Routine immunizations in Nigeria: How the techies can help in mass immunizations and polio eradication. A novel solution developed from experiences gained through practicum and public health course

Immunization is one of the most effective essential public health interventions and cost effective strategies to reduce child morbidity and mortality. Reducing U5 child mortality is one among the eight Millennium Development Goals by the target date of 2015. However, there are three countries that are still reeling under the heavy burden of the poliovirus transmission. Nigeria, one among the three, has remained a reservoir for the re-introduction of polio into 25 previously polio-free countries. This calls for huge resources that have to be mobilized to mount a responsive immunization in these countries, primarily because poliovirus transmission could not be controlled in Nigeria, which is a source. This is because of the poor routine immunization coverage in the country coupled with low quality immunization campaigns - outcome influenced by religious opposition to OPV by Muslim groups, insurgency, militants, and poor health systems, hard to reach areas, poor commitment of voluntary workers hired for campaigns, official corruption, and other factors. In response to this disturbing trend, the Nigerian government initiated an emergency operations center to monitor the immunization campaigns and rolled out a nation-wide emergency action plan aimed at achieving full eradication of polio. \ud In order to strengthen routine immunization the government along with international partners developed the National Routine Immunization Strategic Plan 2012-15, which clearly lays out the key goals, challenges, objectives, and strategies to strengthen Nigeria’s Routine Immunization (RI) system along with a monitoring and evaluation plan. For this plan to be successful, there has to be a reliable and fast way to collect and transmit immunization data so that corrective actions can be initiated. Currently the paper based system of transmitting the routine immunization data to higher levels takes too long to initiate corrective actions that can make a meaningful impact. By collaborating with healthcare professionals currently working for RI in Nigeria and ongoing interviews with health care officers, the author has been able to understand better the real-time difficulties on the ground. This proposal presents a strategy that addresses this critical problem. The use of Interactive Voice Response (IVR) technology in gathering first hand information from the health workers at grass root level will provide sufficient and timely high quality data. The time lag will be reduced from the current 45 days to less than a week. Information on the proportion of planned immunization sessions conducted, number of immunization sessions cancelled, reasons for the cancellation of sessions, availability of vaccines and logistics, and provision of funding for transportation of health care workers to remote villages to conduct outreach sessions will be captured by the IVR system. Data will be collected through automated phone calls to the health care workers on the day of immunization soon after the session is completed. This data will be collected, collated, analyzed and trend graphs will be generated and shared with health care authorities at Local, State, and National levels, through the fastest possible channels - SMS, email, phone calls, etc. for corrective new actions. This exercise will require development and customization of the readily available software technology, crucial advocacy by the Ministry of Health in Nigeria for buy in, collection of critical information on immunization micro plans, collection of mobile numbers of health care workers, MOU's with the mobile service providers, training of health care workers, and supportive supervision. The project will also incorporate evaluation systems at regular intervals to ensure that the program is on track to achieve its objectives of capturing real-time data, reducing cancellation of scheduled sessions, and increasing immunization coverage. The successful interruption of polio transmission will undoubtedly rely on a sustained focus on the primary objective of achieving full eradication through effective and timely response to outbreaks, sustained surveillance measures, and increased routine immunization. \u