EventRep: Ondo State Polio Vaccination OBR2 (April 2022)
A MicroBiotic EventRep Publication
Introduction: The OBR Polio Vaccination was carried out in Ondo State between April 6 and 13, 2022. Ondo State has 18 LGAs and immunization was carried in 12 of the LGAs of the State, leaving 6 out due to security reasons. Pre-implementation activities carried out at the state and local government levels. In all the LGAs, activities carried out included training of ward focal persons and vaccination teams, high risk analysis, security assessment, community dialogue and SMC meeting. Logistics funds for teams were distributed to teams before implementation. The religious, traditional leaders and LGAs Staffs including partners were all mobilized and actively participated. 13,747 vials (687,350 doses) of nOPV were supplied to the LGAs. Cold chain was maintained throughout the exercise with provision of fuel for generators to support the National Grid.
Activities: The 12 LGAs (Akure North, Akure South, Ondo West, Ondo East, Idanre, Odigbo, Ose, Ese Odo, Irele, Ile-Oluji/Oke-Igbo, Ifedore, and Owo) had a total of 129 wards with target population of 654,392; 1,250 house-to-house teams, 157 special teams and 274 fixed post teams. Religious, traditional leaders, LGA team and partners all took part in the activity. Daily refresher training was held with the teams before takeoff every morning and on-the-job support and training was also rendered to teams. Daily review meetings were held at both ward and LGA level. The LGA level review meeting was chaired by the LGA Chairmen or the MOHs. Non-compliance cases were recorded at some churches and schools in some LGAs. Challenges identified by the teams were addressed and all non-compliance and revisit cases were resolved. All these were reported at the State Review Meeting. Cold chain was maintained throughout the exercise. Some teams in some LGAs started vaccination on Friday (08/04/22), one of the pre-implementation days, in order to vaccinate children in schools that were going on vacations and children attending Jumat services in mosques during the Islamic fasting period. Mop-up was also carried out on day 7 to ensure all children were immunized.
The Best Practices Observed: These include: (1) Commitment of the LGA team in supervision (2) Good knowledge of correct house-marking and finger-marking by some teams (3) Good cold chain maintenance during activities and good knowledge of VVM (4) Daily observing of ward, LGA and State review meeting (5) Daily refresher training before take-off and revisits carried out by teams (6) Vaccination of children at Ramadan Lectures, in school that were still in session and in the evening (7) Chairing LGA review meetings by the Chairmen of Odigbo and Ifedore LGAs (8) Resolving of non-compliance cases (9) Incorporating Fulani settlers as team members in Fulani settlements (10) Quick response of Ward Focal Persons to supply insufficient items such as pen marker and extra tally sheet (11) Good interpersonal relationship by team members and constant updating of DIPs (12) Discovery of suspected AFP discovered some LGAs like Ondo West.
The Challenges Encountered: These are (1) On Day 1, there were late take-offs of teams due to heavy rainfall, late arrival of ice packs, and nonchalant attitude of some team members (2) There was poor infection prevention and control (IPC) skills observed in some teams by not using face mask and sanitizers, although they weren’t adequately provided by the state (3) Some teams were not asking about AFP cases and also carrying out wrong house-marking Some teams were not given transport money on time (4) Poor knowledge of VVM by most vaccinators (5) Some teams were not complete in some LGAs, with some lacking supervisors, vaccinators or mobilisers, thus, affecting the quality of the work (6) Non-compliance cases recorded are due to lack of orientation, poor education provided by teams and lack of patience with the public (7) Late starting of review meetings and unavailability of most LGA Chairmen at evening review meeting (8) Disparity between house marking and tally sheet and some supervisors not tallying as they were immunizing (9) There are some bad roads and hard to reach areas within the LGA, and heavy rainfall affected teams’ movement (10) Lack of cooperation among teams at the borders of wards concerning DIPs.
Other challenges include: (11) Watery ice packs and faded finger marks after some days (12) Some teams were also concealing revisits and non-compliance cases (13) Teams were inadequate in some wards such as Oda Ward in Akure South LGA due to expansion (14) Security-challenged settlements in 4 wards (Arimogija, Ute, Elegbeka and Ikaro) in Ose LGA not visited (15) Non-release of counterpart funding by state & LGAs (16) Unresolved non-compliance cases in some of the wards across the LGAs (17) Tendency of violence by some non-compliant households especially the non-indigenes (18) Minor accident to one of the MSTs on duty.
The Recommendations Provided: These are directed individually to both the State and Local Governments. The LGAs should ensure (1) teams adherence to Covid-19 protocols and protective gears should be adequately provided (2) that religious leaders are incorporated for support to aid better vaccination programmes (3) adequate security escorts for security-compromised LGAs and complete transportation funds for teams (4) LGA Chairmen should chair evening review meetings (5) a comprehensive line-list of non-compliance cases to be developed to guide planning (6) early refresher training on daily basis for team members by WFPs and supervisors. The State Government should (1) intensify supervision at all levels and ensure defaulting members of teams are replaced immediately (2) provide strong political will & support for vaccination (3) provide early approval and release of State & LGA counterpart fund to compliment partners fund (4) ensure knowledge gaps identified are followed up strictly to bring about improvement in future campaign (5) introduce alternative measures, with partners, to house marking on walls, for instance, the use of stickers (6) provide continuous advocacy visit, sensitization and resolution of non-compliance after the campaign in conjunction with partners (7) provide more teams for expanding and complex wards and redistribute wards/team workload to avoid lopsidedness/inefficiency on part of some teams by partners, state and LGA teams.
Summary and Conclusion: The activity was organized between April 6 and 14, 2022. Logistics, especially vaccines and money were provided to all the teams covering all the settlements in 12 Local Government Areas of the State – Akure North, Akure South, Ondo West, Ondo East, Idanre, Odigbo, Ose, Ese Odo, Irele, Ile-Oluji/Oke-Igbo, Ifedore, and Owo. All eligible children were immunized. The 12 LGAs have a total of 129 wards with target population of 654,392; 1,250 house-to-house teams, 157 special teams and 274 fixed post teams. WHO also provided support with 131 additional teams. At the end of the exercise, 50,491 eligible children were immunized with a coverage of 103%.
The program was a success at all the LGAs and wards supervised, and parts of our achievements include: On-the-job training continuously provided for teams on the field and correction of identified errors; Encouragement of discussions and constructive criticisms provided for teams during ward, LGA and State review meetings; Replacement of some recalcitrant supervisors were to make work to be of more quality; Resolving of non-compliance cases on the spot or quick escalation for immediate actions; Enforcement of Immediate replacement of watery ice packs, supply of vaccine on the field after exhaustion and re-marking of faded finger marks, and; Line listing of settlements were made for further action and engagement of security personnel.
Bosede Alowooye, Team Lead, AFENET-CDC-NPHCDA Management Support Team (MSTs), Ondo State Polio Outbreak Response Phase 2(OBR2). April 6 -14, 2022.