A relentless struggle unfolds daily in Kano State—a battle not only against the lingering threat of polio but also in the broader pursuit of securing the health and future of its children. Dr. Mohammed Nasir Mahmood, Director General of the Kano State Health Care Development Board, sheds light on the comprehensive efforts and tactics employed in this crucial undertaking. Despite Nigeria’s celebration of polio-free certification two years ago, ominous signs emerged, signalling that the fight was far from concluded. “With an unyielding dedication to immunise every eligible child, Kano State stands at the forefront of Nigeria’s campaign against polio,” declared the DG. He shared these insights in an interview with Associate Editor ADEKUNLE YUSUF. Excerpts:-
The enduring quest undertaken by Nigeria and Kano State over the past two to three decades to eradicate polio has been monumental. Kano State has been deeply engaged in these efforts, confronting its own challenges along the way. Approximately 15-20 years ago, Kano was identified as one of the focal points of the polio epidemic in the country. Fast forward to two years ago, when Nigeria was officially declared polio-free, marking a momentous achievement celebrated nationwide. However, despite this milestone, troubling signs have emerged suggesting that polio still lingers.
A significant contributing factor has been the revelation that many Nigerian children, who should have been shielded through vaccination, remain unprotected. Routine immunisation, commencing at birth and extending to 18 months, stands as one of the most effective measures against polio and a host of other vaccine-preventable diseases including tuberculosis, measles, diphtheria, hepatitis, whooping cough, tetanus, among others. Regrettably, many children, particularly in regions such as Kano, have been identified as lacking this vital protection. Nigeria’s national polio eradication campaign has also encountered challenges, notably due to insecurity in various parts of the country, hindering vaccination efforts and leaving our children vulnerable. This situation not only jeopardises the health of our children but also places Nigeria itself at risk of a polio resurgence.
In Kano specifically, the situation has been particularly concerning. Approximately two years ago, a resurgence of aggressive polio virus was observed, previously confined mainly to Kebbi, Sokoto, Zamfara, and parts of Borno State. This resurgence underscores the inadequate immunisation coverage, signifying that many children remain unprotected. Last year, Kano unfortunately accounted for a significant portion of the country’s polio cases, with 43 out of approximately 240 cases, amounting to about 18 percent of the total. This sobering reality serves as a stark wake-up call, compelling us to reassess our strategies and redouble our efforts in combating polio.
This new initiative is a collaborative effort involving the National Primary Health Care Development Agency (NPHCDA) and various development partners. It’s a direct response to the concerning polio cases observed, targeting Kano and 17 other states identified as at-risk areas. The primary goal is to ensure comprehensive vaccine coverage for all children, thus eliminating the threat of polio resurgence. The initial phase of the strategy involves a large-scale campaign, followed by subsequent supplemental efforts. In partnership with stakeholders, the aim is to reach every eligible child in Kano State—approximately 4 million children—within the next four to five days. This ambitious undertaking requires visiting every household across the state’s 484 political wards and 44 local government areas.
Furthermore, substantial strides have been made to enhance routine immunisation services. Recognising the critical role of sustained funding, immediate action was taken upon discovering the deficiencies in vaccine distribution. With support from UNICEF, immunisation services have been revitalised across Kano State, boasting an extensive network of over 1,000 facilities operating without interruption for the past 10 months. Mobilisation efforts encompass advocacy, communication, and social mobilisation, engaging all stakeholders in the process. Notably, the state task force on immunisation, led by the Minister of Health and the Governor of Kano State, has been reconstituted to provide robust oversight. Comprising key stakeholders from various sectors, this committee ensures seamless implementation of routine immunisation activities. Additionally, a committee chaired by the Deputy Governor has been established, comprising commissioners, government agencies, religious and traditional institutions, and professional bodies. Development partners such as UNICEF and WHO are actively involved, collectively overseeing efforts to prevent polio resurgence, particularly in Kano State. Through collaborative governance structures and comprehensive mobilisation strategies, the collective aim is to safeguard the health of every child and prevent the resurgence of polio.
Widespread participation, especially underserved and hard-to-reach communities
Our team is everywhere. Yesterday, you saw what we did when the state governor flagged off the campaign in a local government. That local government was identified based on certain criteria – many children are yet to be immunised in that local government; there are many issues and challenges in that place. This is based on a recent survey that was carried out. Most of the outbreaks we are experiencing in Kano state do come from there – diphtheria and polio. The district head was there; all the village heads were there. It was part of our strategy to work with the communities and all the people that matter in our drive to achieve full immunisation coverage in the state. We work with all community leaders and traditional rulers to drive the process so that every eligible child is identified and vaccinated. When we are doing this kind of campaign, we – all of us – hardly go to our offices; we are on the field monitoring and supervising the process and return to the EOC (emergency operations centre) to review activities and challenges and how we can resolve any issues.
Vaccine hesitancy
That is one of the reasons we are going out to engage; that is why we are collecting data and that is why we are analysing the data. One of the directives is that there are different levels of conflict resolution. If the problem can’t be solved, it should be referred to the ward team. If the ward team can’t resolve the issues, they should be referred to the local government team. That is why the governor has directed that all the local government chairmen be attending immunisation meetings to resolve all cases of non-compliance. Yesterday, we had about 150 cases of unresolved non-compliance and we took some actions. Sometime, the state does intervene if the local government is unable to resolve any issues of non-compliance.
A lot is going on towards revamping the healthcare infrastructure in the state. Let me talk specifically about primary healthcare. To be specific, Governor Yusuf has prioritised health sector. And anyone that is following issues in Kano State will surely attest to the fact that a lot is happening in the health sector in Kano State and that the health sector is topmost in the agenda of this administration. We have a vibrant Commissioner for Health; he was in that same post 8 years ago and he came back. So he is used to the terrain very well and very familiar with system. Primary healthcare is extremely important if we want to change the healthcare landscape or if we want to improve the health indices – maternal mortality, child mortality and other things. We are very happy because even the Coordinating Minister of Health has also prioritised primary healthcare as the place we need to touch and change if we want to see significant improvement in the healthcare delivery system. Here in Kano, we are also doing our part. One of the major agenda in primary healthcare is to have at least one functional primary healthcare centre per political ward. In Kano, we have 484 political wards. The idea is to have at least one functional primary healthcare facility per ward. What is functionality is about five parameters – building infrastructure, personnel, equipment, drugs at certain quantity and the range of services to be provided. All these are part of cost element. Each of the facilities we have assessed based on the criteria. We need a comprehensive assessment of what we have to be able to do the right thing so as to identify the gaps and move ahead.
Maternal and children health issues
As I told you earlier, one of the most important indices to assess how healthy your health system is or how functional your health system is, including the level of development of the country, is the wellbeing of mothers and children. The wellbeing of the mothers and children can also be looked at from their death – how many children die before the age of 1 or 5; how many die from pregnancy or pregnancy-related issues? Unfortunately, these indices in Nigeria are very poor and Kano State has one of the worst, which is a great concern to the current administration. All these work we are doing – revitalising primary healthcare to strengthen immunisation, revitalising the free maternity programme so that every pregnant woman in Kano will be attended to and delivered free of charge, free drugs and, if necessary, surgery free of charge. We are also providing special support for under-5 children across the state. All of these are going on to improve the indices and change the landscape. The problem is big, but I am sure with this current tempo, we will witness a significant improvement in child and maternal health in Kano State in the next two to three years.
One of the commitments made by my g overnor is the attainment of one functional primary healthcare centre per political ward. This administration has chosen to work to attaining this goal. There is a big gap. When we did an assessment, we found out that only 185 wards have physical structures; we don’t need to do any new building. We just do renovations and make sure all other inputs are made available. Those 185 ones are the ones we are prioritising right now because they are the ones we can quickly address. In the next one month, we are going to have them. The other wards require new buildings. And we are going to attain that goal. Unfortunately, based on a national survey, Kano State is even doing a lot better than most states. Some have said if we apply the criteria for about 9,000 political wards in the country, there may not be a state that meets the criteria. There is a huge gap in Kano but there is a huge gap across the country. This is because the primary healthcare has been neglected for a very long time and that is why we are all working and injecting fund into primary healthcare system. I am sure that in the next couple of years, Kano will be a shining example to other states.
