The eHealth Africa (eHA) story began when we were founded in 2009 to provide northern Nigeria’s health infrastructure with customized technology solutions for data-driven decision-making to improve public health. In 2012, we joined the Nigerian government, international philanthropy and development partners, regional and national NGOs, and implementing partners in the fight for polio eradication in the country. All partners brought different yet complementary expertise and experience to the fight, from grassroots community organizing to funding to policy advisory; each partner played a critical role in eradicating polio in Nigeria.
In 2012, we were a very young and focused team. Our expertise was (and remains) providing technology solutions and operational and technical support. We focus on developing user-centric technology-driven solutions to collect, manage, and analyze data that is still being used today to enhance large-scale public health interventions. We also provide operational and technical support to bridge the gap in access to health delivery services. Through the years, we have worked as part of larger consortiums to implement various programs to address polio in Nigeria, from ensuring vaccine delivery to last-mile health facilities to implementing one of the most extensive community-involved disease surveillance programs in the region.
On June 18, 2020, the World Health Organization (WHO) declared Nigeria polio-free, and here we revisit some of the steps we took on our path to polio eradication.
2012
Nigeria accounted for more than half of polio cases worldwide in 20121. It was an emergency that needed an immediate response.
Walking into the Kano EOC
Enter the Polio Emergency Operations Centers (EOCs)
The EOCs are a linchpin in Nigeria’s fight against polio. In 2012, we built the first of 8 EOCs, which act as command centers for decision-makers, partner organizations, and relevant stakeholders in the health sector to meet, review data, and take prompt actions to mount a coordinated response during emergencies. They are a government-led initiative to improve information sharing and joint programming (planning, implementation, monitoring, and evaluation) for improved polio (now other public health) emergency management. eHA built and currently manages the National EOC in Nigeria’s capital, Abuja, and seven state-level EOCs, located in Bauchi, Borno, Kaduna, Kano, Katsina, Sokoto, and Yobe.
Increasing Accuracy and Accountability through Tracking
Immunization Plus Days (IPDs) are supplementary immunization activities (SIAs), and mass campaigns complement routine immunization. All children under 5 receive two oral polio vaccine (OPV) doses during these campaigns to boost herd immunity. Polio eradication partners introduced Vaccinator Tracking System (VTS) to increase the accountability of vaccinators.
Under the Global Polio Eradication Programme, eHA mapped all 11 of Nigeria’s northern states in 2012. We collected geospatial data relating to points of interest, including settlements' names and locations and habitation status. Using this data, we supported states in developing accurate, comprehensive maps and micro-plans for planning SIAs, including IPDs. During each campaign, VTS uses Geographic Information Systems (GIS) technology to track, collect and store location data to identify missed or partially covered settlements. The data is downloaded, reviewed, and analyzed at the end of each day during the campaign. Decision-makers identify challenges, take evidence-based actions, and ultimately improve vaccination geo-coverage in high-risk states. Since 2012, over 88% of states in Nigeria have used VTS to increase accountability during campaigns.
Assembling Health Camp boxes in our warehouse
2014 - 2016: In all the nooks and crannies
Nigeria employed many strategies and implemented many programs to eradicate polio. Under the guidance of the National Polio Eradication Program, states created and adapted programs to suit their local contexts. Kano state Health Camps, a targeted mop-up campaign, were free health outreach events where members of each community got access to essential health checkups and free medications. They also provided another avenue for immunization against polio.
WHO procured the necessary medicine and equipment and packaged and distributed these essential medicines to health facilities across the state. Health Camps were a massive success; communities needed vital services and medications and attended these outreach events en masse. Using lessons learned from the implementation in Kano state, eHA supported Borno state in running health camps in seven Local Government Areas (LGAs) in 2016.
Child receiving OPV dose during house to house campaign
End Game Strategy
Despite best efforts during supplementary immunization activities, all eligible children did not receive the polio vaccine. In 2016, eHA supported the End Game Strategy (EGS) project in Kano state by tracking down all the missed children during the state’s IPDs so that they could be followed up and immunized before the next immunization campaign round.
EGS was coordinated by the Kano State EOC, partner agencies (including UNICEF), and the invaluable support of the Kano Emirate council. The project line-listed all the children missed and categorized them based on the following reasons: Noncompliance (NC), child absent (CA), and block rejection (BR). Households reported by the house-to-house teams as having “no eligible children under 5” were tracked and verified to ensure vaccinators missed no children in those households. Working closely with the Kano Emirate council, Polio eradication partners addressed noncompliance and block rejection cases. Vaccinators revisited houses with absent children and vaccinated them immediately after their return from travels. eHA provided logistics support to District Heads, Ward Heads, Ward Focal Persons, Health Educators, and Senior team Supervisors to support the follow-up and vaccination of children missed during IPD campaigns.
2016: A setback
On August 11, 2016, after two years without a case of wild poliovirus, the Nigerian government reported that the disease paralyzed two children in security-challenged Borno state. The almost decade-long insurgency in Northeast Nigeria presented a challenge for government and health partners.
Nigerian Polio Eradication partners developed a more context-specific strategy to reach children in all parts of the state. The Borno State Primary Health Care Development Agency (BSPHCDA), in close collaboration with WHO, the Bill and Melinda Gates Foundation, U.S Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), and other partners, launched a series of strategies to interrupt the transmission of the virus and reach all eligible children under the age of 5 in security-compromised, partially Hard to Reach (HTR) and HTR settlements. We leveraged our GIS, field operations, and logistics expertise to collect and analyze geospatial data. The data helped real-time program monitoring and decision-making by the state and relevant key stakeholders. 396,607 children have been immunized in security-challenged areas of Borno state. An additional 2,195,369 children have been vaccinated in non-security-challenged areas.
Mapping Nigeria takes you through hills and streams
Our path to polio eradication in Nigeria has helped us live our mission of building stronger health systems and ultimately improving people's lives in our communities. We have traveled rugged terrain, surmounted obstacles, and developed incredible partnerships along the way. It has been challenging and adventure-filled, but each step taken on this path has been ultimately rewarding.