Braving the waves

Reaching underserved populations with immunization in the Niger Delta

Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria
Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria

“We had not seen vaccination teams in our community for a very long time. Sometimes we go for months without vaccinating our children, if we don’t take our children to the mainland to get them vaccinated”, says Mr. Atebakuro Oton George, a fisherman and father of five, residing in Minibie ward of Nigeria’s Bayelsa State.

A largely riverine state, Bayelsa accounts for over 60% of the delta mangrove of the Niger Delta. Many children here continue to miss their chances at life-saving vaccination, as transport is precarious in the tangle of creeks and rivers that crisscross the state. In 2018 a number of innovative strategies such as, immunization boats at sea and community engagement through the traditional hierarchy and sensitization activities, supported by World Health Organization (WHO) through the Government of Bayelsa were introduced to reach a wider net of children.

“Now on weekly basis, health workers brave the seas and visit our communities to vaccinate our children”, an elated Mr. George continues.

Subsistence farming and fishing are the mainstay of the local population’s economy and diet. Health services are provided by primary health care centers located within the island communities.

“The difficulty of accessing healthcare services is due to suboptimal and expensive coastal and waterway transportation from the distant communities to healthcare centers, hence, innovative strategies are being employed to reach the underserved and vulnerable population with vaccination and other health interventions especially during Supplemental Immunization Activities (SIAs)”, says Dr Edmund Egbe, WHO State Coordinator in Bayelsa.

To reach ‘missed’ children, community engagement activities to increase demand for immunization have been initiated to bolster willingness of caregivers to readily access the interventions even when in the middle of the river or the ocean. The successful implementation of the community engagement framework has resulted in high-level acceptance of immunization services in the State. From April 2018 to April 2019, over 169 836 children received vaccination.

A young child receiving polio vaccination. ©WHO/Nigeria
A young child receiving polio vaccination. ©WHO/Nigeria

Routine immunization coverage has improved remarkably: the first quarter RI Lot Quality Assurance Survey (LQAS)— a quarterly activity organized by the National Emergency Routine Immunization Coordinator Centre (NERICC) to assess routine immunization performance, reasons for non-immunization as well as efforts to improve uptake and utilization of RI in Nigeria—conducted in April 2019 indicate that the State is second best in the country. Previously, the State was ranked amongst others in the country as poor-performing from the last National Immunization Coverage Survey (NICS) conducted in 2016; this led to the inauguration of an emergency response committee in March 2018.

King Diete-Spiff, the Chairman and the ‘Amanayanbo’ of Town-Brass, in his meeting with the State Traditional Rulers Council said, “Sustaining the innovative strategies of vaccinating vulnerable populations will undoubtedly increase immunity against vaccine preventable diseases and reduce the mortality and morbidity rate in difficult to access communities”. He described the polio infrastructure in Bayelsa, supported by WHO and partners, as the bedrock of driving successful healthcare intervention at the grassroots.

Support for polio eradication and routine immunization to Nigeria through WHO is made possible by funding from the Bill & Melinda Gates Foundation, the Department for International Development (DFID – UK), the European Union, Gavi, the Vaccine Alliance, the Government of Germany through KfW Bank, Global Affairs Canada, the United States Agency for International Development (USAID), Rotary International and the World Bank.

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