John Awodi is a Community Health Extension Worker (CHEW) and the immunisation officer at Tungan Maje Primary Healthcare Centre in Gwagwalada Area Council of Nigeria's Federal Capital Territory. His duty involves ensuring vaccines are kept in potent condition and are available for use on immunisation days at his centre.
This was a tough task because of irregular power supply and inadequate storage facilities, until an international health partner working in Nigeria donated a solar-powered refrigerator to the centre. Before then, Mr Awodi had to go to the Township Primary Health Centre kilometres away in Gwagwalada, the area council headquarters, to collect the vaccines needed at his PHC and then to return unused ones after each day of the three times a week immunisation exercise.
The refrigerator has not only reduced stress for him and the other staff, it has also reduced the time women and children spend at the PHC for immunisation, he said.
Immunisation challenges in Nigeria
Nigeria has one of the lowest vaccination rates in the world. This is one of the factors responsible for the country having one of the highest rates of child killer diseases in the world.
Most of these killer diseases can be prevented through vaccination before, during and after birth. Child killer diseases such as pneumonia, polio, neonatal tetanus, measles, mumps, rubella, whooping cough, chicken pox, tuberculosis are vaccine-preventable.
Preventing the diseases, however, is a major challenge in Nigeria because most children under the age of five do not have access to vaccines while some cannot complete the required doses due to insufficient vaccines.
To bridge the gap in vaccines supply and help the country along the path to achieving health millennium development goals, a former minister of health, Mohammed Pate, in 2013 launched a transformation project, which aimed to strengthen the vaccine cold chain in the country.
Cold chain is the ability to sustain a vaccine in a temperature-controlled supply chain from time of manufacturing to vaccination. An unbroken cold chain is an uninterrupted series of refrigerated production, storage and distribution activities along with associated equipment and logistics, which maintains a desired low temperature.
According to the World Health Organisation, vaccines are to be stored within WHO recommended temperature range to maintain product quality until the point of use.
"With the rising cost of vaccines and the greater storage capacity now required at every level of the cold chain, countries must maintain lower stock levels, reduce wastage, accurately forecast vaccine requirements, and prevent equipment break-downs," WHO stated.
"This requires a consistently high standard of supply chain management, which can only be achieved if all the links in the supply chain comply with current standards for storage and distribution."
An efficient cold chain has been identified as important to improving immunisation in Nigeria.
Though considerable progress has been made in the direction, much still has to be done, especially as the country plans to graduate from the GAVI programme, under which it sources most of the funds for vaccines used in the country.
WHO had earlier called on the FCT Administration and its six area councils to improve on vaccination activities by providing more cold chain storage facilities to ensure quality vaccines are given to children for immunisation.
WHO State Coordinator in the FCT, Fureratu Zakari, lamented the poor and inadequate refrigerating facilities in the territory.
She appealed to the councils to work hard to support, provide and persuade the FCTA to offer a cold chain storage system for effective and efficient immunisation activities in the territory.
Cold Chain Stores In Abuja
To assess cold chain storage facilities, Premium Times' reporters visited three area councils in the Federal Capital Territory.
Unfortunately, the stores in the three local government areas reflect needs of refurbishment, to cater effectively for the immunisation needs of the people in the areas.
At Tungan Maje Primary Healthcare Centre in Gwagwalada Area Council, though, Mr Awodi said he now spends more time on immunisation campaign and community outreach since the centre got a solar-powered refrigerator.
"I do not need to go to the Township Centre (in Gwagwalada) anymore to get vaccines every immunisation day," he told PREMIUM TIMES.
The refrigerator has not only reduced his stress of the other staff, it has also reduced the time women spent at his PHC for immunisation, he said.
Mr Awodi said he now has more time for immunisation campaign and community outreach.
"I do not need to go to Township Centre anymore to get vaccines for every immunisation day; instead I focus more on outstation posts. This has improved our immunisation activities as I can now set out early, cover more ground and come back on time," he said.
Mr Awodi said the solar refrigerator at his centre sometimes supports the Township PHC and other PHCs close to Tungan Maje.
"We helped the Township immunisation centre keep vaccines here when their solar panel and refrigerator had fault and they had problem with storage of vaccines. Tungan Maje has become a mini backup facility where we assist to give vaccines to smaller PHCs not far from here," he said. "We sometimes help other locations such as Zuba, Anaagada, Shegwegwu, Kpakuru store vaccines. All these towns are under Gwagwalada Area Council."
The centre carries out immunisation service three times a week, Tuesdays and Thursdays for children; and Wednesdays, which is the ante-natal day.
"Now, our immunisation days are fantastic, people patronise us well and the services are okay, though we still have minor challenges. We now collect vaccines that can serve us for a month from Gwagwalada," he added.
Although Tungan Maje PHC is connected to the national grid, it does not enjoy regular power supply. So, the centre depends on its solar-powered refrigerator for vaccine preservation and production of ice packs.
Other success stories
Abaji Central Primary Healthcare does not have a refrigerator to store vaccines. But the health workers are happy nevertheless, because they do not have to go far for vaccines on immunisation days. Hassana Mohammed, one of the health workers, said a cold chain store is located about 500 metres to the PHC.
"We do not have a problem with vaccine collection and returning," Mrs Mohammed said. "This is because the cold chain store is not far. All we need to do is take our cooler on immunisation days to the cold chain store and they give us vaccines and ice packs to preserve them. We return the unused ones at the end of the day. It only costs us N100 to and fro," she said.
Cold Chain Stores
For Mr Awodi and Mrs Mohammed, the improvement in immunisation exercise was made possible by the proximity of cold chain stores to their PHCs.
The Township Centre, Gwagwalada serves all PHCs under the Gwagwalada Area Council, including Tungan Maje. On a visit to the store, the reporter, however, noticed that it needs more equipment to serve the area better.
The store relies on solar power panels and refrigerators because though it is on the national grid, power supply is not stable. This affects production of ice packs for vaccine distribution.
An official at the cold chain store who asked not to be named said vaccine storage was a problem because their solar refrigerator was bad.
"We are using contingency plans to store vaccines in other PHCs. This mean we are not operating at full capacity the way we should. If we were operating at full capacity, all the vaccines for Gwagwalada Area Council should be preserved here, we should be the distributing centre, giving to the smaller PHCs and vaccine officers during routine immunisation and also providing ice packs to assist them carry the vaccines to the field and back," he said.
The solar panels at the vaccine centre were bad at the time of the reporter's visit and the centre was using deep freezers and relying on other centres like Tungan Maje to store its vaccines.
"Government needs to provide more cold store equipment, staff and a more reliable source of power supply for vaccine preservation. This will go a long way in helping immunisation campaign in Nigeria," the health worker said.
Abaji Township Centre cold chain store uses both solar-powered refrigerators and deep freezers to preserve vaccines. Though it is connected to the national grid, the centre relies more on generator and solar panels for power supply. The officials, however, said the solar panels are often not efficient during the rainy season.
The store supplies 10 wards in Abaji Area Council. With an estimated population of 169, 896, the area has targeted under one population of 6,796; under five population of 33,979 and about 8,495 pregnant women.
Idris Nuhu, the immunisation officer at the centre said they only keep vaccines for children under one.
"It is during campaign for routine immunisation that we stock vaccines for (ages) zero to five. We used to provide ice packs but our solar fridge cannot produce those ice packs. We service 28 facilities and they come weekly for their vaccines every immunisation day. These days vary according to the facilities. They come in the morning to collect the vaccines and return unused ones at the end of the day," he said.
Mr Nuhu said the process has been effective and they were able to monitor the potency of the vaccines through a vaccine indicator which warns if the cold chain temperature drops.
He argued that solar fridge is more effective for storage of vaccines as there is rarely a temperature drop or hitches unless the fridge has technical fault.
"With the solar fridge we have less challenges of power supply, though we cannot use it to produce ice packs. It reduces the challenge of fund to power the generator.
"We also need to have satellite cold chain stores where vaccines can be stored apart from here. But, unfortunately, most of them are broken down, that is why it seems we are overworked here," he added.
Mr Nuhu, however, said for the government to achieve optimal result in immunisation in the area, it needs to provide additional solar-powered refrigerators, and supply diesel to power the freezers in order to provide ice packs for vaccine distribution.
At Kuje Council Area, however, most of the equipment at the cold chain store were not working at the time of the reporter's visit.
The store is meant to serve the entire area council. But it has only one solar metal fridge to preserve vaccines and one deep freezer which served as the cold line for production of ice packs. And the freezer was mainly generator-powered.
The area council has 10 political wards with a population of 283,044. The population of children under five is 56,609, under one population is 11,322 and pregnant women were put at 14,152.
The cold chain officer, Saliu Dauda, said the centre was managing what it has but has not been "very efficient" because he cannot keep all the needed vaccines in the local government area.
He said he thus collects a small quantity from the central cold chain store at Apo and shares them to the 10 other PHCS in the area council because they all have solar fridges to store them.
He explained, however, that he could not monitor the potency of the vaccines and the way they were being administered, as he ought to.
Aside the fact that the roof of the office leaks when it rains, there were three deep freezers in the store in need of repairs. The office is small and hot and relies on a small generator for electric power.
The officer said he usually bought fuel for the generator from his salary as there is no allowance is provided for running of the office.
"For a cold chain store to work efficiently, there must be cooling equipment to safeguard the potency of the vaccines and a good cold line to make ice packs for transportation of the vaccines. We are not working up to the standard which we should. We have 10 political wards and I can only keep some vaccines here. We need more cooling equipment, we have complained to the government but they keep saying it is in the pipeline," he said.
Mr Dauda also said Nigeria needs to provide more solar fridges for vaccine storage because they have proven to be more effective in preservation of the potency of vaccines, as they have to worry less on erratic power supply.
FCT PHC Board reacts
The executive secretary of FCT PHC Board, Rilwanu Mohammed, said the board was aware that most of the cold chain stores in the territory are in dire need of facilities. But he said the board is incapacitated because the Act establishing it is yet to be passed by the National Assembly.
"The PHCs in Abuja are still under the local governments (area councils) and as such it is the local government that is in charge of funding them, though we have been contributing our best. Kuje has been complaining, we are planning to get facilities for them," he said. "We also received same report from Gwagwalada."
Mr Mohammed said the board was looking to get more solar-powered storage facilities for vaccine preservation as this reduces the challenge of unsteady power supply.
"We intend to improve immunsiation programme in FCT, we have been monitoring routine immunisation activities and also plan to reposition all our primary health clinics," he said.
He said the board distributed 10 metal fridges to all the local government areas.
"We don't need electricity because it is also solar. It is a special type of metal plate that can work in any condition. We have two for each area council and we send to areas that we think need them.
"Now, we want to procure some cold chain facilities and we are going to buy this metal fridge, it's a very special one and the best fridge for now. It can work when there is no light or sun. It will continue working as long as it got some light. We have serious gaps in Kuje and Gwagwalada and this is where we have problems," he said.