‘Health champions’: Local women lead the fight against polio in Nigeria

Abuja and Nasarawa, Nigeria – In the neighbourhood of Kado Lifecamp connected the outskirts of Nigeria’s capital, 29-year-old Eucharia Joseph grips a cooler container and sets retired for her day. Inside are oral polio vaccines packed successful ice.

Joseph’s way takes her done dusty lanes, past tin-roofed homes, mosques and churches. By nightfall, she and her squad of six women volition person vaccinated hundreds of children. Their mission: To guarantee nary kid is near unprotected from the illness that erstwhile crippled thousands crossed the country.

In 2020, Nigeria was declared escaped of chaotic poliovirus by the World Health Organization (WHO) – a landmark accomplishment for a state erstwhile astatine the centre of planetary transmission. But the microorganism hasn’t vanished entirely.

A related strain, known arsenic circulating vaccine-derived poliovirus (cVDPV), inactive threatens under-immunised communities. Unlike the chaotic virus, cVDPV emerges erstwhile the weakened microorganism from oral vaccines mutates and spreads via contaminated nutrient oregon water, for instance, successful areas wherever excessively fewer children are vaccinated.

That menace remains. Despite dependable progress, Nigeria inactive reports sporadic outbreaks of cVDPV. As of March this year, the state had reported 10 cases of the mutated strain. Last year, 98 cVDPV2 cases were reported.

With ongoing insecurity successful bluish Nigeria and pockets of absorption elsewhere, the occupation of eradicating polio present rests heavy connected the shoulders of women similar Joseph, who are often the lone ones granted entree to households owed to a confluence of cultural, spiritual and information reasons.

“It’s my gift,” Joseph said of her work, arsenic she adjusted her headscarf nether the sun. “I spell to antithetic localities. I speech to mothers. I beryllium with them. I cognize however to person them. That’s what makes this enactment possible.”

A polio vaccination thrust successful Mararaba town, Nigeria [Hanan Zaffar/Al Jazeera]

Women connected the beforehand lines

Female wellness workers similar Joseph are the backbone of Nigeria’s polio response.

In agrarian oregon blimpish communities, antheral wellness workers are often not allowed to interact with women and children. While successful conflict-affected areas, unusual men moving betwixt households whitethorn beryllium viewed with suspicion, arsenic galore of these areas are battling rebels.

In Borno State – the epicentre of Nigeria’s long-running Boko Haram rebellion and 1 of the regions hardest deed by polio outbreaks – the stakes are particularly high. Male wellness workers person sometimes been suspected by the assemblage of moving with authorities forces oregon quality services.

In immoderate neighbourhoods, the mistrust and absorption widen to pistillate vaccinators arsenic well.

“Most radical successful Maiduguri [the authorities capital] don’t ever similar the vaccine. They deliberation it prevents them from giving birth,” said Aishatu, who chose not to uncover her past name. The assemblage wellness idiosyncratic leads immunisation rounds crossed respective wards successful the area.

Such rumours astir the effects of vaccines person circulated for years, often fanned by misinformation circulating among assemblage networks, immoderate spiritual leaders, and occasionally by equipped groups specified arsenic Boko Haram, which has attacked vaccinators and portrayed immunisation arsenic portion of a overseas agenda.

In immoderate cases, spiritual teachings person been misrepresented, for example, claims that vaccines are forbidden during definite spiritual festivals oregon that immunisation interferes with divine will. There person besides been conspiracy theories saying vaccines are a Western crippled to sterilise children.

Combined with longstanding mistrust of authorities programmes successful immoderate areas, content successful these rumours has made vaccine acceptance a persistent situation successful parts of bluish Nigeria, wellness workers say.

For front-liners similar Aishatu, confronting the beliefs has go portion of the job. Her strategy is persistence and patience.

“We grip it by trying to summation sensitisation,” she said, referring to the repeated assemblage visits, one-on-one conversations, and informal radical talks that pistillate wellness workers usage to antagonistic vaccine myths and physique spot among hesitant parents. “We support talking to the mothers, telling them the truth. Some judge it slowly, immoderate aft seeing others instrumentality it.”

Aishatu has to equilibrium this enactment with managing her household responsibilities. But she sees the occupation arsenic thing beyond a paycheck. “The enactment is simply a nonrecreational one,” she said. “But it besides adds truthful overmuch to life. I cognize I americium helping radical and I emotion it.”

But she besides believes much needs to beryllium done to grow the programme’s reach. “More pistillate vaccinators are needed,” she said. “That’s the champion attack for the authorities to usage for creating much consciousness astir [the request and effectiveness of] polio vaccines.”

In areas oregon situations wherever antheral vaccinators look entree constraints and restrictions, women doing the enactment person been much effective. And for some, their demeanour and attack to patients is what besides makes a difference.

“Women are precise social,” said Esu Danlami Audu, colony caput of Kado who has seen his colony stamp out new polio cases due to the fact that of efforts by women vaccinators.

“They are capable to speech to parents, summation trust, and explicate the value of vaccines successful ways men cannot. That is wherefore they person played specified an important relation successful our advancement against eradication of poliovirus.”

This entree has proven much captious successful regions similar Borno. According to the WHO, pistillate vaccinators and assemblage wellness promoters person been instrumental successful reaching children successful hard-to-access areas, sometimes adjacent risking their lives to bash so.

“All implicit Africa, contempt facing beingness threats astatine galore places, their [women vaccinators’] beingness and persistence person helped flooded barriers of trust, taste norms, and insecurity. This is particularly existent for conflict-affected areas of bluish Nigeria wherever women are often the lone ones allowed into households – particularly those with young children – making their relation irreplaceable,” said Dr Ndoutabe Modjirom, coordinator of WHO-led polio outbreaks accelerated effect squad for the African region.

A neighbourhood successful Kado village, Abuja [Hanan Zaffar/Al Jazeera]

Innovation, persistence and economical ripple effect

To further antagonistic these challenges, wellness workers person besides adopted a premix of innovation and section knowledge.

Geographic Information System (GIS) mapping present helps place missed settlements. Community mobilisers, often section women, show newborns and study missed vaccinations. Mobile wellness units and door-to-door outreach campaigns are routine.

“We spell to schools, churches, mosques and markets,” said Aminat Oketi, a vaccinator successful Nasarawa State and a parent of six. “Sometimes we vaccinate 150, adjacent 300 children a day. The enactment is tough. But erstwhile I spot a kid protected, it is worthy it.”

Although Oketi earns immoderate wealth from her work, the occupation is not good paid. Most vaccinators person conscionable 12,000 naira (about $8) from the authorities for a five-day campaign. Transport often eats into their earnings, forcing them to supplement this income with petty commercialized oregon hawking goods.

Aishatu supplements her income by running a tiny beans trading concern successful Maiduguri to gain an income. “I bargain and merchantability beans,” she said. “I negociate it by separating my clip to enactment [as a wellness worker] and bash business.”

While the campaigns has improved nationalist wellness outcomes, it has besides unintentionally created a instauration for economical empowerment among women, galore say. Empowered by grooming and purpose, galore of these women person go micro-entrepreneurs and informal assemblage leaders.

Vaccinators similar Oketi, who joined the programme 4 years ago, are not lone safeguarding children but besides gathering idiosyncratic livelihoods.

She runs a tiny poultry concern alongside her wellness work. “I person a store wherever I merchantability chickenhearted provender and I rear birds too,” she said. Her humble vaccine stipend hardly covers transport, but the vulnerability to assemblage networks and the consciousness of ngo person translated into entrepreneurial confidence.

“When radical spot you with their children, they besides spot you to supply them with different services,” she said. “My customers travel due to the fact that they cognize maine from the vaccination rounds. It is each connected.”

This is simply a communal trajectory. While immoderate pistillate vaccinators person leveraged their assemblage credibility to commencement tiny businesses, others, similar Joseph, person acceptable up informal wellness outreach networks, advising caller mothers and coordinating attraction for sick children.

According to Cristian Munduate, UNICEF’s state representative, this dual relation of healthcare supplier and entrepreneur reflects a deeper shift. “They are not conscionable women with jobs; they are agents of change,” she said. “Vaccination campaigns person opened a pathway for leadership, agency, and fiscal independence.”

Helen Bulus, a authorities wellness serviceman successful complaint of vaccinations successful Mararaba municipality successful Nasarawa, reflects connected the consciousness of committedness pistillate wellness workers share.

“We are mothers too. Women instrumentality attraction of children, not conscionable their own. That’s wherefore they don’t springiness up [even erstwhile determination is hardship],” she said.

And arsenic they persevere, their enactment creates different affirmative ripples, similar contributing to higher schoolhouse enrolment among girls successful immoderate regions, she added. “As mothers go much economically stable, they put much successful their daughters’ futures.”

A vaccination thrust successful a schoolhouse successful Kado colony [Hanan Zaffar/Al Jazeera]

A planetary model  – with challenges

While chaotic polio present remains endemic lone successful Pakistan and Afghanistan, Nigeria’s acquisition offers captious lessons. Its combat against polio, led by women, supported by assemblage trust, and bolstered by innovative strategies, has reshaped however nationalist wellness tin beryllium delivered successful fragile settings.

The adjacent step, experts say, is sustaining this momentum.

“Routine immunisation indispensable beryllium strengthened,” said Munduate. “And communities indispensable beryllium supported, not conscionable during outbreaks but each twelvemonth round.”

The polio infrastructure has besides transformed Nigeria’s broader healthcare system. Cold chains, information systems, and quality networks developed for polio present enactment regular immunisations, maternal health, and adjacent responses to outbreaks similar cholera and COVID-19.

“We person built a bequest platform. Female vaccinators trained for polio are present portion of nutrition drives, wellness education, and exigency response. They person go wellness champions,” WHO’s Modjirom explained.

Still, hurdles persist. Insecurity continues to hinder entree successful parts of bluish Nigeria. In blimpish areas, misinformation remains rife, fed by rumours that vaccines origin infertility oregon are portion of overseas agendas.

Despite gains, wellness workers accidental determination is small scope for complacency. Experts pass that until each kid is reached, the microorganism remains a menace not conscionable to Nigeria, but to planetary eradication efforts.

“For each paralytic case, thousands much whitethorn beryllium infected,” said Munduate. “That’s wherefore we can’t halt and efforts person to continue.”

The reporting for this communicative was supported by UN Foundation Polio Press Fellowship