EFTA01947452.pdf

Nigeria: Preliminary Polio Findings 1. Political Will Remains an Open Question - The Federal Government is on board with efforts to eradicate polio. In fact, it considers failures to eradicate polio an embarrassment. Political will at the level of local governments, however, remains a roadblock. With the 2015 campaign just around the corner, eradication is likely to become an even lower priority. - While many governments in Africa are nominally decentralized, Nigeria's governance structures are highly decentralized in a way that makes politics a multi-layered process. One must engage the Federal Government, State Government and lower levels such as LGAs and Wards. At every level, government officials are entirely capable of blocking programs that they either do not approve of or feel were not sufficiently channeled through them. A considerable amount of time and energy is spent working with local governments and keeping them sufficiently satisfied. - There is much more money being poured into Nigeria than is necessary for eradicating polio. This overabundance of cash allows local governments to misappropriate funds while still carrying out polio eradication programs. The release of funds are regularly delayed, which in turns disrupts planning and implementation. 2. Non-Compliance is an issue, but not the only issue - Refusal of vaccinations, or "non-compliance," is widely cited as a major roadblock to polio eradication. Rumors of pork being in the vaccine, that polio campaigns are a plot to sterilize Africans, and the use of polio workers by the CIA to collect information on Bin Laden in Pakistan are all widely cited as reasons why people refuse to let their children receive vaccinations. - But most data suggests that with every round, same children are getting vaccinated, and the same children are getting missed. While steps need to be taken about non-compliance, it has been overemphasized and in many ways, being used as an excuse. It allows organizations to say, the problem isn't our programming or our approach, it is the people. - Insistence by some key donors that vaccination rounds take place, over and over again, makes it impossible to evaluate programs. The shotgun approach will not work. Interventions need to be precise, but collecting the requisite information that would allow for precision has not been done and probably cannot be done unless vaccination rounds are carried out less frequently. - "Eradication fatigue," and the perceived obsession by outsiders with vaccinations has alienated some communities, who view vaccinations as the only thing they ever get from the their government. They ask for wells, they get vaccinations. They ask for paved roads, they get vaccinations. They ask for cash transfers, they get vaccinations. Non-compliance is often a political statement rather than an expression of culture or religion. It is an act of protest born out of the fact that for some of these communities, it is the only opportunity they get to interact with and express displeasure with their government. EFTA_R1_00410728 EFTA01947452 - Outsized focus on polio also reinforces conspiracy theories. The thinking being that people from outside the community say they want to help, but they never dig wells, pave roads or building things. They only want to give our children vaccines, so their must be an ulterior motive. 3. Capacity and Quality - Though polio seems to have a unique stigma, it is not an anomaly. It is not as if access to healthcare and delivery of healthcare services is poor. It is important to remember that we are trying to eradicate polio within a healthcare framework that is inadequate in delivering even the most basic services. Improving over-all quality and capacity is necessary. Polio is only on part of it. 4. Perverse Incentives - At this point, polio eradication is a full-scale, multi-million dollar industry. There are offices and NGO's predicated on its existence. There are drivers, cooks, cleaning staff whose livelihoods depend on the continuation of a polio eradication campaign. No one wants to talk about it, but it is an open secret that some organizations might purposely fail to carry out their work so that polio eradication campaigns will continue. Levels of non-compliance might also be inflated for this reason. 5. Security - In Homo state and Yobe state, where the war against Boko Haram has rendered entires swaths of territory off limits, the challenge of eradicating polio is has an added security dimension. Health workers have to rely on day to day assessments form the civilian JTF, an ostensible state sanctioned militia for up to date security information. Some donors and implementers are reticent to integrate their work with vigilante groups, as it may increase the chances that health workers will be targeted. There arc also rumblings that the Nigerian government might seek to have the military or civilian JTF carry out polio vaccinations. EFTA_R1_00410729 EFTA01947453