eHealth Africa, Sokoto Govt Collaborate to Deliver Vaccine to Remote, Vulnerable Locations

by Moshood Isah

Easy access to the land borders  in  north-east and north-west zones, particularly Borno, Yobe, Sokoto, Zamfara, Katsina states has remained a key source of criminality and violent crimes in these parts of the country. As at 2022,  137 out of about 261 borders in the north-east and north-west regions of the country were unguarded as revealed by former chief of Army Staff, Lucky Irabor.

Sokoto State which  shares borders with the Niger Republic  has  battled varying degrees of insecurity relating to kidnapping, cattle rustling and banditry in recent years. Areas primarily affected include Isa, Sabon Birni, Gwadabawa, Illela, Tangaza, and Goronyo. They contribute to a total of  65  out of the  240 wards in the state. Beyond security challenges, hard to reach areas, unavailability of vaccines, unfavorable weather conditions and vaccine hesitancy due to religious beliefs largely  contributed to low immunization coverage rates in Nigeria and most inequitable in the world according to United States Agency for International Development (USAID). As of 2018, vaccination rates in Sokoto state were among the lowest in Nigeria, with only 3% of children receiving pentavalent vaccine by their first birthday as revealed by  National Bureau of Statistics and United Nations International Children Emergency Fund (UNICEF). 

In 2016, eHealth Africa was engaged by the State Ministry of Health  with support from Bill and Melinda Gates Foundation (BMGF) and Dangote group on the Vaccine Direct Delivery project to commence the delivery of vaccine and dry goods for immunization against vaccine preventable diseases in Kano, Bauchi, Zamfara and Sokoto State. The intervention most recently done  in Collaboration with Sokoto State Primary HealthCare Development Agency (SSPHCDA) devised strategic ways to deliver Antigens and dry goods to cold chain-equipped health facilities at ward-level and LGA cold stores at appropriate temperatures (between +2 to +8 Degree Centigrade). 

Using the Logistics Management Information System (LoMIS) ;a suite  of offline-capable mobile and web applications developed by eHealth Africa, they address  challenges with the supply/distribution of health commodities to last-mile health facilities. The LoMIS Suite  applications have been instrumental in providing critical solutions that ensure availability of health commodities, effective vaccine management. It also enables broader health system policy decisions through the use of real data for insight and decision-making and execution  at the community, LGA and  state l level. 

Stakeholders  in Sokoto state agree that the Vaccine Direct Delivery interventions have contributed to reducing the challenge of zero stock for vaccines as a result of  effective automated documentation of vaccines and its consumables while also limiting the use of papers to promote sustainability in both environment and the health sector.  In the words of Murtala Bello, the Director, Pharmaceutical Services, and Logistics Officer, Primary Health Care Development Agency, Sokoto State, “the use of digital solutions has improved  delivery, it has also improved availability of these vaccines.” This according to him has improved accessibility and increased immunization coverage in the State.

According to eHA project Manager, Mohammed Faosy, in the last 6 months (Jan-June), over 2 million vaccines have been delivered to average of 351 cold-chain equipped health facilities monthly, leading to the immunization of over 800,000 children against Vaccine preventable diseases in Sokoto State. This is an 18% increase in the number of children reported vaccinated in the state in the first half of  2022. He reiterated that, despite implementing the VDD project in a security-compromised location such as Sokoto state, the project’s performance in terms of delivery rate has been outstanding. 

Reaffirming this, a Health Delivery Officer, Umar Muhammed remarked that due to insecurity, vaccines could not be delivered  directly to about 5 health facilities in Sokoto state; Kiyara PHC, Damba PHC, Bauni PHC, Raka PHC, and Dangulbi PHC. He however revealed that the delivery team found a creative way to ensure these vaccines get to these high risk areas by liaising and collaborating with the Health facility in charge within those communities to get vaccines to their health facilities through close communications and stipend-based reward to ensure they have vaccines at their health facilities. He said, “we don’t just provide a stipend, we monitor and follow up until vaccines arrive at the facilities safely, deliveries were always 100% successful to the affected facilities”. 

Also, bad road conditions escalated by the rainy season also made delivery of vaccines to Fadarawa Health Post, and Rugga Kijjo Health Post to be carried out using motorcycles from the LGA cold store.  The Health Delivery Officer in the location Salihu Muhammed Hali said,  the team monitors the process until vaccines arrive at the facilities safely within the required temperature, deliveries were always 100% successful to the affected facilities. 

The team commended the effort of the Sokoto Ministry of Health and the Sokoto State Primary Healthcare Development Agency’s (SSPHCDA) commitment to reducing zero-dose children and ensuring that quality vaccines are available at ward-level cold-chain equipped health facilities in the 23 LGAs in Sokoto state.

ehealth Africa Commits to promoting early detection of Circulating Variant Poliovirus through Lab Support

by Moshood Isah

Nigeria may have been declared a polio free nation but the Circulating variant Poliovirus Type 2 strain transmission still lingers. Nigeria reported 168 cases in 2022. This  has made further interventions crucial particularly  around early detection. The growing cases in a  number of African countries require a focused effort to strengthen polio laboratories that can effectively help the affected countries to quickly confirm cVDPV2 cases and launch outbreak responses, including the introduction of novel OPV2.  

In 2018, the World Health Organisation (WHO) introduced a Global Polio Surveillance Action Plan (GPSAP 2018-2020) to support endemic, outbreak, and high-risk countries in evaluating and increasing the sensitivity of their surveillance systems against Polio. The plan also initiated supplemental strategies that may help in closing gaps in detecting polioviruses, including strategies for immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) while also strengthening coordination across surveillance field teams to foster a more effective programme and document zero cases worldwide. 

The new Global Polio Surveillance Action Plan (GPSAP) for 2022-2024. also focuses on increasing the speed of poliovirus detection, improving surveillance quality at the subnational level, fostering the integration of polio surveillance with surveillance for other epidemic-prone vaccine preventable diseases (VPDs), and mainstreaming gender equality in surveillance activities and programming as a key enabling factor.

To achieve parts of the Global Polio Surveillance Action Plan (GPSAP) 2022-2024, ehealth Africa worked with World Health Organisation (WHO)  supported by the Bill and Melinda Gates Foundation (BMGF) to  renovate and upgrade the   Sequencing Laboratory in the Virology department, University College Hospital (UCH) Ibadan, Oyo State. The laboratory was commissioned by Kazadi Walter, Country Representative and Head of Mission; World Health Organisation to Nigeria. This is part of the effort to improve surveillance, rapid detection and response against the spread of Vaccine Derived Polio Virus and other vaccine preventable diseases.  

Speaking during the official commissioning of the Laboratory, Dr. Kazadi Walter reiterated the commitment of WHO towards eradicating polio virus through the provision of facilities and rendering of technical support to Nigeria’s health care. He stated that WHO in collaboration with the government established the Global Polio Laboratory Network of which 16 are currently in Africa, with two located in Nigeria; Ibadan and Maiduguri. According to Walter, the primary objective is to work with WHO in the African Region (AFRO) to equip the global polio laboratory network labs for robust and rapid sample analysis for polio and to provide support in equipping these labs with sequencing capabilities.

Prof. Kayode Adebowale, the university vice chancellor, commended the initiative saying “this laboratory will not only provide vital information for the eradication of polio but also contribute to our university infrastructure, helping us to fulfill our vision and mission in addressing social needs.” The VC said: “The department has played a crucial role in Nigeria’s polio eradication programmes by contributing significantly to the country’s achievements of being declared wild polio-free in 2021.

Speaking on the role of eHealth Africa in the support for Laboratory Supplies across selected countries in Africa, the Project Manager, Tolulope Oginni said, to ensure optimum utility of the laboratory supplies, eHealth Africa leverages previous and current experience in setting up and managing Emergency Operation Centers to strengthen the staff capacity at the Laboratories in operating the installed equipment.

“These interventions  for  the support for laboratory supply and installation with consumables currently ongoing in at least 12 African countries are expected to improve the labs functionality for faster outbreak detection”, he said. With the support of other stakeholders in the region, this intervention will support labs in the African region that are targeted for expansion of sequencing capacity, support to improve existing sequencing capacity, or labs that require support for virus isolation and identification. This intervention has a huge opportunity to explore collaboration with WHO and other global stakeholders to transform the laboratory infrastructure in Africa into world class facilities which in turn will significantly strengthen their capacity and preparedness for disease outbreaks.