The article ‘The NPI: Why Dr. Dere Awosika Should Go written by our seasoned and respected journalist Mallam Mohammad Haruna which was published by Daily Trust of 30^th November 2005 and posted at Gamji Website made an interesting reading to many development workers, more so the linkage between failed and/or weak state with Immunisation and the activities of National Programme on Immunisation (NPI). Although I am not writing a rejoinder, my intention is to re-examine the American Centre for Global Development Report, its definition of failed and/or weak state and of course the choice of Immunisation among the yard stick of assessment and measurement and by virtue of such connection, it was used by Mallam Haruna in his write up to justify his belief and so to say recommended the removal of Dr (Mrs) Dere Awosika from the helms of affairs of NPI.

Going by that report , in his introductory paragraph , he mentioned that ‘Late 2003, the American Centre for Global Development commissioned a high powered panel of 30 former government officials, academicians, businessmen and representatives of Non-Governmental Organisations to examine the challenges that weak or failed states posed to America’s national security. Nine months later in June 2004, the panel issued its report which outlined how America’s foreign policy can be formulated to meet those challenges. ------------ The panel’s report defined a weak state as one which lacked or has a weak capability in three areas, namely security, capacity and legitimacy. In other words a state was weak if it could not ensure the security of its citizens, meet their basic needs and maintain its own legitimacy .--------- Nigeria, in short, was regarded by the American Centre for Global Development commission as a weak, if not a failed, state.

Finally according to the report The US commission on weak states chose the immunisation rate of the countries it examined as the most reliable test of a country’s ability to meet the most basic needs of its citizens. “Immunisation rates”, the report said, “are a good indicator of broader health policies and strategies. In addition, the immunisation rate has a strong relationship with infant mortality and increased literacy rates and has a reasonably positive association with economic growth. To single out immunisation rates vis-à-vis Immunisable Childhood Diseases only as the most important health indicator , to me that assessment was either intentionally done to confuse and mislead Africa and its populace with respect to prioritising health problems according to the western mirror and perception or the commission has not done their home work very well .

The number one most important health indicator in establishing weak and /or failed state and assessing level of progress either health, social and economic wise is the Under five Mortality Rate which need to be critically examine to ascertain why it is rising in Nigeria, what are the factors affecting it and more importantly what interventions could be instituted to check mate such rise . According to the Master Plan of Operation , which form the bases of partnership between Federal Government of Nigeria and UNICEF between 2002 to 2007 , the document amongst others mentioned that Immunisable Child hood Killer Diseases contributed to about 25 % of the Under five Mortality Rate in Nigeria . The remaining 75 % is to be shared among Malaria, Acute Respiratory Tract Infections, Diarrhoeal Diseases and few others like HIV/AIDS. Among the Immunisable Childhood Killer Diseases, Measles is carrying the highest percentage, while Poliomyelitis is carrying the least.

As I mentioned on these pages some times early this year in an article titled ‘The Rising Child Mortality Rate in Nigeria of which I quoted The Punch Newspaper editorial comment of Tuesday, November, 09, 2004. Amongst others, the editorial comment mentioned that the latest UNICEF report revealed that more children are dying yearly from poor nutrition and inadequate health care, it does no credit to the nation. UNICEF was reported to have said that, its current survey reveals that the under five mortality rates in the country as of 1999 and 2004 are 168/1000 live birth and 217/1000 live birth respectively.

The paper went ahead to say that it is heart rending that more children die now when compared to the under five mortality rate as of independence period , 1960 which is 207/1000 live birth . To anybody in his right senses, that revelation was shocking and a food for thought for development workers and policy makers to sit down and critically appraise the factors that led to the rising of the mortality rate beyond how it was at independence.

Is it that all the efforts stakeholders are making are going down the drain with out any impact and success? Even a cursory observer will accept the fact that children in Nigeria are not faring well and the rate at which they are dying of preventable illnesses leave much to be desired about the strategy being embarked upon by local and international development partners and their government counterparts in curtailing and reversing the complications of diseases affecting children.

Let us look at the issues surrounding the rising mortality rate in our dear country , one will accept the fact that , population is playing a key role , if one compares the population of the country during independence and now , it has rise exponentially and also migration to urban towns for greener posture has worsen environmental situation . It led to a lot of environmental hazards, improper sanitary habits, congestion and air pollution, contaminated gutters and refuse dumps all over the areas. These factors are contributory to the spread of a lot of diseases such as Malaria, Cholera and Diarrhea diseases, Respiratory Tract Infections and all these lead to Malnutrition.

These problems couple with inept regimes and attitudinal problems of leaders and policy makers lead to collapse of public health sector without the basis emergency facilities , drugs and equipment to check mate pediatric emergency problems and of course lack of manpower in the hospitals especially at the primary health care units worsen the situation , the more .

On the 13 % or there about of Immunization coverage in Nigeria which The Commission reported which also Mallam Haruna totally pushed to NPI to shoulder such responsibility , I believe , we are not been fair to blame NPI alone on low coverage of Immunisation . That 13 % is not only referring to Polio Immunisation alone but also Routine Immunisation which covers Measles, Tuberculosis, Tetanus, Diphtheria, and Whooping Cough and of recent Hepatitis. For those who are involve in Routine Immunisation with respect to supply, maintenance of cold chain and its availability in our Secondary and Primary Health Centres and also awareness creation at the two levels will agree with me that States and Local Governments will carry the highest blame in its poor coverage, however, that does not mean that NPI is not also culpable in its low coverage. Statistics have shown that where Routine Immunisation is suffering a major set back is in the Northern Nigeria , the same region where also Polio Immunisation has suffered a major set back in the past .

While NPI and its collaborators were aggressively pushing the programme of Polio Eradication in the recent past beyond the sensibilities and comprehension of the common man, side by side with that, one hardly finds all the vaccines for routine immunization in the hospitals. At times, no allocation, or inadequate or the storage facilities are poor or condemned. .Campaigning for Polio Eradication only , has led to a lot of suspicion and boycott from the populace , because while many witness their children dying of Measles , Meningitis and Cholera , all preventable and with very little done to prevent such by the government , and their international partners , yet they are being preached every day to allow their children to be vaccinated against Polio .I believe the implementers of Immunization in Nigeria both local and international will be better off if they sit down and re-strategies , if at all they want the immunization coverage to rise to appreciable level in the country .

Another problem which is contributing and worsening the plight of children and Under Five Mortality Rate in Nigeria is the emergence of HIV/AIDS. Latest statistics put the prevalence of HIV in Nigeria at 5.2 % and about 4 million people living with the HIV and about 800,000 children orphaned by HIV/AIDS. A lot of children could not meet their fifth birth day due to infection with HIV or their parents and benefactors are no more , as such they become vulnerable to a lot of hazards , among them , preventable diseases . One way out of that doldrums, is to ensure effective intervention for HIV/AIDS among children , availability of subsidized Anti Retroviral Drugs and facilities for treatment of opportunities infections.

On another angle , Malaria as I mentioned earlier on is among the major diseases that is contributing to rising child mortality rate in Nigeria , the intervention to curtail that menace is to ensure effective environmental sanitation through clearing of bushes , getting rid of contaminated gutters and refuse dumps and having good drainage system . Other things, is to ensure provision of drugs for treatment of simple malaria and emergency method of reversing febrile convulsion, a very common complication among children. For now, on the part of the International partners and their local collaborators, they are more or less in love and passionate about discussing, distributing and socially marketing Insecticide Treated Mosquito Nets, as a means of reducing the burden of malaria by 50 % by 2010. Observing and implementing other three strategies and components of Roll Back Malaria by both local and international partners would be seen as beginning of wisdom in addressing the burden of malaria , not only in Nigeria , but Africa as a whole .

The Commission report by America going by past experiences of other reports will surely be use if not all but some part of it to formulate foreign policies that will impact in Africa , Nigeria inclusive . It is in line with that, that I found the report faulty, because if America will use Immunization rates only to form the bases of their health support to weak and/or failed state without critically examining Under Five Mortality Rate, such endeavor will not actually address the plight of children.

It is in the same light that I believe Mallam Haruna is mis-led by that report to form the bases of his recommendation and also to conclude by saying that improving Immunization only as a component of Under Five Mortality rate will not lead to Nigeria shifting from being a failed state to a formidable one to be reckon with . Our tasks as development workers and commentators is to draw the attention of Donor Countries and our policies makers at Federal , State and LGA levels to look genuinely at the factors leading to high Under five Mortality rate with the aim of providing workable and practical solutions that will be made available and accessible to all Nigerian children.

Dr Magashi is the Executive Director of Community Health and Research Initiative, Kano, Nigeria and can be reached at healthinteractive@hotmail.com