Results

Lessons Learned from Measles and Meningitis A Integrated Campaigns in Northern Nigeria

A Retrospective Study of Lessons Learned From the 2019-2020 Implementation of Measles and Meningitis A Integrated Campaigns in the Context of COVID-19

Results

Stakeholder perceptions

Stakeholders at the national, state, and local levels were involved in collaborative planning and implementation of the campaign. The process benefited from defined roles, transparency, equal and active involvement, and performance appraisal. Stakeholders’ perceptions of the pros of collaborative planning include:

  • National and State supported the local government immunization teams and involved local stakeholders in the collaborative planning process.
  • Health workers received capacity building and increased efficiency in their work.
  • Local involvement of district leaders, area chiefs, heads of the families, and traditional and religious leaders benefited from communication and social mobilization.

Campaign readiness and coverage

Three days prior to the campaigns, each state was assessed for readiness to implementation according to themes including financing, planning, coordination, waste management, cold chain and logistics, social mobilization, adverse event surveillance, and monitoring.

See the table below. The study states achieved the following readiness scores and post-campaign coverages for the 2019-2020 integrated campaign. The 2017-2018 standalone measles campaign data are also provided for comparison.

Low readiness scores in 2019-2020 as compared to the 2017-2018 campaign may be attributed to delays in submissions of readiness dashboard data and interruptions caused by the COVID-19 pandemic. Overall, states achieved equal or greater coverage compared to the 2017-2018, with the exception of Niger state, which had coverage of 90.1% in 2017-2018. 

Table 1. Readiness scores and coverage from 2019-2020 integrated measles and MenA campaign vs. 2017-2018 measles standalone campaign.

State *Readiness score 2019-2020 (2017-2018) Coverage Measles 2019-2020 (2017-2018) Coverage MenA 2019-2020
Kogi 77% (71%) 93% (87.4%) 91%
Kwara 82% (100%) 96% (94.3%) 95%
Niger 75% (100%) 89% (90.1%) 87%

*The Readiness Score is a summary across 27 indicators in eight thematic areas: Financing, Planning/Coordination, Waste Management, Cold Chain/Logistics, Advocacy, Social Mobilization/Communication, Adverse Events, and Monitoring.

Key Findings

Early advocacy and inclusion of all stakeholders enabled buy-in, integration of resources and effective mobilization. Government leadership played the strongest role.  

The supply and cold chain infrastructure must be sufficient to accommodate the volume of vaccines for the integrated campaigns. 

The integrated planning process can be complex; strong technical skills such as data management, tool modifications, and implementation re-design must be identified.

Financing an integrated campaign can be challenging and could threaten the ability to successfully integrate campaign planning,  especially funds for operational costs. Early forecasts of operational cost needs must be done early to ensure this is incorporated into the necessary budget (national, state or immunization annual budget), followed by strong advocacy for releasing the funds.

Challenges

Challenges Faced

Hindering factors to collaborative planning were identified as follows:

  • Incomplete identification and involvement of relevant stakeholders in collaboration.
  • Poor management of conflicting priorities amongst technical and non-technical stakeholders.
  • Delay in receipt of funds for social mobilization and logistics.
  • Delayed microplanning for population targeting and allocation of resources.
  • COVID-19 protocols related to planning and implementation.

Mitigation

  • A regular coordination platform or forum with clear terms of reference, aims, and responsibilities.
  • Targeted social mobilization and timely advocacy to ensure integrated decision making across all stakeholders
  • Clear processes and procedures for national approval of plans and communication to state and service delivery levels.
  • Address security and transportation challenges in the implementation plan to support health workers’ needs.
  • Use virtual tools for planning meetings, and budgeting/planning for infection prevention and control during implementation.

“Integrating this campaign saved us the cost, it saved us a lot of money, it saved us time, and it built the capacity of our health [workers] in multitasking.” - State Official