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Nphcda 2019 Annual Programme Reports
Nphcda 2019 Annual Programme Reports
COVER PAGE
2019
COMPILED
BY
JANUARY, 2020
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ACKNOWLEDGEMENT
The 2019 Annual Report of the National Primary Health Care Development Agency
(NPHCDA) was compiled through a collaborative process involving all departments,
divisions, ED’s office and Six (6) Zonal Offices of the Agency. This Annual Report was
prepared based on the National Strategic Health Development Plan (NSHDP) II Pillars as it
relates to NPHCDA - Enabled Environment For Attainment of Sector Outcomes, Increased
Utilization of Essential Package of Health Care Services, Strengthened Health System for
Delivery of Package of Essential Health Care Services and Predictable Financing and Risk
Protection. The tremendous supports of the Executive Director/Chief Executive Officer of
the Agency, Dr. Faisal Shuaib, all the Directors and the top management staff of the Agency
is highly appreciated. Dr. Abdullahi Bulama Garba, Dr. O. Olayinka, Mr. Remi Joseph, Dr.
Nneka Onwu, Mr. Steven Yusuf, Mr. Yibis Gotar, Hajia Iyabo Daradara, Dr. Joseph Oteri and
the Zonal Directors were also very supportive in the Course of preparing the 2019 Annual
Report of the Agency. The collection, compilation and summary of the Annual Report by the
Heads of Division of Planning, Research and Statistics including Dr. Usman Gana Abdulkadir,
Analyst Dare Jimoh, Mr. Rotimi Oyewole, Mr. Olalekan Runmonkun, and all members of Staff
of the Planning, Research and Statistics Department of the Agency who were part of the
process of developing this Annual Report are highly appreciated. We cannot end this piece
without recognizing and appreciating the role of Mrs. Maureen Gopep, Mr. Philip Tanko, Mr.
Mohammed Kamal Rabiu, Dr. Aliyu Muhammad Sabiu, Mrs. Juliet Amuche and Susan Magaji
who are members of the Policy, Planning and Partnership Coordination Division of PRS, and
all other staff of the PRS Department who were involved throughout the process of
developing and finalizing this Annual Report. I must sincerely commend the efforts of the
Clean Up and Finalization Team (Dr. Usman Gana Abdulkadir, Analyst Dare Jimoh, Mr. Rotimi
Oyewole, Mr. Olalekan Runmonkun, Mrs. Maureen Gopep, Mr. Philip Tanko, Mr. Mohammed
Kamal Rabiu, Dr. Aliyu Muhammad Sabiu and Mrs. Juliet Amuche) who worked tireless to
see that this report is ready and on time. Finally, the NPHCDA is profoundly grateful to all
those, too numerous to mention, who contributed to the laudable achievements recorded in
the past year and pray that the Almighty God will Bless and Reward all for their efforts.
INTRODUCTION ............................................................... 1
1.0 INTRODUCTION ............................................................................................................... 2
1.1 OPERATIONAL AND FINANCIAL REPORTS ........................................................................ 3
LIST OF FIGURES
LIST OF TABLES
Table 1: Status of TA requests from SPHCBS and their Spread across the PHC Building Blocks ............. 8
Table 2: List of Council Memos Presented by NPHVDA at the 62nd NCH in Asaba, Delta State ............. 10
Table 3: Summarizes SIAs Conducted in 2019 .......................................................................................... 14
Table 4: Summarizes cVDPV2 Isolation from different Sources in 2019. ................................................ 15
Table 5: List of Inaugurated NGI-TAG Members....................................................................................... 23
Annexures:
The report is in line with the National Strategic Health Development Plan (NSHDP) II Pillars as
it relates to NPHCDA.
Polio Eradication Initiative in Nigeria made remarkable Progress in 2019 with no reported case
of Wild Polio Virus (WPV) in the Country since 2016. There was an increase in vaccination and
Surveillance reach in inaccessible areas in the Northeast especially in Borno and Yobe States.
Despite many successes observed in 2019, there were major challenges encountered. One
such challenge was the sporadic outbreaks of circulating Vaccine Derived Polio Virus type 2
(cVDPV2). The country experienced several outbreaks of cVDPV2 and several cases of AFP
cases of cVDPV2 were reported; 18 AFP cases , 59 cases from enviromental samples, and 9
fromhealthy contacts and a total of 21 cVDPV AFP cases reported, 7 from AFP, 4 from Human
contacts and 10 from enviromental samples. In addition to the several outbreak responses
(OBRs, two NIPDs were planned, but the country implemented one due to resource ramp
down and BMGF sponsored one National Sub-immunizations Plus Days (SIPDs) which has
almost same visibility with a National round. Three Sub-national Immunization Plus Days
(SIPDs) were conducted. Sustaining the gains made through Polio Campaigns was also
threatened by potential immunity gaps as revealed by the upsurge in cVDPV2 cases and low
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REPORT
coverages based on Community Surveys and Routine Immunization Lot Quality Assurance
Sampling (LQAS) data. As at December, 2019, the Classification in the database, the total no
of AFP cases was (7129), total no discarded (6743), no of cVDPV2 (18), aVDPV2 (7), WPV (0),
not true AFP (122), Pending Classification (234), Compatible case (5), Ready for NPEC review
(7), Pending adequate AFP cases(171),Pending Inadequate cases (63), inadequate AFP <60
days (21), Inadequate AFP 60-90 days 28. There were also challenges of the non-accessibility
with the estimated Children of 34,845 ,000 unreached in Borno State (Abadan and Marte
LGAs), including settlements along some Islands on the Lake Chad Basin. These Challenges
are due to insurgency, insecurity from kidnapping, Communal Clashes, armed banditry, Cattle-
rustling. Also, other States like Benue, Zamfara, Kaduna were affected.
The year 2019 saw a lot of Outbreaks of Measles, Meningitis, Yellow Fever and cVDPV2 but
these were all contained.
The African Regional Certification Commission (ARCC) Verification Team visited Nigeria from
9th to 20th December 2019, where the team reviewed the National complete documentation,
made corrections to the document, and were posted to Six States – Lagos, Oyo, Abia, Edo,
Ebonyi and Delta States to review State, LGA and health facility level documentation for
Polio Certification.
The NERICC Center made a lot of Progress from 4th July 2017 to date as a Coordination Center.
The first activity in 2019 was the Independent Review Committee meeting that was conducted
on the 7th of January 2019.The Critical Success of the meeting was all the 5 Proposals
Presented to the IRC members were approved making it the first time in the history of Gavi
that 5 Proposals were presented by One Country and all the five proposals were approved.
In February 2019, the NERICC team conducted the Joint Reporting form (JRF) and the National
ToT for the PCV Switch from 2 dose vial to 4 dose vial and all the 36 +1 States participated in
the training in March 2019, all the 36+1 States successfully implemented the PCV Switch
implementation and was completed in the second Quarter of 2019.
NERICC also introduced into the Routine Immunization Schedule Meningitis Serotype A in
August 2019 and Successfully trained HCWs on Men A introduction into RI across the 36+1
States, 774 LGAs and 9565 Political Wards. Over 58,700 HCWs’ Capacity was built. National
Flag-off was done on the 9th August 2019 and State level introductions were completed in all
the 36+1 States. Measles Second Dose was introduced in the4th Quarter of 2019.
Also, in the year under Review, a High-Level Mission by the Gavi Delegation Led by the Gavi
CEO took place in Nigeria. After the renewed engagement with 8 Gavi States, the Country,
Partners and Gavi made a Commitment for a high-level engagement meeting at least once in
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a year and ended their visit with Ceremonial Launch/Flag-Off of the Cold Chain Equipment
Optimization Platform (CCEOP) support from Gavi to Nigeria.
It is said that “All Day Work without Play Makes Jack a Dull Boy” – on this note, the year 2019
ended with a Staff Productivity Award/Send Forth for Retired Officers/Departmental Talent
Show and Annual Sports Competition in December which has been institutionalized since
2018.
The development Projects of the Agency are all targeted towards achieving the above goals
and contributing to actualizing the health-related Sustainable Development Goals (SDGs).
2.1.2 Executive Secretaries SPHCBs Quarterly Review Meetings with Executive Director of
NPHCDA
The Department of Planning, Research and Statistics (PRS) successfully Conducted First and
Second Quarter ES Review Meetings in Nasarawa (20th – 21st March, 2019) and Anambra (26th
– 27thSeptember, 2019) respectively.
First Quarter Executive Secretary Review Second Quarter Executive Secretary Review Meeting:
Meeting: 20th – 21st March, 2019 in Nasarawa 26th – 27st September, 2019 in Anambra
The Executive Director also held an Emergency meeting with the Executive Secretary
SPHCBs on 7th June, 2019 on Local Government Autonomy following the Pronouncement of
LG Autonomy by the Federal government. The aim of the Meeting was to discuss how the
Pronouncement will affect the Implementation of PHCUOR. The outcome of the Meeting
was to watch out as events unfold itself and also to liaise with sister organizations that had
similar structure and working under such conditions already e.g UBEC.
The TSU, as at October 22, 2019 has collaborated with officers within and outside the Agency
to deliver 51 targeted on-site technical assistance to 24 requesting States. The interventions
cut across different PHC building blocks such as Governance and System Strengthening,
HRH Management, Infrastructure and Equipment, Commodity and Supply Chain, Financing
for PHC, Service delivery, Information & Research.
PHC Building No. of States No. of unique TA Not Ready for Delivered Total
Blocks request support
Governance and 29 6 29 30 58
system
strengthening
Information and 1 1 6 6 12
Research
HRH 1 1 4 7 11
Management
Commodity and 20 2 0 1 1
Supply chain
Service Delivery 1 1 1 0 1
Infrastructure 10 8 1 0 0
and Equipment
Community 0 0 0 0 0
Services
Total 20 52 105
The technical support program has delivered technical assistance to 25 States in Nigeria
NPHCDA set up the LDA to build a Cohort of Staff equipped with the requisite Leadership
and Management Competencies to coordinate effective TA delivery to SPHCBs. The LDA was
structured as a management Fellowship Programme which deploys varying Capacity
building interventions to develop a Cadre of in-house workforce skilled in Management,
Problem-solving, Decision-making, and implementation Support.
Thirty (30) NPHCDA Staff from across the Headquarters and Zones were selected from those
that passed the prerequisite competency test to become the first cohort of enrolees on the
Leadership Development Academy. Six learning approaches were utilized to deliver the
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curriculum, which include: in-class sessions, external rotations, mentorship, e-learning,
learning tour and a culminating Capstone Project.
Figure 2: Flag Off of Technical Support Programme (TSP) by HMH Prof. Isaac F. Adewole
Having gone through all the learning approaches designed for the LDA, the enrolees
successfully graduated in November 4, 2019. Also, the capacity of the enrolees has been built
to be able to support the SPHCBs in delivering Technical Assistance.
The Agency attended the 62nd NCH with the theme “Consolidating the Journey towards
Achieving Universal Health Coverage” held from 9th – 13th September, 2019 in Asaba, Delta
State where NPHCDA Presented Four (4) Council Memos as in the table below:
Table 2: List of Council Memos Presented by NPHVDA at the 62nd NCH in Asaba, Delta State
Due to the large number of retirees and the Vacuum created, management in its wisdom
conducted a Workshop on Succession Planning for Staff in August, 2019.
Also, a 2-day retreat for Senior Management Staff of the agency took place in Abuja on 30th
October, 2019. The engagement provides an opportunity to appraise and align on the
agency’s vision. The staff also brainstormed on key Strategies to Strengthen & Optimize the
agency’s programmes and priorities and address barriers to optimal program effectiveness.
1. To ensure that appropriate calibre of staff are deployed for all field activities
4. To ensure that only authorized staff members participate in field activities except where
partner’s involvement or other experts are required.
5. To ensure proper monitoring of all staff participation in field activities with the aim of
recommending sanction for non-compliance.
Membership included Union members, all Union Chairmen and Admin Officers of the Zonal Offices
and a legal officer.
Executive Director Dr. Faisal Shuiab, some Directors with Members of the Programmes Implementation
Monitoring and Compliance Committee at their Inauguration: Abuja; 17th September, 2019
At the end of the meeting, Governors and the two Foundations made commitments aimed
at Promoting Stronger Collaboration between the Governors, the NPHCDA, Federal Ministry
of Health and Development Partners to move the needle and transform Primary Health Care
(PHC) at the subnational level.
The Outcome of the meeting led to the 2019 SEATTLE DECLARATION with 9 Commitments
towards improving HCD for PHC.
Seattle Declaration (See Annex 2)
Many States were evaluated during the rounds using LQA Survey and States and LGAs that
failed were asked to repeat the round according to SOPs.
The critical success of the meeting was all the 5 proposals mentioned above were presented
to the IRC members by the team and for the first time in the history of Gavi 5 Proposals were
presented by one Country and all the five Proposals were approved.
• There will be an NVSTT planning meeting before the next fortnightly meeting
to ensure proper planning for the new vaccines’ introduction and PCV Switch
• National level sensitization to leverage on the EPI review meetings
• To present a schedule for the cascade training at state level at the next NVSTT
meeting – Training team; 18 February 2019
• To make the most recent PCV stock data available to the NVSTT
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• To hold further discussions and decide on the modalities for the pre-switch
spot check
• To send communication to the states on the switch plans.
• To present the demand generation plan for the PCV switch in the next
meeting
• The call for materials to be sent out for the collection to be done immediately
after the meeting.
• Create an email for the NVSTT (newvaccinestrategictaskteam@gmail.com)
• Follow up on mapping of partners to activities for the funding of Men A
introduction.
2.3.2.5 Joint Reporting form (JRF) and the National ToT for the PCV Switch from 2 dose vial
to 4 dose Vial
In February 2019 the main activities conducted by the NERICC team were the Joint Reporting
form (JRF) and the National ToT for the PCV Switch from 2 dose vial to 4 dose vial and all the
36 +1 States participated in the training and in March 2019 the main activity conducted by the
Centre was the State level training on PCV switch that started in the second week of March
2019.
Key achievements:
All the 36+1 States successfully implemented the PCV switch based on the above objectives
and the PCV switch implementation was completed in the second Quarter of 2019.
The goal of the engagement was Primarily to identify the Specific Challenges of the poor
performing States and design interventional strategies aimed to address the identified
challenges and improve the overall performance of the LGAs.
2.3.2.7 Engagement Meeting with Medium and High Performing States of NERICC
Strategies – 19 States (3 from NCZ and 16 from the South) were engaged in July in Awka
Anambra State.
Over 150 Senior Officials from the States were engaged and NERICC concepts and Strategies
were presented to them. Three States (Oyo, Kwara and Benue) were mandated to
inaugurate SERICC in their States, while others were given an option to consider
establishment of SERICCs in their States.
Objective:
To update knowledge of immunization officers at all levels on Meningitis disease and its
surveillance, build their capacity on handling and administration of MenA Vaccine
Achievement:
Successful training of HCWs on MenA introduction into RI across the 36+1 States, 774 LGAs
and 9,565 political wards.
Over 58,700 HCWs’ capacity was build based on the above objectives
Executive Director and Traditional Rulers during Men-A Dr. Faisal Shuaib ED NPHCDA Administering of
National flag-off in FCT: 9th August 2019 Men A Vaccine
2.3.2.11 RI-RMNCH Programme Assessment for Performance management & Action (PAPA)
Planning meeting, NToT and implementation have been successfully executed in all the Q3
PAPA States and findings disseminated to all the relevant stakeholders. PAPA LQAS for first
to 3rd Quarters were successfully conducted and disseminated.
The 8 States were selected by Gavi for an extended support in the form of HSS, the States
are currently developing their HSS Proposals. The States are: Kebbi, Katsina, Zamfara,
Jigawa, Taraba, Gombe, Niger and Bayelsa.
Mock review meeting in Kano was concluded successfully and proposals submitted to Gavi
and endorsed by ICC. Now awaiting IRC review proposed for 2020.
• Appreciate the effort the FGoN is making in increasing the funding for
Immunization and PHC System based on the agreed commitment between
Gavi and FGoN
• Reiterate the Commitment of Gavi on the implementation of the agreed
accountability framework between FGoN and Gavi.
The key activities during the visit included but not limited to the following:
Meeting with Honourable Ministers of Health, Finance, Budget and National Planning
The meeting was successfully executed as planned and the expected outcomes achieved.
Nigeria should introduce the HPV Vaccine in its immunization programme in line with the
proposed 2021 timelines in the Nigeria Strategy for Immunization and PHC System
Strengthening 2018 – 2028. The HPV introduction should target age group 9 – 14years.
The Country should consider introduction of the HPV Vaccine in both sexes (Boys and Girls)
with a phased approach initially targeting Girls - this is due to the burden of Cancer of Cervix.
In the medium to long term, the Country should improve on its immunization financing
status and consider inclusion of HPV schedules for boys.
The Nigeria Immunization Programme should use the following Strategies for HPV
introduction:
• Facility based
• Outreaches (in Schools and out of Schools)
Dr. Chinedu Simeon Arua Core Member Consultant Radiation and Clinical
Oncologist/Epidemiologist
To review new evidence and data on Rotavirus vaccine products and proffer
recommendations
The group met on the 18th of October 2019 to deliberate on the request sent by the FMoH/
NPHCDA on the need to review its previous recommendation on the type of Rotavirus
Vaccine to be introduced into RI considering new information on the different product types
now available. The Rota Disease Working Group was then formally inaugurated to gather
and review all the new information on the different product type to enable the group make
a final decision.
To review the Rota Disease working Group draft recommendation on Rotavirus vaccine
introduction into RI
After 2 meetings held by the Rotavirus Disease Working Group, a general meeting was held
on the 18th of November 2019 at Valencia Hotel, Abuja, with 16 members present including
the Chairman of the group, and the following recommendations were made concerning
Rotavirus vaccine and submitted to the FMoH:
It was the decision of the NGI-TAG to resubmit the previous recommendation of Rota Vac as
the preferred Rotavirus vaccine choice for Nigeria.
•Despite the challenges, the group achieved all its objectives of setting it up.
CHALLENGES
2.3.4.1 Meningitis A
Neisseria Meningitidis is the leading cause of bacterial Meningitis and other serious
infections worldwide. Nigeria has Twenty-Six of its Thirty-Six States and the FCT along the
Meningitis Belt. So far, the Country has conducted 4-phased Meningitis Campaign to control
CSM using Men Afri Vac from 2011 to 2014 targeting persons aged 1 to 29 years of age.
Due to the high burden of the disease amongst under five children and following the WHO
recommendation of conducting Campaign after introduction of Meningococcal - A
Conjugate Vaccine into the Routine Childhood immunization, Nigeria planned to implement
a follow up Campaign targeting children 1 to 5 years (North West and North East States) and
1 to 7years to reach the cohort of children that were born after the completion of previous
Campaigns.
The overall goal of the 2019/2020 Men A Campaign was to eliminate epidemics of
Meningococcal Meningitis due to Sero Type A from Nigeria by vaccinating at least 95% of
Children in States with high disease burden.
Participated at the Integrated Disease Surveillance and Response (IDSR) review and update:
August 25th -31st 2019 in Lagos
Short Term, Medium Term and Long-Term Prospects for Cholera Control in Nigeria review by
Global Task Force on Cholera Control (GTFCC) - November 2019
Meeting of National Committee for the Verification of Measles Elimination in Ilorin- 7th – 9th
October 2019
Northern AEFI cluster training involving 19 Northern states in Kano - 26th – 30th October 2019
National Expert Committee meeting on AEFI in Rivers - 18th – 20th November 2019
Participated Mid- term Joint External Evaluation on Nigeria health security - 18th – 22nd
November 2019
As at October 31, 2019a total of 1,583 suspected cases of Cholera were reported of which 339
were confirmed cases and 22 deaths among suspected cases (CFR = 1.38%) were reported
from Seven States (Adamawa, Bayelsa, Ebonyi, Delta, Kano, Katsina and Plateau) from the
beginning of 2019. Of the suspected cases, 33.3% were aged 1 - 4 years. Among all suspected
cases, 56.3% were Females whereas 43.7% were Males.
Nigeria: January to October, 2019: Epi Week 1 – 43: States/LGAs affected by Cholera with
attack rate per LGA
Table 6: Cholera Outbreaks, Year to Date Comparison Between 2018 and 2019 (Nigeria)
Oral Cholera Vaccination Campaign Implementation in Phase O Hotspot LGAs in Nigeria: Nov
2018 – Sept 2019
• Coverage Survey: The aggregated weighted coverage for the 2 LGAs included
in the survey in Borno State was 87%
• AEFI was of negligible significance in all the Campaigns
• At present, impact evaluation is yet to be conducted. However, there has not
been any reported cases of suspected Cholera Outbreak in any of the LGAs
that have been Vaccinated since 2017 except in Maiduguri Municipal Council
where there was a high influx of unvaccinated IDPs from other parts of Borno
State affected by crises.
WASH Components
• Since the beginning of 2019 Outbreak, the Water, Sanitation and Yygiene
(WASH) intervention, led by the Federal Ministry of Water Resources (FMWR),
has been providing motorized Solar-powered boreholes, Sanitation units with
Hand Washing facilities, as well as blocks of Latrine compartments in affected
States
• House-to-House Hygiene Promotion activities are ongoing in affected
Communities of Adamawa State with Water purifiers being distributed to
households. As at October 31, 2019, Adamawa State has accounted for 51% of
the cases of suspected Cholera Outbreak in 2019
• 170 Water points have been mapped for treatment within the affected LGAs in
Adamawa State
• Nigeria is also working with other Lake Chad Basin Countries to Strengthen Cross-
border Collaboration for Cholera Control
Challenges
• In addition to the hotspot prioritization which has been planned for review in
January 2020, and in response to a call for a multi-sectoral long-term plan for
the Cholera Control in Nigeria, a 5-year National Strategic Plan of Action for
Cholera Control has been developed. This is to drive a coordinated approach
to Cholera Control in Nigeria and this plan currently forms the basis for all
cholera control interventions in the country.
• Seven (7) Strategic areas of interventions have been identified as
complementary tools for achieving the medium-term goal. These are;
Leadership and coordination, Epidemiologic surveillance, Laboratory
surveillance, Case Management and Control, Social Mobilization/Risk
Communication, Improvement in the Supply of Safe Water, Sanitation and
Hygiene and the use of Oral Cholera Vaccine.
• A Critical part of the goal plan was to reduce the incidence and mortality due
to Cholera by 67% by the year 2023. This medium-term goal forms part of a
larger framework of eliminating cholera in Nigeria by 2030 as part of global
target
• Measurable indicators and annual targets have been set for the monitoring
and evaluation of each sphere of activity contained in the plan
• Efforts were being made to identify relevant partnerships to conduct impact
evaluation on the various Cholera Control Strategies so far deployed as well
define research priorities for strengthening cholera control in Nigeria
Conduct outbreak investigation together with NCDC and WHO on suspected yellow fever
reported cases including entomology studies
Katsina implemented YFPMVC from 28th sept – 9th oct 2019 (27th sept 2019 in Dan-
musa&Kankara due to the YF outbreak)
YF Preventive mass vaccination campaign in 3 LGAs in Borno state- 11th to 20th December
2019
Edo (13 LGAs), Delta (1 LGA) and Ondo (6 LGAs) – June/July 2019
Ebonyi (Abakaliki, Izzi and Ebonyi LGAs) and Cross River (Yala LGA) – 8th -18th September
2019
Together with NCDC and Partners, a Yellow Fever risk assessment was done to prioritize
highest risk states for Preventive Campaigns to forestall outbreaks
Preventive Mass Vaccination campaigns planned for Anambra, Ekiti and Rivers in 2020.
Meningitis A and Measles Mass Vaccination Campaign was integrated in 18 States of the Northern
Zone except Kano and Yobe. Kano had stand alone for Measles and Meningitis A while Yobe had only
Measles Campaign. The target for Measles was 9 – 59 months, while the target for Meningitis A
varied from 1 -5 years and 1-7 years across 25 States. The Campaigns began on the 31st October 2019 in
Kano.
Stand-alone Meningitis A vaccination campaign started on the 6th December 2019 in Imo and Enugu
states. Oyo, Ebonyi, Cross Rivers, Anambra will conduct their Men A mass vaccination Campaign in
2020.
The NPHCDA has supported most of the affected states in responding to these outbreaks through
providing the states with vaccines. The NPHCDA zonal and state offices were leveraged upon to
provide technical support to the states. However, the NPHCDA has conducted some reactive
vaccination in some very high prone areas: The Measles OBR took place in the following States viz;
Yobe, Ogun, Benue, Lagos, Borno, Igabi LGA of Kaduna and Hong in Adamawa.
Conclusion:
Most of the Outbreaks that have occurred were areas where vaccination could not take place due to
security challenges - IDP camps and their host communities. The agency through its vaccine
forecasting for the year 2020 has planned to prioritize preposition of vaccines in these vulnerable
areas.
Three rounds of SIAs were recommended in these LGAs. These rounds were implemented
with administrative coverages of 130%, 122%, 133% for Td1, Td2, and Td3 respectively. In Itapa
community, administrative coverages of 185%, 99% and 109% for Td1, Td2 and Td3 was
attained. The high coverage above 100% can be attributed to influx of people from
neighbouring LGAs, Communities, and denominator issues as projected 2006 census was
used. Following implementation of recommended activities in 2018, MNTE was validated in
the South-west zone in May 2019.
A high-risk assessment conducted in the South-South zone identified 94 LGAs in the six
States as high risk. One round was recommended for 94 LGAs in the six states, 2 rounds for
56 LGAs in five states, then 3 rounds for 8 LGAs in one state. NPHCDA with support of
Partners has implemented two rounds as recommended reaching an administrative
coverage as follows; Akwa-Ibom (Td 1 - 112% ; Td 2 - 84%),Bayelsa (Td1 - 95% ; Td 2 72%),Cross-
river(Td 1 – 118% ;Td 2 - 91%),Delta (Td 1 - 97%),Edo(Td 1 - 80% ; Td 2 - 56%)and Rivers(Td 1 -
102%).
A high-risk assessment was conducted for Northern States in March 2019 and 136 LGAs were
identified as high risk in 16 states namely: Kano (3), Katsina (14), Kaduna (3), Kebbi (10),
Sokoto(6), Zamfara (6), Benue (18), Kogi (15), Kwara (10), Niger (7), Plateau (16), Taraba (4),
Yobe (3) ,Borno (19), Bauchi (1) and Adamawa (1). Three rounds of SIAs were implemented
as recommended for these LGAs. National MNTE Northern States (North-West and North-
Central zones) implementation training was conducted on the 9-10th September 2019.
A National workshop with South-East and South-West Zones was conducted to develop Plan
of Action to sustain elimination of Maternal Neonatal Tetanus (5 - 9 September 2019).
ADMIN
NO OF DATE OF TARGET POP NO COVERAGES
S/NO STATE LGAs IMPLEMENTATION (15-49YRS) IMMUNIZED
2.4.2 National Primary Health Care Under One Roof (PHCUOR) Scorecard 5 Assessment in
36 States and FCT.
The Department of Primary Health Care Systems Development (PHCSD) Conducted the 2019
National Primary Health Care Under One Roof (PHCUOR) Scorecard 5 Assessment in 36
States and FCT.NPHCDA and Nigeria’s Governors Forum (NGF) Secretariat with support from
other Partners (PACFaH@Scale (PAS), Health Policy Plus (HP+), Network for Health Equity &
Development (NHED) and Health Reform Foundation of Nigeria (HERFON) conducted the
PHCUOR Scorecard 5 Assessment in September/October, 2019 in the 36 States and FCT. The
goal of the PHCUOR Scorecard 5 Assessment was to Produce an Advocacy tool to help
To identify areas of strengths, best practices, gaps/weaknesses and challenges in each state
To produce a scorecard as an advocacy tool for engaging policy makers including State
Governors as well as other PHCUOR actors in all States to improve political commitment and
funding for effective Primary Health Care (PHC) implementation to enhance rapid
achievement of Universal Health Coverage (UHC)
To develop, print and disseminate a report that provides a guide for States and the FCT to
request technical support from NPHCDA and partners to improve their performance
83%
80%
77%
74% 73% 72% 71%
64% 64%
GOVERNANCE & LEGISLATION MINIMUM REPOSITIONING SYSTEMS HUMAN FUNDING OPERATIONAL OFFICE SET UP
OWNERSHIP SERVICE PACKAGE DEVELOPMENT RESOURCES SOURCES AND GUIDELINES
STRUCTURE
7
NPHCDA – National Primary Health Care Development Agency
100 97 97 97
94 93
92
90
84 85
81 82 81
79
80 76
74 73
72 72
69
66 66 66 66 67
63
58
60 55 56
54 54
51
40 39
40 36
24
19
20
2.4.3.2 Flag Off/Launch of the Scaled Up LGAs-Health Facilities of Bauchi and Gombe States
In order to increase political buy-in and program visibility and awareness, Gombe and Bauchi
State PIUs organized flag off ceremonies for newly scaled up LGAs. The Launch /Flag off
event focuses on the goals and objectives of the NSHIP intervention, creates awareness on
the existence of the NSHIP initiative in the scaled up LGAs and health facilities.Governors
and traditional leaders present promised to support the project at all levels as they have
witnessed the positive impact has made in the already benefiting communities. Both
governors promised to look into sustainability of the project in their respective states.The
flag off event occurred in the new scale up LGAs of Gombe (Akko and Billiri) and Bauchi
state (Kirfi, Itasgadau, Darazo) from the 18th-20th July 2019.
2.4.4 Conduct of First Lots Quality Assessment Survey (LQAs) for Ondo State; by World
Health Organization
The Modified PBF in Ondo State includes replacement of routine quantity verification with
Lots Quality Assurance Survey. Quality verification and counter verification continues in
accordance with the project design, WHO is now responsible for the conduct of LQAS with a
shift in focus from facility-based impact to population -based impact. The baseline for all
LGAs was conducted in January this year and first LQAS was conducted in July 2019.Below
are the results of the baseline and first survey conducted for the 9 LGAs implementing PBF
in Ondo State.
Conferment of CHIPS Champion Award on the Sultan of Sokoto, Kaduna 2nd April, 2019
During the Second NTLC meeting, the ED, NPHCDA who was represented by Director
Disease Control & Immunization solicited for the sustained support of the Royal Fathers in
Primary Health Care generally with special focus on RI and Maternal and Child Health
interventions while adding that the Agency continue to evolve Strategies to improve and
Strengthen Primary Health Care for the benefit of all Nigerians.
Outcome:
• To do a photoshoot with the real CHIPS Agents for the IEC material
• To get appropriate pictures for each scenerio
• To have available pictures for the CHIPS Programme Unit
Various Scenarios were discussed and agreed on by the National level team before the
activity. Some of which included CHIPS Agent Counselling a Womanwho is holding a baby
inside a house;A CHIPS Agent trying to teach a mother proper positioning and attachment of
her baby during breastfeeding; A CHIPS Agent completing her data tools; A CHIPS Agent
escorting a Caregiver to the Health Facility etc.
A CHIPS Agent escorting a Caregiver to the CHIPS Agent Counselling a Woman A CHIPS Agent completing her
Health Facility who is holding a baby inside a house data tools
• Operationalization of NEMCHIC
• Consultative Retreat
• Categorization of States based on RMNCAH+N key Indicators
• Development of state engagement tools
• Development of NEMCHIC operational guideline
• Engagement of RMNCAH+N stakeholders
• Development of Monitoring & Evaluation (M&E) framework
• First state engagement (Bauchi and Kebbi)
• Harmonization of state engagement visits and tools under the Optimized
Integrated RMNCAH+N and Immunization Supportive Supervision (OIRISS)
• Second state engagement (Katsina, Combe and Taraba)
• Engagement with partners:
• REAKTHROUGH ACTION – NIGERIA for harmonization and standardization of
community engagement and WDC tools
• e-Health Africa
Executive Director, NPHCDA declaring a State of Public Health Concern on Maternal and Child Deaths
with some Traditional Rulers; Abuja, April 8th 2019
• To appraise the situation of Maternal and Child Health for each state including
a review of the progress and status of the states’ RMNCAH +N operational
plan in line with SSHDP and NSHDP
• To identify enablers and bottle necks to reducing maternal and child mortality
in the different states
• To align on priority interventions and stakeholder’s ownership of
interventions.
• To introduce the concept of National Emergency Maternal and Child Health
Intervention Centre (NEMCHIC) and develop Terms of Reference for State
coordinated platform.
• To facilitate peer to peer learning amongst the high and low performing
states towards reduction of maternal and child mortality.
• To plan for the conduct of NEMCHIC technical and advocacy visit to states in
the low category of RMNCH+N performance
Accordingly, all the states of the federation were categorized according to levels of performance on
MCH indices based on data from 2018 NDHS report and 2019 Q1 PAPA survey. The categories are Low
1- States (Very Poor) Low 2 - States (Poor) Medium 1 - State (average) Medium 2 - States (below
average) and High State (Good), see Fig. below.
SOKOTO
KATSINA
YOBE
JIGAWA
ZAMFARA
KANO BORNO
KEBBI
BAUCHI
GOMB
NIGE KADUN E
R A
ADAMAWA
KWAR
A
PLATEA
U
FC
OY T NASARAW
O A TARAB
A
EKIT
OSU I KOG
N I BENU
OGU E
OND ED ENUG
N
LAGO O O U
S
EBONY
ANAMBR
I CROSS High States (Good)
A IM
RIVER
DELT
O Medium 2 States (below average)
ABI
A RIVER A Medium 1 States (average)
S AKWA Low 2 States (Poor)
BAYELS IBOM Low 1 States (Very poor)
A No data
Advocacy Visit to Deputy Governor Kebbi State Advocacy visit to HRH Emir of Argungu(Kebbi State)
• Establishment of SEMCHIC
• High level commitment and support from the traditional council on
implementation of SEMCHIC interventions
• PHC facilities provided with Mama and delivery kits
• On the job training on Data Management and Infection control/hygiene
• WDC understands the need to include RMNCAH+N Issues in meeting agenda
• Development of SEMCHIC work plan
Other State engagements were Bauchi, Taraba, Katsina
Dr Nwosu Presenting Mama Kits to Gov Taraba First Lady Bauchi State Decorated as NEMCHIC Ambassador
2.1 Figure 1
Target
No of
S/N Activity Entity Achieved Gap Remarks
Development of
SPHCB/NPHCDA 2019 costed All 11 SPHCDBs and
1 work plan 12 12 0 NPHCDA
The key activities conducted includes the review and update of training materials for the
volunteers and sub-national planning meetings.
Southern States Assessment took place in the Second Quarter of 2019 while the Northern
States took place in 2018. The following five Domain Areas were Assessed:
• Infrastructure • Staffing
• Ward • Health Commodity Supplies
Mechanism/Governance • Basic Services
SUMMARY OF FINDINGS:
4.2.2 2019 Conditional Assessment/Survey for Project under the 2018 Appropriation
The Project Monitoring and Implementation Division carried out a Conditional Survey of all the
Health Facilities that were to be renovated from One to Six (6) Million Naira.
Staff of the Project Monitoring Implementation Division (PMID) were engaged in the exercise to be
able to conduct a Physical Assessment of the level of dilapidation of selected PHC facilities
appropriated in 2018 budget and produced a narrative report with the Bill of Quantity for each Site.
The Zonal Technical Officers (ZTOs) and the LGA officers were directly involved in these sites’
inspection along with the Staff from the Headquarters and State Offices – State Coordinators.
1 North-Central 10 10
2 North-East 3 3
3 North-West 7 7
4 South-East 16 16
5 South-South 9 9
6 South-West 11 11
TOTAL 56 56
Provision of 300KVA generator set for the Annex office (October-November, 2019).
Challenges:
• Inadequate Personnel
The ICT Unit, with the quantum of responsibilities being taken up and solutions
proposed currently lacks the requisite personnel. This is slowing down the deployment
of available solutions and the response time to issues, particularlytroubleshooting. The
Unit is in dire need of personnel with competencies in database/software
management, hardware management, network administration etc.
• Office Space
Sequel to the enlargement of the server room, the remaining space in the ICT Office
can no longer accommodate the staff, including NYSC and IT personnel attached to
the Unit. The proposed movement of critical databases from Partners to the NPHCDA
server would also mean that access to the server room must be restricted.
• To Review the Current 2019 Forecast and its Performance for the States
• Conduct the Forecast considering the new trend of coverage per vaccine
antigens
• Review consumption on coverage data for preceding year to guide the
forecast assumptions
• Determine target and activities for the coming year including new vaccine
introduction campaigns and expected coverage projections
• Forecast quantities for the year 2020 using the just concluded nationwide
physical stock count of immunization supplies
• Prepare a shipment plan for vaccine and devices based on our storage
capacity
Summary of Findings
Following the Physical Count exercise across the Country, the following findings were made:
Qualitative Findings:
• Physical Stock Count should be conducted monthly at State level and Weekly
at LGA and Facility levels by the cold chain officers at all levels with regular
effective Supportive Supervision by the SLWG
• The National Logistics Working Group (NLWG) to agree on more reliable
denominator to be used by states for vaccine forecasting
• High doses containing vaccines like BCG should be reduced by the
manufacturers, immunization sessions and SIAs properly monitored, improve
the capacity of vaccine stakeholders across all levels and revamp cold chain
infrastructures
• States should provide budget line and release funds timely for vaccine
logistics to all levels in the State
• Establish/Reactivate SLWG, provide budget line to fund the LWG and monitor
the implementation of Continuous Improvement Plan (CIP)
• National and States to provide data tools, States to improve capacity of
stakeholders on DHIS2 usage by training and retraining and National to
improve the functionality of the DHIS2 platform by allowing the State to have
full access and control facilities on the platform
61 | Page NPHCDA/2019 ANNUALREPORT
4.3.2 Vaccine and Related Commodities Physical Stock Count in Nigeria from 10th – 23rd
June, 2019
As part of the drive to improve Vaccine Accountability and Stock Management, the NPHCDA
through the National Logistics Working Group (NLWG) conducted a nationwide Physical
Stock Count (PSC) Exercise from the National level to the Service delivery points. The
Purpose of this exercise was to provide Strategic and actionable insight into the volume of
Vaccines and related Commodities available ahead of the 2020 Vaccines and devices forecast
exercise.
• To Conduct a Physical Stock Count of all Antigens and devices at the National,
Zonal, State and Local Government Area (LGA) Cold and Dry Stores, Health
Facilities (HFs) with Cold Chain Equipment and other Storage points across the
Country;
• To determine the actual quantity of Vaccines and related Commodities in
Country
• To verify the accuracy and completeness of stock records at all levels in
compliance with best practices
• To obtain selected indicators that provide insight into performance of
Nigerian iSC and its alignment with the Dashboard for Immunisation Supply
Chain (DISC) indicators
• To support stores to arrange products according to Earliest Expiry FirstOut
(EEFO) principle
• To identify gaps and recommend strategies for improving stock and inventory
management practices per EVM Standards.
FINDINGS
The following were some of the findings from the various Zones and their corresponding
States, LGAs and HFs.
• Results of the PSC at the SW Zonal Store revealed that all the assessed
vaccines and diluents were available in the store. The most stocked vaccines
and devices were bivalent oral polio vaccine (bOPV) and 0.5ml syringe
respectively while the least stocked vaccine and devices were Yellow fever
vaccine and 2ml syringe respectively.
• PSC results from the Six SW State stores revealed that the most stocked
vaccines were monovalent oral polio vaccine type 2 (mOPV2) with the highest
stock found in Lagos State store, Yellow fever with the highest stock found in
Ondo State store, and bOPV with the highest stock found in Lagos State store.
Total stock of vaccines, diluents, devices, data tools and asset – including diluents (in vials
and doses) segregated by batch number, expiry date and VVM status.
The Tables below showed the sums of the Vaccines counted at each Zonal, State and LGA
Cold Stores.
The physical count exercise at the South East Zonal stores (cold and dry) reported all
vaccines on the routine immunization list as been currently available. The most stocked
vaccines at this store were bOPV (6,406,280 doses) and Penta (1,348,110 doses), and the
most stocked diluent is BCG Diluent at 624,120 doses.
Review of the store’s LMIS (NISCMIS) revealed it stocked out of two vaccines (BCG and
Yellow Fever) for a period of 17 days.
The following are initial observations and/or challenges identified from the data presented in
the pivot table of stock:
• Critical for the zonal cold store is the volume bOPV meant for SIA in VVM
stage II. The following are recommendations for addressing this;
• During the SIA for which the bOPV will be used, emphasis must be placed on
maintaining the integrity of cold chain (using appropriately conditioned ice-
packs during transport and campaign trips etc.).
• In the mean-time care must be taken to ensure the cold storage for bOPV is
not compromised.
All the Cold Chain Equipment at the Zonal Store were functional and well maintained.
However, both air conditioners at the zonal store are not functional due to damage as a
result of electrical surge when connected to the national grid.
There were significant differences (> 2%) the ledger stock balance and that in the LMIS in 5 of
the 9 vaccine stock balances compared in the table above. The LMIS is the primary stock
tracking tool at the store, it is apparent there are significant flaws in the data management
flow at the zonal store.
The stock balance following the completion of the PSC only had two exact matches with
zonal store LMIS stock balance, PCV 4 and Td.
Similar to the zonal store, four of the five state stores in the zone use both GON ledgers and
LMIS for data management (Imo State Cold Store has not been equipped for LMIS).
However, the PSC team did not have access to the LMIS data for Anambra State Store
during the exercise as there was a technical issue with the system according to the CCO. The
LMIS in Abia State is functional but read zero for all stock balances.
Out of the two state stores with available stock balances for both the ledger and LMIS, only
Enugu State store had an 100% match in its record for the five selected tracer vaccines in the
table above. The PSC count for three of the vaccines (BCG, bOPV and Penta) was also an
exact match with records on the ledger and LMIS. Ebonyi State Cold Store also had an exact
match between the PSC balance, the ledger and LMIS for two vaccines.
The results of the Zonal Cold Store audit are presented in the tables below:
Quantity of Vaccines and Diluents located in the South South Zonal Cold Store, Warri.
BCG 281,860
Measles 385,750
YF 831,830
bOPV 7,034,000
HepB 289,530
IPV10 168,670
Penta 790,130
Td 241,240
The results from Table above showed that bOPV, Yellow Fever and Penta vaccines are in
higher supply compared to Measles, Hepatitis B or Tetanus vaccines. In terms of diluents,
Measles and Yellow Fever diluents dominate in terms of availability in the Zone. However,
there is an uneven ratio of lyophilized Measles and Yellow Fever vaccines to their respective
diluents. In both cases, the diluents out-number the vaccines by a large margin.
RECON2M 39,000
RECON5M 645,390
In terms of devices found in the dry store, the AD syringes had the highest stock balance of
over ten million pieces, as seen in Table above.
The findings in the zonal cold store reveals that the quantity in doses for BCG vaccine and its
corresponding diluent used for RI is 60,620 and 8,140 doses respectively. A total number of
9,765,220 doses of bOPV in VVM stage I was used for both RI and SIA. Measles and Yellow
fever vaccine and their corresponding diluents were seen to have a total number of 308,710
and 422,310 and 229,520 and 306,990 respectively. From the findings, it is shown that a total
quantity of 720 doses of bOPV in VVM I stage to be used for SIA at the North East Zonal Cold
Store, have a close expiration date December 2019, 01-12-2019 and also the findings shows
that a total quantity of 200 pieces of AD BCG Syringes (0.05ml) have a close expiration of
December 2019, 01-12-2019 at the North East Zonal Cold Store. A total number of 2,111,981
devices were counted at North East Zonal Cold Store, with the AD Syringes (0.5ml) having
the highest number of quantities in pieces, a total sum of 1,263,900 pieces, followed by the
AD BCG Syringes (0.05ml) with a total sum of 448,350 pieces and safety boxes having the
least quantity, with a total sum of 2,235 pieces.
In Adamawa state has a total number of 167,960 doses of bOPV vaccines are in VVM stage II
for RI activities. We also have 13,120 doses of Penta in VVM stage II as well. 31,952 pieces of
AD BCG Syringes (0.05ml), 74,000 pieces of AD Syringes (0.5ml) were also found.
Across the states in the North Eastern State Cold Stores, a total number of 255,040 doses of
BCG were counted with corresponding 180,180 doses of BCG diluent. A total of 2,272,100
doses of bOPV were counted with over 1,017,680 of these already in VVM stage II. A total of
From the findings, it was shown that in Adamawa state, Gombi LGA Cold store and Song LGA
Cold store had IPV10 and Penta vaccines in VVM stage III. Also, Hong LGA Cold store was
seen to have 220 doses of bOPV in VVM stage IV. Additionally, in Michika LGA cold store of
Adamawa state, Hep B vaccine used for RI programme expired on the 1st of April 2019 and in
Damaturu Satellite Cold Store, Yobe state, mOPV2 was seen to have expired on 01/09/2018.
Findings also shows the vaccine/diluent that had expired in the Zonal cold store. Measles
diluent of batch number 9912414 and 03-1674 expired in 01/05/2019 and 01/08/2018
respectively. Furthermore, Yellow fever diluent with batch number 46 and M8003-1 was
found to have expired on 01/04/2019 and 01/01/2018 respectively. Td was also seen to have
expired on 01/01/2018.
Across State cold stores in the North East Zone, findings showed that there were less than
1% (<1%) closed vial wastage of vaccine and diluents.
At the North East Zonal Cold Store level, most of the storage points had full stock availability
of over 80% for the resupply period. Analysis of findings from the physical stock count also
revealed that at the state cold store level, 94.9% of the state cold stores had full stock
availability over the resupply period. In the North East zone three states (Bauchi, Borno,
Yobe) have state satellite cold store. The state satellite cold store supplies stock to the LGA
cold store. Very few states satellite cold stores experienced stock out over the specified
resupply period. 94.7% of the satellite cold store had full stock availability. Findings also
showed that 89.40% of the LGA cold store across the North East zone had full stock
availability of vaccines and devices across. At the Health Facility Level, Majority 92.7% of
health facilities had full stock availability over the specified however, only 5.9% of the health
facilities in the North East Zone experienced stock out of vaccines and devices over the
specified resupply period.
Significant non-functional cold chain equipment as shown in the table 48 include 2 walk-in
cold room in Taraba and 1 walk in freezer also in Taraba. All walk-in cold rooms at the North
In calculation of the DISC indicator stocked according to plan (SATP) requests over a
specified period were used to calculate the average monthly consumption (AMC) and the
stock on hand which was obtained during the physical stock count exercise was then used
to calculate the months or weeks of stock. The estimates from Bauchi, Adamawa, and Yobe
state cold stores show that these stores are understocked while the Borno state cold store
is overstocked.
Compliance with best storage and record keeping practices seemed to decline significantly
down the supply chain as it was observed that the LGA separated and documented expiries
better than the health facilities. Comparison across the states showed that Gombe state
health facilities had a poor compliance to best storage and record keeping practices. 14% and
10% of the health facility in Bauchi and Adamawa were seen to document damages and
expiries following best storage and record keeping practices. More than 60% of the LGA cold
stores across the 6 north eastern states observe EEFO principle and store vaccine under the
right temperature. LGA cold stores especially in Bauchi and Borno did not seem to have
shelves and pallets to properly store their dry stock items. Separation and documentation of
expiries seemed to be a common challenge at the health facilities and LGA cold stores. All
the state cold stores in the NEZ including the zonal cold store observe the EEFO principle in
vaccine/diluent and devices storage except the Borno state. Shelves and pallets can be
found in the dry store of the NEZCS and that of the six states cold stores in the zone. All the
state cold stores seem to separate expiries from the usable products. Finding also shows
that these expiries are documented and properly recorded into a designated checklist.
Data Accuracy was determined using the WHO’s validated standard methodology for
immunisation Data Quality Audit (DQA). This methodology was adopted to compare stock
balances across physical count quantity, ledger balance and LMIS balance at the Zonal, State
and Health Facility Cold Stores. An Accuracy Ratio of between ≥ 0.95 to ≤ 1.05 indicates
consistent data and AR of < 0.95 or >1.05 indicates data over reported or under reported.
The figure below shows that some satellite stores still have challenges with data accuracy
and records are not transferred adequately into the ledgers and the LMIS system available.
At the State level similar documentation challenges exist across board except in Bauchi state
where adequate records are kept and transferred across the physical count conducted,
ledgers and LMIS available.
Vaccines and diluents were taken stock of and recorded at the National Strategic Cold Chain
Store. All vaccines and diluents counted were in the VVM stage I and were used for both
Routine Immunization and Supplementary Immunization activities. The quantity in doses for
BCG vaccine and its corresponding diluent used for RI is 2,358,480 and 2,451,140 doses
respectively. The total number of bOPV is 12,222,760 doses as seen in the table shown above.
Measles vaccine and its corresponding diluents used for RI have a total number of 4,937,040
and 3,576,900 while Yellow fever vaccine and its diluent was seen to have 2,732,360 and
4,824,460 quantities in doses respectively. At the National Strategic Cold Chain Store AD
BCG Syringes (0.05ml) and AD Syringes (0.5ml) have a total number of 4,167,660 and
1,045,953 pieces respectively. The 2ml and 5ml RUP Reconstitution Syringes were 3,592 and
665,558 pieces respectively. 5L safety boxes were 34,106 pieces in quantity.
The North Central Zonal Cold store, the team found disparities between BCG vaccine and its
corresponding diluent at 2,284,480 and 631,020 doses respectively as well as Measles
vaccine and its diluent with a total number of 252,660 and 343,100 doses respectively. The
table above also shows that Yellow Fever vaccine and its diluents are 151,300 and 206,550
doses respectively. 1,565,600 doses of bOPV were found to be in VVM II. Other vaccines
counted include IPV 10, Penta and Td with 346,000, 352,360 and 188,660 doses respectively.
A total of 992,990 pieces AD Syringes (0.5ml), 45,730 pieces of AD Syringes (5ml) and
143,225 pieces of Safety boxes (5L) were counted in the zonal cold store.
At the National and North Central Zonal Cold Store there were no historical expired and
damage vaccines found over the specified period. Across facilities and cold store in the
North Central Zone, findings showed that there were less than 1% (<1%) closed vial wastage
of vaccine and diluents. With exception of Kwara State where Penta vaccine was found to
have 4.96% Closed Vial wastage rate.
At the National and Zonal Cold Store level, no stock out was recorded, as they both had a
100% full stock availability over the resupply period. Analysis of findings from the physical
stock count also revealed that at the state cold store level, 87.50% of the state cold store had
full stock availability over the resupply period. Findings also showed that at the Local
Government Area Cold Store level, 92.50% of the LGA cold store across the North Central
zone had full stock availability of vaccines and devices over the resupply across. At the
Health Facility Level, Majority 93.6% of health facilities had full stock availability over the
specified period.
A further analysis was done at the state level and findings showed that health facilities and
cold store in Kwara State did not have any stock out of vaccines and diluents within the
A DISC indicator (functional Status of cold chain equipment) was determined in combination
with other cold chain assets by estimating the ratio between the quantities of functional and
non-functional items. Vaccine carriers, walk in cold rooms and freezers were 100% functional
at the National Strategic Cold Store. The Store had just one non-functional domestic freezer.
The walk-in freezer room, refrigerator rooms and cold boxes were 100% functional at the
NCZCS.
The chart below depicts the proportion of all vaccines and their corresponding diluents at
each supply chain level in all the seven (7) states. 32.9% BCG was at the zonal cold store. Also
at the zonal store, was bOPV at 87.0%, mOPV at 86.4%, and PCV4 at 44.1%, Penta at 48.3%, Td
at 50.5% and YF at 55.7%.
In addition, them OPV2 was mostly available at the zonal cold store (86.4%) as it is only been
used on an outbreak basis.
Antigens like IPV10 (83.6%), Men ACW (92.3%), Men A Diluent (96.8%), and PCV (49.0%) were
mostly found in the state cold stores pending distribution to the satellite, LGA and health
care facilities.
The chart below shows the total doses of all vaccines expiring in July 2019 up to December
2020. There are relatively large number of vaccines that will be expiring in 2019 like the Penta
with 1,176,922 doses, Measles 68,320 doses, Hep B 1810 doses, and Yellow Fever 7270 doses.
While, most of the vaccines, will expire in 2020 like the BCG with 1,258,377, bOPV 16,160,296,
Men A 14, IPV 3660, and PCV with 220 doses.
The table below shows the total number of vaccines at each supply chain level and their year
of expiry for 2019, 2020 and 2021 and above.
While twenty million, one hundred and six thousand, three hundred and fifty-eight
(20,106,358) doses of vaccines will be expiring by 2020, six million, nine hundred and sixty-
one thousand, five hundred and seven (6,961,507) will expire 2021 and above.
By the end of 2019, one million, two hundred and eighty-six thousand, six hundred and four
(1,286,604) doses of vaccines would have expired.
RECOMMENDATIONS
1. The Air Conditioners are non-functional and will put pressure on the WICR/Fs.
b. Capacity building for store, cold chain and stock management should continue to be built
to ensure the zonal store adheres to best practices.
1. Cold Stores should be air-conditioned. Only Anambra CS is air conditioned. A hot and/or
humid interior reduces the efficiency of the CCE unit stored in it.
2. The State stores seem to have sufficient storage space. Repairing the non-functional Ice-
lined Refrigerators and WICRs will vastly increase available storage space for the short–term
and foreseeable future.
3. The Ebonyi State Cold Store has significant challenges with electricity and off-the-grid
solutions should be considered.
4. Training and capacity building to ensure appropriate management of the CCE assets and
the stock is needed across staff at the state stores.
5. A significant number of the state stores require infrastructural upgrades that are essential
to the security of the vaccine and CCE stored in them.
2. LGA cold Stores should be air-conditioned to extend the lifespan on the Ice-lined
refrigerators and increase the efficiency of the storage devices kept there.
3. Stores should be encouraged to institute the Early Expiry, First Out (EEFO) stock
management principle.
4. A significant proportion of CCE at the LGA and State stores are non-functional, with
number of LGA stores having to store their vaccines at nearby facilities. Nearly half of the
CCE in Abia are non-functional. States need to develop a Preventive Maintenance Plan to
routinely service functional CCE as well as identify and fix non-functional yet repairable ones
within a reasonable time. This should be preceded by an obsolescence analysis to identify
CCE that should be discarded – using environmentally responsible and safe techniques -and
not counted as part of the state cold chain asset. Obsolescence analysis (and performance
testing) also needs to be conducted for passive devices to ensure they are still viable and
functional.
5. A significant number of the state stores require infrastructural upgrades that are essential
to the security of the vaccine and CCE stored in them.
1. Oguta local government area cold store, in Imo State, stored their vaccines at Egbeoma
health center.
2. 500 doses of expired vaccines (Penta) were retrieved during counting at Egbeoma health
center
3. One functional freezer belonging to Oguta local government Area is at Imo state Cold
store.
General
The NPHCDA should pursue certain best practices to achieve the required safety standards
1. Air conditioning rooms/stores that house CCE significantly improves their efficiency and
this should be pursued as a best Practice.
3. Capacity building on skills on the organization of stores - dry or cold – (EEFO, the use of
pallets and shelves, etc.) is critical to appropriate record keeping and proper management of
stock and assets.
4. Activity should not be conducted during the rainy season as it was difficult to access some
areas it also increased the hours spent on the road consequently increased the number of
days for completion of the exercise.
The 2019 PSC presents comprehensive findings on the total physical stock of all vaccines,
diluents and devices available at the SWZ cold store, six State stores (Ekiti, Lagos, Ogun,
Ondo, Osun and Oyo State), all LGA stores and all HFs with cold chain equipment, with key
indicators that provide insight into the performance of the supply chain across the SW zone.
It is worthy of note that all the stores across all levels of the supply chain have a system to
run the store. This however should be in full compliance with the effective vaccine
management (EVM) standard at every level of the supply chain. This audit has provided
strategic and actionable insight into the volume of vaccines and related commodities
available insomuch as to guide the NLWG in the 2020 vaccines and devices forecast exercise.
Based on the presented survey findings, some recommendations are: (a) use of electronic
data tools for record keeping at the lower supply levels; (b) development of vaccines and
diluents redistribution protocol; (c) deployment of technically sound store keepers; (d)
continuous professional training of the stores technical officers so as to catch up with the
industry global best practice. Others are: (i) incentivizing best practices in EVM standards at
every level of the supply chain system; (ii) investment in store structures and equipment; (iii)
monitoring of performance of stores and supportive supervision; (iv) effective waste
management practice of cold chain waste; (v) questions on EVM compliance should be part
of subsequent PSC paper checklist; and (vi) vendor’s data manager should be granted access
to the server, alternatively, ODK input file should be shared with the vendors.
▪ The Zonal Cold Store should distribute more Yellow Fever diluents from its large stock
(see Table 4.1), to stores or facilities lacking this commodity. This will also help to utilize
vaccines and devices which are close to expiry.
▪ The Zonal Cold Store and Some State Cold Stores appear to be understaffed. While there
may be sufficient security guards in these facilities, it is recommended that more staff
trained in vaccine management are required to carryout the essential duties of the Zonal and
State Vaccine Cold Stores.
Record Keeping
▪ The data provided in this report should be used to assist Cold Chain Officers (CCO) to
update their stock records.
▪ Optimize the use of the web-based stock recording tool. The maintenance of accurate
stock records is critical for effective management of the stock. The use of the web-based
LMIS tool should be effected at all levels of the supply chain. It is also recommended that
the users of the LMIS be well trained vis a vis their roles.
▪ In order to maintain the drive for accurate and updated records at various supply chain
levels, the Physical Stock Count exercise should be conducted annually.
EEFO Compliance
▪ The vaccine stores at Zonal, State and LGA levels should ensure strict compliance with
EEFO principles. Store managers should ensure that all the stock movements are recorded in
the stock record tool (LMIS).
1. Identify and redistribute excess stock of vaccines at all levels of the supply chain.
6. Invest in store infrastructure like pallets, shelves, lighting, heat and ventilation equipment.
1. Identify and redistribute excess stock of vaccines at all levels of the supply chain.
6. Invest in store infrastructure like pallets, shelves, lighting, heat and ventilation equipment.
7. Continue Routine Monitoring and Evaluation of the vaccine supply chain system.
OIC should ensure that stores are properly arranged. All Inventory item arrangement should
be based on EEFO principle. Further to this, vaccine and diluents should be stored according
to the following:
• Vaccine type
• Vaccine manufacturer
• Vaccine Vial Monitor (VVM) stage
• Date of expiry
Where the VVM stage of the vaccine has progressed, the OIC should be knowledgeable
enough to make an exception.
Facilities with near-expiry stock should liaise with the LGA or State Store to initiate the
process of having the affected stock moved to other facilities that may be in need.
A demarcated area marked “PRODUCTS FOR DISPOSAL” should be designated for holding
expired stock before proper disposal.
There should be an increase in the interaction between lower cadre staff and senior staff to
improve supervision, knowledge transfer, coaching, and training. Particularly, lower cadre
staff should be sensitized on the benefits of the EEFO principle of stock management.
The facilities should define their stock level including, maximum, minimum and re-order
levels. The stock level can be determined using the facilities’ daily/weekly stock consumption
rate as the basis for definition.
4.3.4.1 DHIS 2
DHIS 2 Training and Refresher with Support of AFENET N-STOP
All States have now graduated and migrated to DHIS 2 Platform for RI Reporting
Figure 14: Map showing States that have Graduated to the DHIS2 Platform
Map Showing the States that have Graduated on the DHIS2 Platform (State now take full
ownership)
• Instil a culture of digital health interventions that will generate data from evidence to
practice
Four posters were submitted by the CDC/NSTOP/NPHCDA GEEKS project and the GEEKS
fellows for each poster provided further explanations in the various sub project topics to
participants during the conference. A key outcome from the conference was the emphasis
on development of a public health informatics workforce through capacity building within
the continent. The established education working group within HELINA promised to bridge
this gap and collaborate with institutions in setting up public health informatics curriculum.
The next country to host the conference will be selected through a bidding process and
interested countries were encouraged to participate in the process. The HELINA board will
continue to engage participants via emails post conference and strengthen collaboration
with agencies e.g Africa CDC.
The NPHCDA BHCPF Program Implementation Unit (PIU) was set-up in the NPHCDA to
effectively manage, coordinate and implement the NPHCDA gateway in realization of the
importance of the program towards the attainment of Agency’s goals and achieving
Universal Health Coverage.
In 2019, the team responded to all directives from the Management of the Agency, National
Steering Committee resolutions and played visible roles in the management and roll out of
BHCPF. There is a significant progress in the implementation of the BHCPF with
commencement of major activities such as baseline assessment, capacity building and
disbursement of fund to State Primary Health Care Board by the NPHCDA Gateway,
disbursement of fund to the benefiting & eligible PHC facilities from the State Primary
Health Care Board in three (3) States (Abia, Ebonyi, Osun) and FCT.
In line with the Agency Strategic Plan and approved workplan, the PIU carried out the
following activities in 2019 to ensure smooth take-off and effective implementation of
BHCPF as well as quality PHC service delivery in Nigeria:
5.1.1.1 Flag off of the BHCPF by HMH in Osun, Niger and Abia State
The BHCPF achieved another milestone as the HMH launched the enrolment of beneficiaries
and actual take-off of the BHCPF in Osun, Niger and Abia States as listed below.
1 Osun 3rd May HMH launched the BHCPF enrolment of beneficiaries in Osun
2 Niger 10th May HMH launched the BHCPF enrolment of beneficiaries in Niger
• To share experience and lesson learnt from baseline assessment in Abia, Osun
and Niger
• To appraise participants with the facility assessment methodology and tools,
configuration of mobile form on devices for assessment, enumerators
training, supervise the assessment process and data quality control in the
States.
5.1.1.2.1 Desk review of the Baseline Assessment Report of the four (4) States Abia, Ebonyi,
Osun & FCT
The Program Lead directed the desk review of baseline assessment report of the four (4)
States Abia, Ebonyi, Osun & FCT following the request by the states for approval and
authorization to disbursed fund to PHC facilities after completion of baseline and capacity
building for health workers and WDC. This was conducted on 2nd to 4th October 2019 at the
NPHCDA Conference Room, Asokoro Annex Office.
2 2nd Cohort NToT HP+, MNCH2 & WHO 10th - 14th June
5.1.1.3.3 SToT for States of Abia, Ebonyi, Osun, FCT, Ebonyi, Yobe, Kano, Kaduna, Katsina,
Bauchi, Delta, Niger, Edo, and Jigawa State
In preparation to actual take off and implementation of the BHCPF in Nigeria as the NPHCDA
disbursed fund to the state, a training targeting National, State and LGA trainers (NToT & SToT) to
further cascade the PHC workers and WDCs was conducted in Osun and Abia States as listed below:
The goal of the training was to strengthen the capacity of a core group of staff of the Gateways and
partners to be able to cascade the BHCPF training to the State and Health facility/WDC level.
First State Abia, Osun, 17TH – 21ST Follow up with each state to obtain pending
Engagement Niger, June 2019 information and materials for NPHCDA’s
in the Nine Anambra, documentations.
State Kano, Edo,
Kaduna, There is need to start capacity building of health
(States in Delta and workers so that funds disbursed can be
receipt of 1st FCT effectively deployed for the intended purposes
tranche
disbursement The federal ministry of health is yet to share the
of the BHCPF) report of the baseline assessment of primary
health care facilities in most states. The reports
need to be made available promptly to enable
the effective commencement of the programme
Second State Adamawa, 22nd – 25th Follow up with each state to obtain pending
Engagement Bayelsa, July 2019 information and materials for NPHCDA’s
in the State Benue, documentations.
(States in Ebonyi,
receipt of 2nd Nasarawa, There is a need for the state to move quickly to
tranche Kwara and meet up with all requirements and for capacity
disbursement Plateau building of health workers to be conducted so
of the BHCPF) that funds disbursed to state TSA can be
effectively deployed to facilities.
The HMH and Steering Committee members ruled and installed the 25% Counterpart Fund by
the State Governments through SPHCB for infrastructure and HRH development as Stated in
the NHAct 2014.
The NSC was updated on fund flow and Implementation activities of the BHCPF programme
as at October 2019. Specifically, the NSC is invited to note that:
• A total sum of N13.8bn has been disbursed to NHIS, NPHCDA, DHS and NCDC
TSA accounts following the approved criteria by the National Steering
Committee
• The NPHCDA Gateway has further disbursed N5.55bn and N100.2m as
programme and operational funds respectively for the next four (4) quarters
to the TSA accounts of sixteen (16) SPHCBs.
The members were updated on processes and status of engaging Independent Verification
Agents (IVA) and the External Auditor (EA) for the programme:
• The ToR, Procurement approach and other relevant documents have been
developed for the engagement of the IVA and EA, with a NO objection
obtained.
• Funds for the professional fees of the IVA and the EA will be sourced from the
Government of Nigeria, the World Bank, and Bill & Melinda Gates Foundation
(B) Readiness checklist of the NPHCDA gateway (Status as @ 8TH Jan, 2019)
General Challenges
Executive Director NPHCDA, HMH, HMSH at FMoH HMH Giving BHCPF Cheque to the Deputy Gov. of
at NSC Meeting in 2019 Niger State
• Expenditure Division
• Budget Division
• Financial and Fiscal Reporting Division
• Revenue and External Assistance Division
REVENUE:
The total revenue received for the first three quarters of the Year 2019 (January-Sept 2019)
was N122,109,737.75which was mainly from the receipt for Recurrent/Overhead. From the
2018 Capital release, the sum of N17,667,668,538.46 was for 2018 rolled-over to the year
2019. These forms part of the entire release for the year 2018 as the Appropriation for 2019
fund was partly received in the fourth quarter of 2019 amounting to 3.3 Billion Naira.
EXPENDITURE:
The total expenditure of the Agency for the first three quarters of 2019 was N91,526,467.23
for the recurrent expenditure while that of Capital Expenditure isN17,641,746,994.63.
7.1 Staff Productivity Awards and Send Forth for Retired Officers
Scenes from Staff Productivity Awards and Send Forth of Retired Officers, Abuja; 2019
Scenes of “Giving Back To the Community” Gboko, Benue State; 12th October, 2019
2. Council noted that 35 States of the Federation and FCT were represented.
4. Council further appreciated the role of Development Partners in health, Civil Society
Organisations, the media and other stakeholders for their contribution towards the
success of the meeting.
5. Council agreed that the 63rd NCH will hold in Ondo State in June 2020.
CONCLUSION
6. A motion for adjournment was moved by the Honourable Commissioner for Health,
Borno State and seconded by the Honourable Commissioner for Health, Cross River
State.
7. The 62nd Session of the NCH was formally closed by the Chairman of Council
following the vote of thanks by the Director, Health Planning, Research and Statistics,
Federal Ministry of Health, Dr Meribole.
2. Understand the need for a fully costed minimum service package (MSP) tailored to
state realities (e.g. fiscal space, number of workers, number of facilities) as a way of
attaining the ward minimum health care package – then develop and implement
such an MSP
3. Fulfil all associated Basic Health Care Provision Fund (BHCPF) state requirements
(e.g. state counterpart funding)
5. Attend Q1 2020 summit to discuss PHC action plan – with the goal of articulating a
compelling vision for sustainable PHC investment in Nigeria
In addition, we commit to the following asks for Polio and Routine Immunization (RI):
7. Strong state task force on PHC and immunization; should involve regular meetings
chaired by Deputy Governors, driving and tracking on quality of RI services and
campaigns, and reporting out each quarter at a minimum
9. National Economic Council (NEC) should have polio and RI as specific agenda items
each month between now and June 2020. NEC should monitor aggressively and
identify gaps, keeping the pressure on and driving the program to a successful
conclusion.