Centre for Health Sciences Training, Research and Development

1. Centre for Health Sciences Training, Research and Development

2. Outline • Immunization coverage and access in Nigeria: Context, Progress and Challenges • Nigeria Vaccine Access Programme • The Edo State Programme • Key Milestones • Learning for Scaling and Adaptation • Next steps – NVAP-HPV

3. Immunization Coverage & Access in Nigeria: Country Context, Progress and Challenges

4. POLIO ERADICATION RACE THE LAST LAP Polio Certification )! Highway

5. POLIO ERADICATION BY 2014 2009 (388 cases) 2010 (21 cases) 2011 (? cases) Wild Polio 1 2012-2013-2014 ( -0 case) Wild Polio 3

6. Pneumonia, Bacterial meningitis and Diarrhoea diseases account for 18%, 2% and 16% of childhood mortality and morbidity Achieving MDG 4 will require a drastic drop in the mortality arising from these diseases. Leading causes of female cancer deaths – breast and cervical cancer Screening and treatment available for both Vaccination available only against HPV, identified cause of cervical cancer Urgent need for a global drive on HPV vaccination in LMI UNSG’s Strategy to improve women’s health and MDG5 NCDs for women New Vaccine Introduction – Achieving MDG 4 &5

7. New Vaccine Introduction – Focus of the NPHCDA

8. The Nigerian Vaccine Access Programme is implemented by Centre for Health Sciences Training, Research and Development (CHESTRAD) as a public private partnership with the National Primary Health Care Development Agency NPHCDA) and other national and global stakeholders. It is an operational research, evidence informed advocacy and accountability initiative aimed at expanding access of Nigerian communities to prioritized new vaccines and strengthen delivery systems for routine immunization and other life saving interventions.

9. Operational research and advocacy initiative to: expand access to prioritized new vaccines for prevention of infections due to the Rotavirus (Rota), HaemophilusInfluenzae Type b (Hib), Pneumoccoal virus (Pnuemo) as well as Diptheria, Tetanus, Pertusis, Hepatitis B, including Poliomyelitis (Penta) and the delivery HPV vaccine reduce bottle necks to expanding coverage of routine immunization services reduce the burden of vaccine preventative diseases among women and children a part of the overall national strategy to reduce unacceptable death and ill-health among Nigerian women and children What is NVAP I?

10. Initial NVAP States The Nigerian Vaccine Access Programme is a civil society led public private partnership hosted by the Centre for Health Sciences Training, Research and Development (CHESTRAD) in collaboration with national and global stakeholders. It is an operational research, evidence informed advocacy and accountability initiative aimed at expanding access of Nigerian communities to prioritized new vaccines and strengthen delivery systems for routine immunization and other life saving interventions.

11. Commence with selected states to implement NVAP with a specific focus on access to HPV vaccines Work with the National Primary Development Agency to access HPV vaccines free of charge from the two manufacturers of HPV vaccine, and other prioritized vaccines from other MNCH Integrate this into existing distribution channels in both the private and public sector as may be cost effective, operationally appropriate Estimate the delivery costs and volume of need for scale up and/or adaptation programmes within both public and private sectors Determine pricing and costing scenarios (including vaccine price) and other operational inputs for programme sustainability National Approach

12. Catalyze effective policy response and support for the expansion of routine immunization and access to new vaccines (initial focus on HPV and cervical cancer prevention) as a part of national and state based efforts to expand vaccine access and improve the health outcomes for women and children (PUBLIC POLICY ADVOCACY) Foster consumer education and promote population acceptability of HPV and cervical cancer prevention/treatment interventions (CONSUMER EDUCATION AND ORIENTATION) Establish a vaccination programme against HPV in the first instance targeting girls aged 9-13 years in selected states (VACCINATION) Objectives I

13. Promote the expansion integration of treatment activities within public and private sector delivery points in the state (SCREENING AND TREATMENT) Document cost effectiveness and sustainability of different delivery channels for state scale up and national sustainability (SUSTAINABILITY) Establish a robust performance management system to track adverse reactions, coverage and determine vaccines/resource needs for HPV vaccination service integration into sub-national and district health care services scale up and national adaptation (PERFORMANCE MANAGEMENT) Objectives II

14. Edo-GAP • Initial state identified by CHESTRAD for OR for the introduction of HPV • Support for 27,500 girls from the GAP programme in March 2010 • Multi-sector platform established to support implementation and sustainability • State level funding to support all local costs to provide vaccines free to members of the target age group • National support required for tax and duty waivers, vaccine storage, distribution and policy relevance • Education Sector capacity assessment completed

15. Learning for Scaling and Adaptation Before a single dose of the vaccine is delivered!

16. Learning and Scaling • Country context • Lessons from the Polio eradication and routine immunization efforts • Cancer prevention and control policies/advocacy • New vaccine introduction (national strategies and state eligibility) • Communication • ‘New’ vs ‘old’ • Population acceptability • Engagement channels • Vaccine Delivery platform • Campaign (vertical), routine (horizontal) and now ‘diagonal’ • ‘New age group, new platform’ • Vaccine packaging - bundling, number of doses

17. Learning and Scaling • Health Systems Constraints • Procurement • Logistics, supplies and cold chain management • Infrastructure • Human Resources – incentive systems • Sector Capacities • Education (school attendance and registers) • Finance (financing local delivery costs, negotiating vaccine pricing), • Information, Women, Youth Development, National CS (Communication and accountability capacties) • Information (Managing engagement and communication) • Global to Local: • fostering an enabling environment

18. Key Milestones October 2010 – March 2011

19. Key Milestones for 2010 – Achieved (March – September 2010)

20. Next steps – NVAP-HPV

21. 29, Aare Avenue New Bodija Estate Ibadan, Oyo State NIGERIA Email: nvap.programs@chestrad-int.org