, religious leaders, traditional leaders, and village heads have been flagging off vaccination campaigns from their palaces and chambers, which has undoubtedly improved acceptance of vaccines, especially in rural communities.

The urgency of reaching rural communities has also prompted the deployment of digital innovations like Geospatial Tracking Systems (GTS) to track and identify missed settlements. These systems have helped increase vaccination coverage while providing data-driven insights for decision-making. This has improved the quality and accountability of campaign implementation by validating the reports generated by vaccination teams.

Similarly, digital innovations like Planfeld, recently piloted by eHealth Africa, have been instrumental in enhancing the accuracy of planning vaccination campaigns and reaching every settlement. The application provides information on the exact number of settlements being targeted, the number of children in those areas, and the amount of vaccine required for the activity.

Aside from the deployment of technology, social behavioral change interventions at all levels have been  another key approach in the journey to end polio. Irrespective of their roles, every step taken toward alleviating this disease is crucial. From international public health leaders to caregivers in the most remote locations, the influence of every stakeholder remains vital to the final push to end polio in Nigeria and the African continent.

Importantly, the emergence of other potential public health crises—such as cholera, monkeypox, hypertension, and diabetes—increases the urgency of ending the long-standing battle against polio. This will ensure that more global health funding is directed toward addressing other health issues, averting potential public health emergencies.

As we unite to push for a future without polio, this will be a testament to our collective resolve and humanity’s ability to unite for a common cause. We are indeed on the brink of history as we deliver the final blow to this disease once and for all.

Moshood Isah is a Communications Coordinator at eHealth Africa.

5 Reasons Digital Innovations are Crucial for the Final Push to end Polio in Nigeria

Judith Owoicho

It is August 2023, in a remote Nigerian village in Northern Nigeria. Children 5 years and below are on a queue waiting to be vaccinated against polio. At Least, 2,509,687 children have already benefited from the 18-day mass vaccination campaign to boost their immunity against Circulating Variant Poliovirus (cVPV2). (World Health Organization [WHO], 2023).

This raises an important question. If Nigeria was declared polio free in 2020, why do we still require polio vaccinations campaigns today? After years of collaborative efforts, significant progress was made in eliminating polio. However, the threat of circulating variant poliovirus (cVPV2) lingers, particularly in remote areas of Northern Nigeria. Efforts are being made to ensure that we see the end of this disease.

As Nigeria continues the journey towards finally eradicating polio, digital innovation has become a vital tool in ensuring the success of the country’s vaccination efforts. One of such innovative solutions is the integration of GIS tracking systems on eHealth Africa’s polio interventions. This revolutionary innovation has transformed how vaccination campaigns are planned, tracked, and executed. 

A Ward focal person ties a box containing the vaccines he has received for the day as he get ready to begin his day’s work Bodinga LGA, Sokoto 13 December, 2023
A Ward focal person picking up tracking devices from the project field officer as they begin their day’s work Bodinga LGA, Sokoto 13 December, 2023
A child receives a FIPV vaccine in Kofan Kade, Mallam Dani’ma Quranic school, Sokoto north LGA Sokoto State. December 10, 2023

Here are five key reasons why digital innovation is the game-changer in Nigeria’s final push to end polio.

1. Every community is reached with accuracy

The foremost challenge in eradicating polio in Nigeria has been reaching remote and conflict-ridden areas where vaccination coverage is inconsistent. With difficult terrains, and insecurity, It is often nearly impossible to ensure that no child is left behind. With eHealth Africa’s GIS technology, teams are able to track and locate settlements in hard-to-reach areas with geo-coordinates of over 70% of settlements that were previously unmapped. This level of precision has allowed vaccination teams to better plan and ensure that no community is overlooked, increasing vaccination coverage rates. In 2023, the geo-coverage rate of vaccination activities tracked rose to 89%, representing a 6% increase over the previous quarter. This data-driven approach has been instrumental in reaching more than 1.4 million children in tracked settlements across the country.

2. Vaccination Campaigns are Monitored Real-time

One useful aspect of digital technology is its ability to provide real-time data and feedback. Vaccination campaigns can now be tracked in real time, allowing for immediate course corrections if any gaps are identified. The GIS technology has made it possible to track vaccination teams as they move from one settlement to another, providing health authorities with the data they need to ensure that every planned area is covered. With this technology during the vaccination campaign in April 2023  12,791 settlements across 56 LGAs in Katsina, Niger, Sokoto, and Zamfara, were reached, achieving an impressive 81% of the planned coverage. This real-time accountability has ensured that vaccine wastage is minimized, resources are optimally allocated, and the campaign’s impact is maximized.

3. Tailored Trainings for Vaccination Teams

Digital innovation not only improves logistical planning and monitoring but also equips health workers with the necessary tools and knowledge to enhance their effectiveness. With the GIS Intervention, eHealth Africa trained 107 individuals across five states—Katsina, Zamfara, Kebbi, Niger, and Sokoto—to effectively use digital tools and geospatial data to improve their vaccination outreach. These training efforts have empowered local teams and equipped health workers with the knowledge needed to adjust strategies on the go, to achieve more successful campaign outcomes.

4. Enhanced Micro Planning for Campaigns

Polio eradication requires meticulous planning, especially in regions where settlements are small, scattered, and often unmapped. Digital health tools have drastically improved micro planning by providing vaccination teams with up-to-date settlement data and templates to develop detailed vaccination plans. The Master List of Settlements (MLoS), regularly updated through digital tracking, serves as a comprehensive guide for teams in the field. This detailed approach has proven instrumental in increasing vaccination coverage in previously underserved areas, as seen in the 89% overall coverage rate achieved during the 2023 campaign, which targeted 4,861 settlements.

5. An Expandable Model for other Public Health Campaigns

The success of eHealth Africa’s GIS technology in Nigeria is proof that digital innovations  can effectively address a wide range of other public health challenges. The systems, data infrastructure, and training models developed for polio eradication are not only efficient but also highly adaptable and can be applied to combat other diseases and public health emergencies.

The successful deployment of GIS technology by eHealth Africa in Nigeria is evidence that digital innovations can help in the solution of many other public health problems. The systems, data infrastructure, and training models developed for the polio eradication program are not only effective but also flexible enough to be used for other diseases and public health threats.

Through continued investment in these technologies, Nigeria is not only positioned to become polio-free but also to build a more robust and resilient healthcare system that will benefit generations to come.

How Planfeld Can Eradicate Perennial Vaccination Campaign Challenges – Primary Healthcare Workers

By Moshood Isah

Primary Healthcare workers during Planfeld workshop in Zamfara

Vaccination campaigns, especially in Nigeria, are a Herculean task, particularly when navigating complex and hard-to-reach terrains. From the planning stage, where primary healthcare workers identify households and calculate target populations for vaccination, the challenges are immense.

Khadija Ibrahim, a Ward Focal Person from Bagama A in Suleja Local Government Area (LGA), often braves rain and harsh weather conditions while moving from one community to another to identify households and target populations for vaccination. According to Khadija, although community leaders play crucial roles in identifying target populations, some gatekeepers can be reluctant due to a lack of incentives.

While community leaders need to support public health campaigns, Khadija lamented that “sometimes, your community leader does not want to accompany you, and you cannot enter without them.” This sometimes leads to inaccurate information and, in many cases, missed settlements during the vaccination campaign, which affects the spread of the Circulating Variant of Poliovirus and other vaccine-preventable diseases.

Due to the challenging terrain in rural areas, Ward Focal Persons often rely on motorcycles for transportation. “There was a year when I had an accident and dislocated my left wrist while distributing vaccines as early as 6 a.m.,” Khadija recalled. Given that all documentation for planning and implementing public health campaigns is done manually on paper, these documents are vulnerable to destruction by rain, accidents, or human errors.

“This manual method is difficult because sometimes you may go to a community and find that the number of children is not as high as the numbers given to us,” Abdullahi Muhammad, another Ward Focal Person, said. This affects reporting and vaccine management.

Muhammad supervises 14 vaccination teams, each visiting over 100 households for daily immunization rounds. He noted that “because the profiles of the settlements are captured manually, it’s difficult to understand the accessibility of these settlements, whether they are rural, urban, nomadic, or scattered.” These complications also impact the identification of starting points, midpoints, and endpoints during implementation.

The challenges in developing an effective microplan sometimes lead to the postponement of vaccination campaigns. Thus, the introduction of Planfeld—designed to enhance the planning of vaccination campaigns and ensure every child has access to the polio vaccine and other routine immunization services—comes at an opportune time.

Muhammad is among the first healthcare workers to express excitement about the Planfeld pilot. “Planfeld saves time; rather than spending four to five days developing a microplan, we can achieve it in just a few minutes,” he said.

Echoing this sentiment, Usman Abubakar, the Niger State Immunization Officer (SIO), remarked that the Planfeld pilot workshop is timely. He noted that digitizing micro plans will significantly address the issue of resource allocation, which he considers one of the most challenging tasks in his 20 years in the health sector.

Having spent nearly two decades leading and supporting vaccination campaigns across the state, Khadija, Umar, Usman, and other unsung heroes of public health interventions share one common aspiration.

eHealth Africa is dedicated to advancing digital health innovations through a user-centered approach, aiming to meet the needs and aspirations of underserved communities.

5 Lessons from the Planfeld Pilot Workshop Across Six States in Nigeria

By Moshood Isah

eHealth Africa team, partners and Stakeholders from the Kaduna State Primary Healthcare

Between August and September 2024, eHealth Africa’s Disease Prevention and Monitoring team conducted a comprehensive pilot workshop for its innovative digital solution, Planfeld. The tool is designed to enhance the planning of vaccination campaigns and ensure that every child has access to the polio vaccine and other routine immunization services. During the workshop, held in Kaduna, Niger, Katsina, Zamfara, Sokoto, and Kebbi States, eHealth Africa exposed over 350 primary healthcare workers, partners, and stakeholders to the efficacy of Planfeld in planning vaccination campaigns with greater speed and accuracy.

The impactful workshop, funded by the Gates Foundation, provided stakeholders with the opportunity to give insightful feedback during the tool’s demonstration. Here are some key lessons learned:

1. Time Management: Reducing Vaccination Plan Development from 5 Days to 10 Minutes

In all six states where Planfeld was piloted, Ward Focal Persons managing vaccination campaigns reported that developing a micro plan typically took between three to five days. This process involved manually collecting data from communities and engaging with local gatekeepers to identify target households and populations (children aged 0-59 months). However, with Planfeld, an updated Master List of Settlements, and input from primary healthcare providers, a near-accurate micro plan could be generated in just five minutes. Umar Muhammed, a Ward Focal Person in Niger State, noted, “If Planfeld works perfectly, it will solve all our challenges, as it can generate micro plans within a few minutes.”

Similarly, Victor Obagunlu from Solina, who attended the workshop in Kaduna State, said, “Planfeld is beneficial because it significantly reduces the time and energy spent on developing micro plans.”

2. Effective Resource Management and Allocation for Vaccination Campaigns

The workshop highlighted that with an accurate Master List of Settlements (MLoS) uploaded into Planfeld, the right number of vaccination teams can be effectively assigned to households. According to Friday Daniel, eHealth Africa’s Associate Manager supporting this intervention, “Accurately assigning vaccination teams to the right number of settlements will reduce undue burden and ensure every household is reached within the vaccination period.” Like many digital innovations, Planfeld relies on data for better decision-making, ensuring both financial and human resources are effectively utilized.

3. State Primary Healthcare Leaders Are Open to New Innovations

Dr. Larai Aliyu Tambuwal, Executive Secretary of the Sokoto State Primary Healthcare Development Agency (NPHCDA), summarized the views of other agency leaders by stating, “The integration of digital innovation in primary healthcare services will significantly improve precision in delivering vaccines to every settlement, ensuring comprehensive coverage.”

Key stakeholders at the state level were generally receptive to digitizing the microplanning process to enhance its quality. Mustapha Aliyu Alinkilo, Director of Disease Prevention and Control in Zamfara State, commented, “Technology will enhance the quality of microplanning in the state, and deploying the monitoring aspect of Planfeld will ensure a near-perfect vaccination campaign.”

4. User-Centric Approach Is Key to Success of Digital Innovations

To ensure an effective transition from manual to digital microplanning, eHealth Africa’s Program Manager Abubakar Shehu emphasized the importance of involving all relevant parties during the planning phase. “We brought in key players in the generation of micro plans at the state level, led by the Incident Manager and the State Immunization Officer for both Polio and routine immunization,” Abubakar said. Key partners, including the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), African Field Epidemiology Network (AFENET), and SOLINA, participated in the pilot workshop.

A crucial lesson learned from the Planfeld demonstrations is that understanding and prioritizing the needs, preferences, and behaviors of users is essential when developing digital innovations. Feedback from over 350 prospective end-users has highlighted areas for optimization to ensure that the Planfeld application resonates with its target audience.

5. Opportunity for Optimization of Planfeld

As with any digital solution, Planfeld has room for optimization. After the workshop in Niger State, the State Immunization Officer (SIO) Usman Abubakar Kpantu suggested that Planfeld be optimized to include the allocation of accurate resources and commodities, especially vaccines, to various settlements. Abubakar recommended, “Micro plan structures should accommodate advocacy, communication, and social mobilization tools to promote ownership of vaccination campaigns across communities.”

Other stakeholders advised that Planfeld should identify the exact number of households and children a vaccination team should expect to cover during daily activities. This, they believe, will further enhance planning accuracy and ensure that no child is left unvaccinated.

Overall, as agreed by all stakeholders during the Planfeld pilot workshop across the six states, an accurate Master List of Settlements is crucial for developing effective micro plans. An accurate micro plan remains vital for reaching every household and target population with the appropriate vaccines. Therefore, primary healthcare providers and community gatekeepers play essential roles in collecting and disseminating accurate information. This will help ensure that technical partners like eHealth Africa use the right information to support vaccination campaigns, as efforts continue to eliminate the Circulating Variant Poliovirus and other vaccine-preventable diseases.

In Nigeria, eHealth Africa Optimizes Systems for Seamless Vaccination Data Collection and Retrieval

By Emmanuel Uko

Building and optimizing software applications to improve public health outcomes is at the core of  eHealth Africa’s work. With the Electronic Management of Immunization Data (EMID) application, the organization went beyond optimizing the app to redesigning a new process flow for vaccination data capture. The redesign of an optimized process flow was necessary as research shows that inadequate health data is a challenge in Nigeria due to unintentional duplication, lack of synchronization and dearth of data storage systems.

The quality of data collection tools and the uncoordinated nature of the collection process compounded the data challenges, thus the need for a redesigned data collection process flow. eHA’s Technical Project Manager, Software Engineering, Dayo Akinleye said, “The redesigned process flow was necessary because the new process eliminates the possibility of duplicate records for offline users; utilizes the current quick response (QR) code for easy identification and seamless operation; and eliminates redundant information generated on the Public Registration portal (PubReg). The old process flow used the KoboCollect platform, so it did not have these capabilities. It was also unable to synchronize with the District Health Information Software (DHIS2).”

Former process flow with the old EMID application
Image: eHA
New process flow with the native (optimized) EMID application
Image: eHA

Both process flows allow users to register via the PubReg portal and receive registration ID before visiting the vaccination center to receive the vaccine. At the vaccination site, both processes allow for manual registration of clients into the EMID physical register, and receive a vaccination card with QR code.

eHA’s EMID Project Manager, Stephanie Okpere (right), during a Strategy Group meeting at NPHCDA Headquarters, Abuja.
Photo Credit: eHA

Tope Falodun,  eHA’s Associate Project Manager on the EMID project, affirmed that “the new process departs from the old as it allows for instant validation of clients once registered. Upon successful validation, the optimized EMID system generates a vaccination ID for clients that register at the physical site. For those who register via PubReg, their registration ID is replaced with the vaccination ID, eliminating duplicates, unlike the old system. The new vaccination ID is generated from the QR code for both online and offline clients to avoid duplicate registration. If the registration on the optimized (native) app is unsuccessful, the error message redirects the user to the specific item that needs to be updated or corrected. After correcting the error message the recorder saves the information to complete the registration and validation process.”

EMID Recorder for Isale-Agbara PHC, Egunsola Ayobami (middle), at the pre-deployment training of the native (optimized) EMID application in Osogbo, Osun State
Photo Credit: eHA

End users have found the new process flow more responsive than the old one, and better fit for purpose. As the EMID Recorder at Isale-Agbara Primary Healthcare Centre in Osogbo, Osun State, Egunsola Ayobami, confirmed, “one of the important variations from the old system is the ability to validate a client instantly, making the work easier and faster. It is also easier to use. When in doubt, I now know how to contact helpdesk, and their responses are instant,” he concluded.

Deployment of the native EMID application across Nigeria, with its optimized process flow, guarantees seamless data capture, storage and real-time retrieval. 

eHA’s areas of  expertise are data management, project logistics, infrastructure and ICT services, working in the following focus areas: health delivery, public health emergency management, disease surveillance, laboratory and diagnostics, and nutrition and food security.