PAS coalition across the states of Lagos, Kano, Niger and Kaduna continued to participate and support the activities of the states’ routine immunization committees with a view to improve RI services in the states.

In Kaduna State, PAS-CSO – the National Association of Nigeria Nurses and Midwives (NANNM-PAS) attended more than 17 SERICC meetings for the quarter under review. Some of the issues discussed and contributions include;

• MEWG reported that the number of under-5 children treated with Amoxicillin DT for pneumonia in June 2020 PHC Services Report, was not gotten from the NHIS dashboard, so was removed.

• There was a decline in RI activities in 4 best performance LGAs from 2 to 4. It was recommended that Desk Officers of affected LGAs should find out the factor(s) responsible and report back.

• An update was provided by M&EWG on the decline in reporting by LGAs, only 13 out of 23 LGAs (56.5%) conducted 100% of planned fixed RI sessions. Jaba and Soba LGAs still have data quality issues.

Data Validation Findings in Low Performance LGAs – Recommendations

• It was recommended that MEWG should communicate with LGAs to update and resend the template.

• With regards to Q3 No Objection Approval, Programme Officers should study and make clarifications where necessary bearing in mind that some RI activities were integrated with other PHC services. The TWG should meet and bring up activities they want to carry out for review and approval by Partners. Clarification should be given that based on RI Integration with other services.

• Issues arising from the LGA data validation exercise should be presented according to the various interventions by the Zonal Coordinators.

• Zonal Co-coordinator should meet with DPM3 to develop a better validation tool for use.

• AOB: NANNM-PAS enquired if the budget line of IMCI, specifically CKD (Zinc Lo-ORS and Amoxicillin DT can be included in the health budget for 2021 in the integrated PHC services for pneumonia and diarrhoea. It was explained that it is usually captured under procurement of commodities and budget line is not captured directly under KADSPHCB, but rather KADHSMA. A meeting with Supply Chain Agency was suggested as they deal with procurement of commodities.

Update from M&EWG Meeting

• The approved/conditional activities in the 2020 Q3 no objection approved workplan were discussed. All TWGs should look through the no objection so they can start implementing their activities that have been approved.

• With regards to the reporting tool for the monthly LGA data validation exercise, the Zonal Co-coordinators were asked to work on the tool in time for the next validation exercise.

Update from CEWG

• Training of the newly appointed EHOs will be integrated alongside other training activities.

• WK 34 feedback was shared which showed that 859 out of 1,191 HFs were captured, data quality issues were identified in 18 out of 23 LGAs, and I75 HFs experienced high stock out.

Recommendations

The following recommendations were made; (1) LGAs should identify and act on HFs with issues; (2) LERICC weekly report should be shared with SERICC on Mondays; (3) OIRIS supervision visits should focus more on HFs with zero level reporting; (4) Update SERICC report and time sheet; (5) Compilation & validating of reports; and (6) Planning meeting for September activities

Local Emergency Routine Immunization Coordination Centre (LERICC)

ZARIA LGA, KADUNA STATE

In Zaria LGA, Kaduna State, PAS-CSO – MAFAHSU/PAS attended 3 LERICC meetings for the month of August 2020. Some of the issues discussed and contributions include;

• Five Private Health facilities submitted their monthly data report to the LGA. While Five Private Health facilities are yet to submit their reports, which include: Zaria Clinic at Tudun Wada, MSH TukurTukur Ward, Jamaat Hospital at Kwarbai B and AD at Wuciciri and also Aminchi at Dambo Ward.

• Some HFs conduct only one session per week.

• Some improvement in completeness of SMS report was observed in week 30 compared to week 29, but still some HFs did not send their complete report.

• Suboptimal utilization of General Facility Attendance Register and GMP register was observed in HC Rubuchi and HC Sayentunkara. It was also observed that personal/patients record cards are not available in HC Rubuchi, HC KafinMardanni and SayenTunkara.

• Some newly posted RI providers with knowledge gap on how to conduct shake test, MDVP and six key messages were identified.

• ICH Banzazzau and Himma City Hospital have not submitted the monthly report within the stipulated time.

• Irregular rotation of health facility staff was observed, and that private health facilities are not invited for trainings.

Recommendations

• MAFAHSU/PAS recommended that Supervisors are to ensure all the necessary data tools are utilized and validated during supportive supervision.

• WFPs should conduct a regular supervision to Private facilities to collect their data.

• MAFAHSU/PAS suggested that RI providers should report only outreach session that were approved officially by KSPHCDA. Also, HFs that do not conduct daily session should conduct more than one session considering their target population.

• MAFAHSU/PAS suggested that LGA team and WFPs are to intensify regular supportive supervision to HCs.

• MAFAHSU/PAS recommended that WFPs and Facility in-charges should identity the possible means of providing patients/clients with cards before they are supplied by government or partners.

MAFAHSU/PAS suggested that in-charges/WFPs should plan for rotation of the staff into various units within their health facilities.

KANO STATE

In Kano State, the state’s Emergency Routine Immunization Coordination Centre (SERICC) conducted series of virtual meetings via zoom during the reporting period of August 2020. PAS-CSOs – Medical Women Association of Nigeria (MWAN-PAS), and Women in Media Communication Initiative (WIM -PAS) participated in 11 and 13 SERICC meetings respectively during this reporting period. Some of the key issues discussed and contributions for the month include;

Introduction of Immunization Academy

This new intervention was introduced by CHAI with the support from BMGF. The project was presented to the Ministry of Health and permission for carrying out the project was given. The objective for the new intervention is to bridge the huge gap in the capacity of health workers which sometimes led to poor performance in some health facilities. The academy will use E-learning approach – it will be more interactive, cost effective and can be assessed from anywhere and anytime by the frontline health workers. The platform has a lot of videos on different immunization topics via English Language. The process of translating the topics into Hausa for easy understanding is underway.

Vaccine Utilization at Dawakin Tofa Zone

During the RISS visit to Dawakin Tofa zone, irregularities was observed in the information on the fridge tag chart reading that requires SERICC’s quick intervention. SERICC tasked the logistics working group to check quality of the vaccine at the zonal store, and to find out how funds disbursed to zone was utilized. SERICC will make a follow-up visit to Dawakin Tofa Zone and meet with zonal team about the issues observed.

Training of 8 Newly Appointed PHCCs

The SPHCMB has approved the appointment of 8 new Primary Healthcare Coordinators (PHCCs). Their appointment letters and terms of reference were issued to them, and computer systems to aide their work. A five-day training was scheduled to build their capacity for their new assignment. The state has approved the training of the 8 newly appointed PHC coordinators in the state with provision of TOR and working tools, as well as training of 60 health facilities on a monthly basis for September, October, November and December.

July 2020 Zonal RI Review Meeting

The objective of the meeting was to review progress of RI activities in the month of July 2020. All planned LERICC meetings were conducted. There was high number of Mai Unguwas that are not attending reconciliation in Kumbotso LGA, Gwale Zone. Rimin Gado LGA did not complete the planned outreach sessions in Dawakin Tofa Zone. High wastage rate was experienced for BCG and Measles in Rano Zone. Low performance in defaulter tracking was observed in Nassarawa Zone with the exception of Minjibir LGA. High Penta 3 dropout rate of 14.8% was observed in Albasu LGA, Wudil Zone

Some of the actions taken to mitigate the issues are: –

• Conduct advocacy to the District Head for buttressing of the need for Mai Unguwas to attend Reconciliation in Kumbotso LGA

• Rimin Gado LGA should ensure the conduct of all planned sessions and return funds for unconducted sessions

• M&E officers should address service providers on how to reduce wastage rate

• LGA CEFPs in Nassarwa zone should be more proactive and use available community resource persons to track defaulters

• SSPO should identify affected health facilities and conduct RISS to address the issue

SERICC State Supervisors List

All SERICC members were reassigned to various LGAs for monitoring of all routine immunization activities and report back to SERICC when need arises. WIM-PAS was assigned to monitor Madobi and Dala LGAs. Each state supervisor was provided with an introductory letter approved by the PM-SERICC.

Planning Meeting on Borno State Team Visit to Kano

A planning meeting was held by the Kano SERICC team in preparation for Borno SERICC team visit to Kano for a learning tour on missed opportunity for vaccination. A comprehensive 4-day learning exchange schedule for the Borno SERICC team was organized. Borno State studied Kano’s missed opportunity strategy across secondary, tertiary and high-volume primary health care facilities. The learning exchange visit was also be an opportunity for Borno SERICC team to understand MOV in Kano State. A Committee was formed to oversee the visit. One of the recommendations given by the Borno State team during the learning tour, was extension of more health facilities inclusion on missed opportunity for vaccination.

National PHC Performance Monitoring, June 2020

PHC performance in Nigeria for June 2020 was reviewed using the DHIS2 report. The review measured the performance of PHC implementation and serve as feedback to the national and sub-national levels. The projected census and operational targets were used to calculate RI coverage. All reports submitted on the DHIS2 platform and entered at the LGA level were summarized. The completeness Of RI datasets was examined for June 2020. Only Bayelsa State in phase one NERICC supported states and Imo state in phase two NERICC supported states had completeness rate below 50% in at least one of the datasets. There were improvements at the National level in all selected antigen coverage rates in June 2020 compared to the previous months under review. Bauchi, Bayelsa, Gombe, Kaduna, Kogi, Sokoto and Taraba in Phase one NERICC states reported <50% coverage rates in at least one selected antigen. Anambra, Benue, Cross river, Enugu, Lagos and Osun in Phase two NERICC states reported coverage rates below 50% in at least one of the selected antigens.

DHIS2 and SMS data analysis – Kano State

Impact of COVID-19 on PHC service delivery, Vaccination trend analysis, and Analysis on conduct of daily fixed sessions in secondary and tertiary facilities were examined using DHIS2. There was a notable decrease in number of HFs offering essential PHC services since March 2020. There is an evident decline in the number of health facilities offering essential services between March and April which could be due to the Covid-19 pandemic and the resultant restrictions. Further analysis will be conducted to determine the extent of the disruption of services. Across the LGAs, there was a decrease in the proportion of health facilities delivering essential PHC services in April 2020. Preliminary causes of decline in PHC services include: Complete/partial closure of some facilities; Delayed and/or non-conduct of services due to unavailability of health workers as a result of limited availability of commercial vehicles during lockdown; Lack of testing kits for PMTCT services; and Data reporting error from some facilities and LGA M&E officers. The data obtained from DHIS2 will be further validated by the reports from the state DFR and detailed information from the state M&E officer. Similarly, there was significant reduction in the uptake of all essential services from April 2020. Further increase in the number of cases in Kano State may lead to continued decline in the demand for PHC services. Total lockdown was imposed on the state by the federal government at the end of April, 2020

Kano state will have to increase public sensitization on the safety of accessing healthcare at facilities (not designated as COVID-19 isolation centres) to increase the demand for services. The team will continue to closely monitor the effect of the lockdown (May included) on PHC services and advise the state accordingly. Administrative data revealed a decline in vaccine doses given in Kano from April 2020. A breakdown of the data by weeks showed a relationship between dips in session conduct and its effect on vaccinations doses given.

The high percentage of planned sessions conducted (639%) in the first week of the year was due to error in reporting. The state organized a training for responsible officers to curb this, leading to a decline in error reporting in the state. The decline observed in week 17 and 18 could be due to the total lockdown imposed in Kano State on April 28, 2020, making it difficult for caregivers and HCW to access care at the health facilities. Health workers and caregivers currently face difficulties in accessing facilities due to transportation restrictions and restrictions from security operatives stationed on the roads. Service deliveries at some private facilities have also been interrupted. As such, many private health facilities are either closed or have limited operations. A breakdown by weeks shows that number of secondary and tertiary HFs that submit complete weekly report varies.

Recommendation

SERICC through its M&EWG will track implementation of the SMS report feedback it provides weekly to the LGAs and defaulting HFs.

JULY 2020 ZONAL RI REVIEW MEETING REPORT

The RI performance was assessed across the zones for the month of July 2020.

DAWAKIN TOFA

RMG LGA did not complete the planned outreach sessions. High number of defaulters /left outs was reported in DTF and Makoda LGAs. The Issue of non-functional cold chain equipment in LGA Cold Store was observed. RMG should ensure that all planned sessions are conducted, and refund the fund for unconducted sessions. Community dialogue should be organized to ensure all defaulters / left out are tracked and immunized. Zonal CCO should report the issue of non-functional cold chain equipment to State Logistics Officer.

RANO

Poor vaccine utilization and reporting were observed in this zone. Some sessions were not conducted. High wastage rates for BCG and Measles were also reported. There is a need to mentor RISP and RIFP of LGAs on the proper filling of VM1a and VM1b. Responsible officers should ensure that all RI sessions were conducted. LGAs should be addressed on how to minimize the wastages.

NASSARAWA

Over-reporting of fixed and outreach sessions was observed in 3 LGAs: Gezawa, Warawa and Nasarawa. KMC LGA achieved only 38% in TD coverage despite large number of ANC attendance in MMSH. There was low performance in defaulter tracking across the LGAs, only Minjibir LGA achieved above 80% in defaulter tracking. LGA team should ensure accurate data entry and review the dashboard 24 hours after data entry for correction. KMC LGA team should find out the root cause of low TD coverage particularly in MMSH. LGA CEFPs in the zone should be more proactive and use available community resource persons to track defaulters.

WUDIL

There are discrepancies in administered antigens data in ABS, GRK and SML LGAs. High Penta3 dropout rate of 14.8% was observed in Albasu LGA. Data harmonization meeting should be conducted to address the issues. There is a need to identify the HFs affected, conduct OJT and RISS to address the issues.

GWALE

High Penta3 Dropout was observed in Tarauni LGA, and the lowest immunization coverage in all antigens. High number of Mai’unguwas did not attend reconciliation meeting in Kumbotso LGA. Only Kura LGA achieved the National target coverage in Measles. There is a need to intensify SM and Community Linkage Activities. LGA team should develop mitigation plan to improve defaulter tracking and forward to Zonal Office. Advocacy to District head for reinforcement of Mai’unguwas on attending reconciliation meetings should be carried out. This issue should discuss during LERICC meetings and report back to Zone.

LAGOS STATE

In Lagos state, the RITWG (Lagos State SERICC) held only one meeting in August 2020, due to the state-wide training of healthcare workers on Covid-19 by NPHCDA for Lagos State. PAS-CSO – Alumni Association of the National Institute (AANI) attended the meeting and made and contributions.

During the meeting, AANI-PAS suggested that the State should come up with a plan to mop-up the unimmunised gap due to the effect of the pandemic as a strategy on mitigating the impact of Covid-19 on the RI program. This was well received and was communicated at the National level. There is an ongoing planning (not yet official) for affected states to do so across selected poor performing LGAs.

New challenges identified includes under-reporting of AEFI despite improved indices. The SIO promised to re-engage the stakeholders to ensure reporting. There was also the issue of unimpressive data reporting on the uptake of Measles vaccine especially MCV2, implying that after 6 months, caregivers are not as committed to their wards’ immunisation completion.

The State’s RITWG continues to carry out activities in line with the year’s work plan. The 2020 CIP will be reviewed again at the end of Quarter 3, 2020. The State RI department is still awaiting the release of funds. Thanks to the support from SOML, more planned RI outreach sessions were conducted. UNICEF supported demand generation activities across the State such as Stakeholders (including traditional and religious leaders) engagement meeting in all 20 LGAs, sensitisation across all wards, encouragement of the utilisation of RI and other PHC services at the PHCs, and promotion of vaccination especially MCV2. WHO is supporting LGAs to conduct outreach sessions, e.g. Alimosho LGA. With more ease on movement by the Lagos State Government, more improvement in the RI activities outcomes are expected.

Overall, there has been an improvement in the state RI program. Data shows that July records the highest immunisation coverage record in the last 4 months and as well as the lowest drop-out rate in the last 4 months. Even data disparity was at 2% reflecting the effect of data harmonisation efforts.

NIGER STATE

In Niger State, the State Emergency Routine Immunization Coordination Centre (SERICC) resumed the conducted of virtual meetings using zoom during the reporting period of August 2020. PAS-CSO – Centre for Communication and Reproductive Health Services (CCRHS-PAS) participated in the 2 SERICC meetings held during this reporting period. Some of the key issues discussed and contributions for the month include;

SERICC/LERRICC Expanded Zoom Meeting

The Feedback on the situation of consistent stock out of Penta vaccine in the state was discussed. Also, the NERICC meeting held on the 5th August, 2020 with Niger State having the lowest reporting rate was discussed.

Some challenges were observed during the review of NERICC meeting; stock out of vaccines during the conduct of sessions in some HFs, high measles and BCG wastages rates, poor conduct of supportive supervision, and decline in the conduct of both fixed and outreach sessions in the state. NERICC recommended that state desk officers should follow up with their respective states and provide feedback to NERICC.

Niger PAS requested that SRIO and PM SERICC should deep dive on the stock-out issue. A brief summary of why stock out and the need for continuous flagging to the national for re- stocking of Penta vaccine was discussed.

LGA Monthly RI Review Meeting

The trend of reporting rate for RI dataset from April to June, 2020 across the 25 LGAs in Niger State were reviewed. Katcha, Magama, Mokwa, Paikoro, Rafi and Shiroro LGAs were identified as the red flagged LGAs in terms of reporting. Niger PAS stressed the importance of reporting by LRIOs to the State team, and the need to call on the LIOs from the red flagged LGAs to improve and provide up-to-date reports.