Working hard to meet the target set by World Health Organisation (WHO) of eradicating the polio virus in Nigeria, the Executive Director/CEO, National Primary Health Care Development Agency (NPHCDA), Dr Ado J.G Muhammad is optimistic that come 2013, Nigeria will indeed be polio- free through the collective effort of all concerned. He spoke with AMINA ALHASSAN AHMAN and AHMAN MAKAMA on this and a number of issues concerning primary health care services.?
Since you were handed the mantle of leadership of this agency, what are you doing differently to move it forward?
Since I assumed duty, what we have done is to carry out diagnostic of what the primary care issues are in Nigeria.
We came up with a blueprint building on the gains that have been achieved by my immediate predecessor, Dr Muhammad Ali Pate, and we identified the need to deepen provision of human resources for health, which is a major challenge, especially in the rural areas; the need to strengthen primary health care system in Nigeria and also need to support states and local governments to build their capacity in terms of further care services.
In addition, we are looking at the issue of mother and infant mortality/morbidity which have over the years been very embarrassing for Nigeria.
We are working out mechanisms on how to address not only mortality, but also morbidity because as you know, Nigeria is one of the countries that records the highest number of infant and maternal deaths in the world.
We are very concerned about that, so we are working very hard to ensure that it is tackled once and for all.
It’s one thing to talk of plans to improve the agency and another when it comes to implementing them.? Challenges are bound to crop up. Can you identify some of the challenges and how you intend to tackle them??
Some of them include the issue of polio virus transmission in Nigeria. As you know, Nigeria is one of the countries that transmits polio virus, and it worries us as a government and that must stop.
We have received the highest political support from the president, Dr Goodluck Jonathan, who has provided us with resources, enabling environment, encouragement, resources and his personal involvement.
Secondly, as an attempt to also end polio transmission, we are deepening our relationship with traditional leaders under the leadership of Sultan of Sokoto.? We have had several meetings with him and other traditional leaders and that is also yielding fruits.
We are also discussing with various communities because when you are discussing primary health care services, what is paramount is that you must involve the communities.? We cannot lose sight of the fact that the global community, our partners need to come on board as well.
Now, in terms of infant and maternal mortality, one major challenge we have is non-availability of human resources for health care. This we are tackling through the midwifery service scheme. We have presently about 2,000 midwives in place and we in tend to take an additional 2,000.
We are also engaging community health officers and workers nationwide while bringing a new dimension to the service delivery, which is engaging young girls who have finished their secondary school and train them as village health workers in various communities nationwide.
We want to start giving women incentives so that they attend antenatal care and bring their children for immunisation.
How do you rate the situation of polio in the country?
Eradication of polio is a collective effort. No single individual or organisation can stop transmission of the disease. It involves everybody from the media, to different levels of government, religious leaders and organisations.
Between 2009 and 2011, Nigeria had crashed the number of polio incidents by about 95 per cent; from 1000 cases, it came down to about 21 cases. We achieved that feat because the Nigerian government is committed and because we involved traditional institutions, emirs and traditional leaders.
But we saw an alarming increase in the number of cases again. What went wrong?
We came into 2011, which was an election year. It was a transition year, and while the federal government was meeting up with its own obligation in terms of providing the resources, operational funds and commitment, the same could not be said of states and local governments.
They were busy with elections and transition, and that affected supervision and compromised quality, so we started seeing recurrent cases of polio. We may have celebrated too early when we were down to 21 cases and we thought that we were home-free, but the virus started fighting back and we started seeing an increase in the number of cases.?
Another major issue was the selection of team members who have to be qualified to carry out the task. This is because the most important thing is for the vaccine to be dropped directly into the mouth of the child. When this is not done properly, then there is a problem. Young boys who are not fully equipped or committed are not mentally ready to handle such responsibility.?
I’ve reviewed the policy, and instead of having one or two people who will select the vaccinators, we set up a committee made up of WHO, UNICEF, the Agency and traditional institutions to screen and make sure that only competent vaccinators are selected.
There is a large population being missed because Nigeria is a very big country with a lot of difficult and hard to reach terrain. So we are using our geographical information system (GIS) satellite that will help us identify every locality in Nigeria,? concentrating on Kano, Kebbi and Jigawa, we intend to scale it up.
In addition, there are places that chronically reject the vaccines year in, year out due to misinformation based on religious beliefs, while some are due to socio-cultural reasons.
What hope does the agency have under your stewardship to achieve the target set by W.H.O on eradicating polio in Nigeria?
We are giving ourselves a target, that by next year we will stop transmission. We are optimistic that by next year we will see a total eradication of the virus. President Jonathan is very committed and has shown it by leadership; constituting a presidential task force on eradication of polio virus in Nigeria under the chairmanship of the minister of state for health, Dr Muhammad Ali Pate. I am the secretary of the taskforce.
Only recently, during the Commonwealth Heads of State’s meeting, the president announced the provision of an additional $30million per year for the next two years; that’s a total of $60million to fight polio, in addition to other resources.
The task force is to provide leadership to interrupt the virus, and that includes accountability framework for every level or tier of government. Everyone has their own responsibility and will be held accountable for their action or inaction.
We are redesigning the selection of vaccinators, team members and supervisors and reducing the workload on the teams because this compromises quality.
For instance, for a team to vaccinate 300 households is not acceptable because they will get fatigued, thus compromising quality. So we are trying to reduce the number from an average of 320-150 per special team.?
Given that primary health care services like routine immunisation is funded by international donors and those aids are drying up due to a number of factors, what effort is the agency making to take ownership of the immunisation programme?
First of all, I would like to correct that impression. The Nigerian government funds its routine immunisations 100 per cent, without any support from international bodies. Nigeria is one of the few countries that do that; and globally we have been commended for that.
Even for the polio eradication, the Nigerian government also contributes significantly in terms of logistics, social mobilisation and some other activities. Having said that, yes, the global community also contributes significantly.
We appreciate that and recognise the need to also make contributions for logistics and mobilisation, which has scaled up in the last three years.?
A number of cases of Lassa fever have been reported with about 40 deaths so far including health workers. Can you tell us why we are seeing an outbreak of the disease and what the agency is doing to prevent its spread?
Well as you know, the virus lives in rats and infects humans when they come in contact with these rats’ urine and faeces.? Lassa fever can also be contracted through body fluids like blood and excrements of infected persons.
To control the epidemic the federal government has responded by deploying a rapid response team to all affected states to immediately distribute old stock of drugs to manage the disease.?
Over 750,000 doses of Ribavirin injections and tablets were procured and distributed as well as safety gloves and protective vests for the health care providers. A multi- agency committee has been set up including NPHCDA to come up with ways to tackle the problem.
To prevent the spread of the disease, Nigerians need to take care of their personal hygiene including avoiding contact with rats and rodents; all foodstuff and drinking water needs to be properly stored in a safe place away from contacts with rodents; affected patients must be isolated, while barrier nursing care should be applied.
Because people living in rat infested rural areas or in crowded and unsanitary environment are most at risk, it is vital to educate them on dangers of the disease.