For the average child in Kano State, North West Nigeria, growing to adulthood is a rare privilege.
This is because of the most important health indices that guarantee a healthy disease-free life for children, immunization, is missing in the state.
Kano is presently one of the Nigerian states where the zero dose condition is still prevalent.
Zero dose according to the United Nation Children Fund (UNICEF) is a child who has not received any vaccine in the routine national immunization schedule or Children who do not receive DTP1 (Pentavalent vaccine).
These children are often used as a proxy indicator for zero-dose children.
Zero dose children remain vulnerable to vaccine-preventable diseases along with un/under-immunized or “missed dose” which refers to persons who do not complete their immunization as in national schedule. These children are present across communities, but some communities have more zero dose children than others.
Between 1975 and 1980, health system development was initiated with Primary Health Care (PHC) as the cornerstone and the National Basic Health Services Scheme (NBHSS) was developed based on a PHC approach.
Unfortunately, however, stakeholders believed that the NBHSS programme could not achieve its goals due to implementation challenges; hence, PHC services were not delivered across Nigeria.
However, in 1985, Professor Olukoye Ransome-Kuti was appointed Nigerian Minister of Health and he it was who adopted PHC in 52 local government areas as models based on the Alma Ata Declaration of 1978 and fortunately Nigeria’s first comprehensive national health policy based on PHC was launched in 1988.
PHCs were eventually expanded to all local government areas across the nation and a record was set on achieved universal child immunization of over 80%, and devolved responsibility for PHC to local government areas
However, despite the introduction of a comprehensive national health policy with a focus on PHC, that placed emphasis on preventive medicine and health-care services at the grass root, routine immunization and other forms of immunization still suffers a setback as zero dose local governments still persist.
The National Immunization Coverage Survey (NICS) 2021, shows that Pentavalent coverage for Kano state stands at 42.4%, Jigawa at 48.8%, and Katsina at 41.2%, an indicator that requires a step up in the immunization coverage, hence the need for an effective plan in the reduction of zero dose children in Kano from 45% in 2022 to 43% in 2023 and to 40% 2024 with a target of 250,985 children in 2023 and 240,946 children in 2024 as stated by UNICEF.
However, myths, disinformation, misinformation and rumours have been blamed for low immunization uptake in Nigeria.
Recent findings have also identified other factors as key to the persistence of zero dose level in Kano state.
For instance, it was discovered that majority of the health workers in most PHCs are casual workers and have been working for years without being regarded for proper employment, despite exhibiting a strong sense of commitment to the job which negatively affects their output.
A visit to Gayawa PHC in Ungoggo local government of Kano state revealed that the facility has 21 health workers and out of this number, only seven are on the payroll, while 14 are casual workers who have been managing the facility.
According to one of the casual workers who have been managing the conduct of the facility for years, Malama Asiya Abdullahi, their plight needs urgent attention as they have over spent their stay as casual workers.
She explained that some of them have been serving as casual workers for almost 20 years, even as the monthly stipend given to them as allowances is no longer coming.
“The N5,000 we have been receiving as allowance has not been given to us for almost 7 years now. I have spent 20 years working here and every time the government wants to recruit, we will apply and we will not be employed because we know no one in the government. We are the ones doing the jobs here as you can see and this is our community, we have been serving because we knew our community needs our services and without our services even routine immunization cannot be conducted,” she lamented.
21st CENTURY CHRONICLE also gathered that due to poor timely training, lapses on vaccines storage and mode of application have been visible as well as other lapses that may hinder effective conduct of immunization in the PHCs.
A mother of two who was seen at the facility, Malama Mairo Gayawa revealed that she only brings her children for BCG and usually doesn’t complete her children’s dosage of the immunizations as expected because she has to travel a long distance from her home to the facility adding that if one didn’t come early, it is possible for that person to miss the immunization as the health workers close early.
Another visitor to the health facility, Malama Umma Bello, who brought her child for immunization said she has 5 children but only two out of the five received part of the scheduled immunizations, adding that in as much as she wanted them to be immunized, she couldn’t get them immunized as expected because she couldn’t afford leaving her house early to meet the health workers.
The deputy in-charge of the facility, Hajiya Hannatu Ibrahim revealed that the facility is the only PHC in the community that caters for thousands of community members and that the facility can only operate in the morning despite the need for it to operate for 24 hours.
“Though we are about 21 manning the facility, we can only operate in the morning because 15 out of the 21 are casual workers that work here based on the passion they have and the commitment they have shown to the community. We do ANC, birth registration and immunization. We also entertain delivery if it is during the day time,” she revealed.
Community Health Extension Officer in the area, Malam Idris Buhari, said the issue of inadequate health workers or health workers on casual bases coupled with other issues that range from poor storage and vaccine administration processes among others were responsible for the increase in zero dose level.
It was however, gathered that in January 2023, Kano state adopted the National Z-drop prioritization template and conducted a desk review, subsequently, 389 settlements in 87 wards across 15 local governments in the state were categorized as high-risk areas and in April 2023, the NERICC provided feedback on Z-Drop prioritization submitted by State Emergency Routine Immunization Coordination Centre {SERICC}. The state has since reverted to the updated plans and in January, the state conducted Routine Immunization (RI) in 14 LGAs out of which 6 were zero dose LGAs to arrest the Diphtheria outbreak in the state with funding from UNICEF. During that period over 50,000 children were immunized with Penta 1 between January, February and April RI.
It was further revealed that the Chief UNICEF Field Officer, Mr Rahama RM Farah, had stated that the National Immunization Coverage Survey results had shown that over the years, Nigeria had made progress in immunization coverage, but gaps still exist in the system.
“The zero doses presently recorded are connected to issues related to myths, disinformation, misinformation and rumours and these are responsible for poor immunization uptake in Nigeria, thereby exposing children to high risk and avoidable deaths. For instance, in the three states of the North West of Nigeria: that is Kano, Katsina and Jigawa, there are over 600,000 children who have not been vaccinated against childhood killer diseases in the states. This is closer to about 40% of the total unimmunized children in Nigeria,” he revealed.
