Abuja, 26th Septembers, 2014 - The drum-beats and the sounds from the algaitas (trumpets) reverberate in the communities to herald the arrival of the vaccination teams, trigger the extraordinary flow of children out to the streets, mothers/ caregivers peeping through the doors and over the low fences of the compounds to have a glimpse of the Directly Observed Polio Vaccination (DOPV); essentially the administration of OPV to eligible children and distribution of appropriate attractive pluses like milk sachets, soap, candies and whistles, under the watchful eyes of senior supervisors.
 
Describing how the DOPV operates, Mr. Charles Korir of WHO Field Support Unit who coordinated the roll-out, stated that it “is implemented within the framework of the regular Immunization Plus Days (IPD) strategy, but characterized by exclusive outside vaccinations in streets, transit points and social events (naming, wedding and religious ceremonies) within the first 2 days and followed by 4 days of regular IPDs using House-to-House, Transit teams and Health Camps, followed by a mop-up”.
 
The recourse to the DOPV found adequate justification in the independent monitoring data from previous rounds which showed that 70% of the children missed during IPDs were due to ‘child absent’ while non-compliance accounted for approximately 12%. Sadly, majority of absent children were on the streets, playground, schools, markets and social events such as naming ceremonies during immunization campaigns. Although the proportion of missed children due to non-compliance is relatively low, yet there is evidence of concealment of the extent of non-compliance by teams who finger mark children without vaccinating them. Furthermore, experience has shown that children from non-compliant families can be reached outside in the streets once attractive pluses are available.
 
Relating his experience with DOPV, the ward focal person (WFP) of Sabongari ward of Tudun Wada, one of the LGAs that recorded WPVs in Nigeria in 2014, Mallam Lawal Abdul gleefully posited ‘that the 2 days of DOPV were stress-free for us as it eliminated the haggling with parents while children from houses with habitual non-compliance thronged the vaccination points”. Additionally, the WFP maintained that “right from time we’ve been applying different tactics to reach the children to no avail, but this (DOPV), proves to be the easiest and best of the lot as we do not need to keep dragging and debating with parents/ caregivers in order to vaccinate their children”.
 
The positive impact of DOPV also resonated with GPEI partners. Ms.  Melissa Corkum, the UNICEF Chief of Polio Communications in Nigeria lucidly gave an eye-witness account of DOPV when she stated that “DOPV has proven to be an effective strategy in areas with high non-compliance. Mothers were literally passing their children over house walls to ensure they were immunized. In one chronically non-compliant household 17 children were passed over the house wall and were immunized, including a newborn baby. Mothers were encouraged by the attractive pluses including milk sachets for their young” .
 
Understandably, programme managers, vaccination personnel and GPEI partners would welcome the scaling-up of the DOPV but the most gratified stakeholders are in the different hierarchies of the traditional institution.
 
Dr Basheer Mohammed, the Dankadan Kano and District Head of Tudun wada who personally supervised the implementation of the strategy noted that “the DOPV strategy is an excellent one because it allowed the observers to witness first-hand, how the vaccine was delivered and recorded. Our evening review meetings were also replete with reports of children from traditional non-compliance household, swarming the vaccination points without cajoling”.
 
The 28th Expert Review Committee (ERC) had endorsed the strategy, buoyed by the results of the pilot in Bauchi State in August 2014 which revealed increased utilization of DOPV to reach absent children and children from non-compliant households. Since the ERC also posited that ‘success in Nigeria is dependent on success in Kano as the only place reporting persistent WPV in Nigeria’, more LGAs in Kano participated than in other states. For the September, 2014 sIPDs, the strategy was implemented in 20 out of 44 LGAs of the state and 423,183 children were immunized on the streets out of their own volition and without any form of coercion whatsoever.