As a thought leader in global health, I write opinion pieces covering different aspects of healthcare globally, in Africa and Nigeria. I have written opinion pieces on COVID-19, vaccine nationalisim, decolonization, decolonizing global health, mental health, tuberculosis, HIV/AIDS, health and technology, universal health coverage, health financing, enterteainment, documentaries, music, movies, WASH etc. Read my opinion pieces below.
Naomi Osaka’s Bravery can be a Teachable Moment about Mental Health
It Takes a Community to Defeat COVID-19
The media is awash with the devastating news of deaths and sufferings due to COVID-19 coming out of India. What most media outlets overlook is the way Indian communities are rallying to save lives, reduce sufferings and stop the current wave of the pandemic. India is really struggling with Covid-19 and needs global support. Importantly, communities have to be acknowledged as the true heroes in this second wave of COVID-19 outbreak in India. Without support however, even they cannot flatten the COVID-19 curve. The government must show responsibility to ensure that these community efforts are amplified.
Strive Masiyiwa, Dangote Group, Safaricom… Africa’s private sector leads the fight against Covid
Private sector organisations are unsung heroes in healthcare delivery across Africa, and they should be recognised and celebrated. Whether formal or informal organisations, the private sector contributes to improving health across the continent. Notably, Africa’s exemplary Covid-19 response would not be so successful without the participation of the private sector. Their support has spanned Covid-19 prevention, diagnostics, therapeutics and emergency care.
Africa: Re: Open Letter to International Funders of Science and Development in Africa
If global health by its nature addresses issues such as health inequalities and inequities, it is most ironic that the funding and administrative structures that enable activities in the sector are steeped in similar inequities driven by supremacy. Clearly, that culture must change. Bringing about this necessary change will not rely on efforts by international funding organizations alone. Vital stakeholders in this discussion would include African national governments and the African Union.
How West African Leaders Can Tackle Youth and Gender Inequities
Recently, both Republics of Benin and Chad held their 2021 national elections. These countries are among thirteen countries on the continent billed to elect new political leaders in 2021 alone. This is a good opportunity to improve conditions on the continent. Indeed, the COVID-19 pandemic has magnified other issues on the continent like youth unemployment that better leadership could help improve. These are three ways West African leaders can better help their nations at this time of COVID-19 and beyond. First, the rate of youth unemployment must be effectively tackled.
To President Buhari: ‘There is still time to become Nigeria’s universal health coverage hero’
President Muhammadu Buhari has embarked on another medical tourism trip to the UK for two weeks. By the time he comes back to the country next week, he will have spent more than 200 days going on medical tourism since he was sworn-in as Nigeria’s President in May 2015. In comparison, millions of Nigerians do not have access to healthcare and have no form of health insurance cover.
COVID-19 pandemic-related suicides are increasing – here’s what we need to do
A silent pandemic is brewing in the midst of the COVID-19 pandemic – a mental health one. New research published by Nature Human Behaviour (1) shows monthly suicide rates increased in Japan by 16% during the second wave of the pandemic (July to October 2020), with larger rates of increase among females (37%) and children and adolescents (49%). The increase among women was about five times that of men. The increase in suicide rates was attributed to lost jobs, lost incomes and a sense of hopelessness.
Three Ways the US Can Promote Equity in Ending the COVID-19 Pandemic Globally
As richer western nations continue hoarding COVID-19 vaccines to the detriment of poorer nations, there is some light on the horizon. On April 15, 2021, the U.S. will join the Global Vaccine Alliance (GAVI) and co-host the launch of the Investment Opportunity for COVAX Advance Market Commitment. The aim of the event is to raise more funds to ensure at least 1.8 million doses of COVID-19 vaccines are available to 92 low-income nations. The U.S. recently donated $4 billion to COVAX and this new leadership role is highly commendable.
Grammy Winner Burna Boy Makes Music — And Social Noise
Burna Boy’s Grammy Award win for Best Global Music Album makes me feel – as we Nigerians say — “Proudly Naija.” And I am not alone. Nigerians everywhere are ecstatic that he has won the prestigious award. In case you’re not familiar with his music, here’s how NPR described it when he came to perform a Tiny Desk concert in 2019: “The Nigerian singer and songwriter is one of the biggest African artists in the world. He’s also a pioneer of Afro-fusion which incorporates sonics and influences from a myriad of genres, laid on an Afrobeat foundation.
13 Things I Did (And Did Not) Love About 'Coming 2 America': An African Perspective
In the 1990s, I watched Coming to America as a young medical student in Nigeria. I loved Eddie Murphy’s character Akeem (a common name in Nigeria) – quick wit, rakish charm, carefree — and the wealth of the African nation Zamunda, a nice contrast to typical depictions of Africa as poor. Now, 22 years after graduation from medical school, I watched its sequel, Coming 2 America.
Battling misinformation wars in Africa: applying lessons from GMOs to COVID-19
Through the 1990s, scientists downplayed GMO misinformation spread by activist groups – and scepticism about GMO technologies continued to grow, despite overwhelming evidence on their safety. With a new issue like the COVID-19 vaccine, opinions are being formed now.
Four lessons from Covid to help African leaders prepare for next pandemic
Vaccine nationalism is a fancy way of describing the vaccine inequity being perpetrated by richer western nations that are buying up Covid-19 vaccines to the detriment of poorer nations.
In a time of Covid, we must not forget other tropical diseases
Madhu Pai, Professor and Canada Research Chair of Epidemiology and Global Health at McGill University wrote about the “covidization” of research and every aspect of development, meaning everyone has focused research, funding and attention on COVID-19.
Why I'm An Invisible Man In The Global Vaccine Campaign
I am shocked that these wealthier nations think this is the best way to protect their people from a global pandemic that does not respect borders.
What developing countries can teach rich countries about how to respond to a pandemic
Their mantra might best be summarised as: act decisively, act together and act now. When resources are limited, containment and prevention are the best strategies
Here's How Africans Can Advocate for Covid-19 Vaccine Equity
As an African, I am disappointed at these leaders who have become so dependent on rich western nations to fund every aspect of healthcare delivery on the continent…
Protecting Mental Health of Families in a Pandemic
Dealing with COVID-19-related city lockdowns has been exceptionally stressful, particularly for those parents who have had to balance work, personal life, children…
Women Need Support and Understanding after Miscarriage
Recently, Meghan Markle, the Duchess of Sussex, wrote a piece sharing about her miscarriage. I knew, as I clutched my firstborn child, that I was losing my second, she wrote.
The COVID Comorbidity Crisis
Growing evidence shows that COVID-19 survivors can suffer from long-term health effects, not least heart-related complications.
A Nigerian Finds Hard Truths — And Hope — In Netflix Series On Nigeria
The street where I grew up in Kano, northwest Nigeria, is called Independence Road. Each day, it reminded me of Nigeria’s independence and sovereignty from Great Britain on Oct. 1, 1960.
Eye Care Globally Amidst the COVID-19 Pandemic
As COVID-19 continues to wreak havoc—infecting more than 33 million people globally—it has also caused significant disruptions in eye health services, with a particular emphasis on care for cataracts.
Africans Mourn Chadwick Boseman: 'A Great Tree Has Fallen'
The death of actor Chadwick Boseman last week at the age of 43 came as a shock to many Africans. I liken it to the death of a great African King.
We Are Africans. Here's Our View Of Beyoncé's 'Black Is King'
There are two kinds of reactions to Beyoncé’s new Black Is King video: lavish praise – and deep criticism. The praise comes from her many fans and from many reviewers.
Aren’t We Missing Food Security Experts in the Incoming President-Elect Biden-Kamala Harris Administration?
Food insecurity across the U.S. continues to be on the rise because of the effects of COVID-19. According to Feeding America, over 50 million Americans will experience food insecurity, including 17 million children.
Nigerian Focus Group Reveals Why Ending Gender-Based Violence is Necessary
COVID-19 lockdown leads to an increase in sexual and gender violence. Sadly, the United Nations documented more than 3600 cases of rapes during the COVID-19 lockdown in Nigeria.
Tooth decay is a disease of inequality. Here's how governments can improve dental care
New research from The Lancet’s oral health series shows that tooth decay affects 34% of the global population and could affect up to 90% of indigenous children. Tooth decay is one of the most common and neglected noncommunicable diseases. It is a disease of inequity, disproportionately affecting some of the world’s poorest people. This should not be allowed to continue.
COVID-19 shows why Universal Health Care is essential
COVID-19 has highlighted the lack of universal health care globally and its negative impact on world health. The lessons learned support the need for universal health care and should be used as guides to ensure that everyone has access to equitable, affordable and safe healthcare, irrespective of ability to pay, poverty, race, gender and level of education. Only then, will the world be better prepared for the next pandemic.
Lessons from Nigeria in Responding to Coronavirus
Most of these measures occurred after a significant number of cases were documented. In contrast, Nigeria, where I am based, has shown a remarkable level of preparedness and response to the Coronavirus pandemic even with just 12 cases diagnosed. These efforts are led by the Nigeria Centre for Disease Control (NCDC). Nigeria’s past experiences of quickly responding to the 2014 Ebola outbreak and continuously responding to other infectious diseases such as Lassa fever, have strengthened its health security capacity.
Our Top Global Stories Of 2020 Not About The Pandemic
It seemed like there was only one global health story this year: the pandemic. But that wasn’t the only topic that grabbed our audience’s attention. According to NPR’s data on page views, readers were attracted to all kinds of Goats and Soda stories in 2020. The mix of content might surprise you. A 2019 story about how to teach kids to control their anger made a huge comeback. Readers loved our commentary on the Netflix reality show Indian Matchmaking — and an explainer on locusts. And photos of our beautiful planet made a big impression.
Helping Premature Babies Survive
Preterm birth complications are the leading cause of death globally for children under five. Of the 15 million babies born before the 37th week of pregnancy every year, approximately one million will die. But new research conducted at secondary and tertiary health facilities in Bangladesh, India, Kenya, Nigeria, and Pakistan offers hope for increased survival rates.
Making the Most of the Malaria Vaccine
A new malaria vaccine now being piloted in Sub-Saharan Africa, where 90% of malaria cases occur, could be a game changer in global health. But, if the new vaccine is to fulfill its potential, health ministries will need to make some important changes. Each year, malaria kills one million people worldwide, the majority of whom are children under five years of age.
UNAIDS and WHO Africa Leaders Should Prioritize Women’s Health
In these powerful roles, they should also prioritize addressing issues uniquely affecting women — from HIV to childbirth to infectious diseases — because when women are healthy, the society progresses. Further, the health of women is a measure of a society’s level of development. As a father to two daughters, I am rooting for Ms. Byanyima and Dr. Moeti to succeed and leave the world healthier than they met it. This is what they can do.
Here’s How the World Can Be Better Prepared to Handle Epidemics
To be assigned a ReadyScore, countries should undergo a Joint External Evaluation (JEE) which is a voluntary, collaborative, multisectoral process to assess country capacities to prevent, detect and rapidly respond to public health risks whether occurring naturally or due to deliberate or accidental events. Right now, only 100 out of 195 countries (51 percent) have conducted the JEE.
The Mental Health Consequences of the Lekki Toll Gate Attack
On October 20, 2020, young Nigerians who were protesting against police brutality were shot by men in Nigerian military uniforms. Unarmed, peaceful citizens were massacred at the Lekki Toll Gate in Lagos, southwest Nigeria.
Google’s $10 Billion Investment in India Should be Inclusive of Persons with Disabilities
Over the next seven years, Google will invest a whopping $10 billion in India to improve technology, health and education, according to CEO Sundar Pichai. This is unprecedented and could be a game changer that could improve health, education and economic empowerment.
5 ways to meet the needs of people with disabilities during pandemics
A 12-year-old visually impaired girl in India recently died for lack of food, medicines, and financial help — all things which were harder to access during the coronavirus lockdown.
How Google's Project Loon Can Improve Epidemic Preparedness
These balloons are part of an initiative by Google’s Project Loon and Telekom Kenya. Although this project has been long in the making, it was fast-tracked by the Covid-19 pandemic.
Strengthening Biosecurity Preparedness in Africa
Recently, the African Continental Free Trade Area (ACFTA) mooted a single market for goods and services due to the ease of traffic to deepen the economic integration of the African continent. A single market would enhance the prevailing biosecurity threats.
The new dexamethasone- COVID-19 study should be viewed with caution
A new study shows a steroid, dexamethasone, improves the survival of some COVID-19 patients, especially those with severe forms of the diseases. These include some on ventilators and some who require oxygen.
Nigeria’s Mental Health Desert
The survey of 5,315 respondents, conducted by our organizations – EpiAFRIC and the Africa Polling Institute – found that 84% believe that mental disorders are attributable to drug abuse, 60% link such disorders to “sickness of the mind,” 54% to “possession by evil spirits,” and 23% to “punishment by God.”
Countering Misinformation Should be Part of Health Interventions
Fifteen percent of respondents said that they would eat garlic and ginger to prevent COVID-19 infection. Twenty-six percent of the respondents said they were immune to COVID-19. Among the 26%, reasons given for the perceived immunity were: I am a child of God (40%)…
Four Ways to Combat Malaria in the Time of COVID-19
African governments must focus on opportunities within the informal health sector in addition to working towards universal health coverage for all as a way to combat malaria. These are four ways to achieve that.
Remote work is good for business, and the world
The success of remote work is no coincidence. Studies have shown that when it is done right, remote work can improve employee productivity, creativity and morale. It has also been established that remote work leads workers to take fewer sick days and less vacation time, resulting in more workdays overall.
Four Ways Nigeria Can Reduce Importing COVID-19 Via Its Border
As a public health physician in Nigeria, I have worked in communities along these land borders and seen firsthand how porous they are. Some of them are farmlands, some are forests while some are parts of households.
One Health in Nigeria
Three abattoirs were surveyed, photographed and operators interviewed. The abattoirs were filthy with animals slaughtered on bare floors, and dogs feeding on leftovers. Car tires were used to burn furs off slaughtered animals.
Neglected Diseases Kill More People than COVID-19 – It’s Time to Address Them
As COVID-19 surges globally and leaves fear and panic in its wake, global efforts are underway to find a cure. Yet, the same level of response is lacking for several other infectious diseases that kill millions annually.
News Agencies Must Paint a Complete Picture of Coronavirus
Recently, New York Governor Andrew Cuomo said, “We have an epidemic caused by Coronavirus, but we have a pandemic caused by fear “. This fear is worsened by how news agencies report the outbreak. These are some examples. “Bodies ‘pile up’ in morgue as Iran feels strain of coronavirus” – CNN
Businesses can help stop coronavirus and future infectious disease outbreaks
CEOs and boards must realize that funding epidemic preparedness makes business sense and have huge returns on investments — and it’s just the right thing to do.
Let’s Prevent Post-partum Depression and Provide Care to Those in Need
No one really cares about how the women feel, if they are still haunted by the memories of childbirth, how they are coping with the immense bodily changes, if they are emotionally ready to have sex, if they even want to go through pregnancy ever again.
Why the Coronavirus Should Worry Us All
The rapid nature of its origin and speed in transmission reminds us that national security is threatened when a pathogen can travel from a remote village to major cities on all continents in 36 hours. Therefore, global health security should be given the same priority as national security.
Why an Ebola Vaccine Is Not Enough
When the US Food and Drug Administration approved the new Ebola vaccine Ervebo last month, I was elated. Ervebo can generate a quick immune response after a single dose, with protection occurring within ten days.
It’s Time to Put a Full Stop on Period Poverty
Recently, when I used a men’s restrooms at the George Washington University’s Milken School of Public Health in Washington, DC, I was pleasantly surprised to see free packs of tampons and sanitary pads. This was a first for me.
Four Lessons to Reverse Inequity in the Global Health Workforce
Recently, Madhukar Pai, the Director of McGill University Global Health Program wrote about the inequity in global health research. He observed that researches are skewed in favor of the global north.
It's time to channel household expenditures into health insurance in Nigeria
Ten years ago, our first child, Yagazie, was born, her Igbo name meaning “it is well.” She weighed 3.5 kilograms at birth and was a bubbly child. As new parents, my wife and I were elated.
Lay media reporting of monkeypox in Nigeria
In October 2017, the first confirmed case of a monkeypox outbreak was reported in Bayelsa State, Nigeria, although suspected cases started to be reported in September 2017.
Four Ways to Prevent Lassa Fever Deaths
Dr. Wouter, a Dutch doctor who helped perform surgeries and train colleagues in surgical skills in underserved areas of Sierra Leone died of Lassa Fever. He was infected as a result of performing a Caesarean section on an infected pregnant woman.
Community Efforts are Key When Addressing HIV/AIDS
Three years ago, I led an evaluation of an HIV project that focused on increasing access to quality care and supporting services for people living with HIV in Nigeria. It also aimed to reduce HIV-related stigma and discrimination.
Gasping for Air: Doctor’s death exposes inherent risks of Nigerian public hospitals
Despite her deep dedication to duty and commitment to her patients, Rosemary, unfortunately, died in the same hospital where she worked, in the same department she headed.
4 ways to end the abuse of women during childbirth
This week I was reminded of those experiences when I read the findings of a new study published by The Lancet. One third of new mothers report abuse during childbirth in Ghana, Guinea, Myanmar and Nigeria…
Four ways to address the heart disease-related outcomes of malaria
Recent research shows malaria increases the risk of heart failure by 30%, implying a double jeopardy for the health and wellbeing of people in malaria-endemic countries. The unique connection between malaria and heart failure means an increase in the burden of non-communicable diseases.
How to keep kids in school and fight malnutrition
But there is a solution close at hand for both problems: Home Grown School Feeding (HGSF). The programs have been shown to both combat hunger and keep children in school, and must be urgently scaled-up to reach every primary-school age child in need of food and education.
Four Ways the African Development Bank Can Support a More Secure Africa
Free movement of people and goods across Africa increases the risk of transmission of infectious diseases. The continent must realise that it is no longer a question of if disease outbreaks will occur, but instead, of when, and how fast.
Medical Negligence in Nigeria Must End
Oyin Gucci is a Nigerian woman whose Twitter profile reads, “I am simple. Was once a mother”. A few days ago, she shared the sad story behind her bio. In a series of tweets, she narrated how she lost her nine-month-old son a few months ago due to negligence by a doctor at the General Hospital Ikorodu, in Lagos State, Nigeria.
Dear President Buhari; Without Health, We have Nothing
Mr. President, “without health, we have nothing”. You clearly understand this, for when you were ill you went to great extent to get excellent healthcare. We are thankful that you got the quality of healthcare you needed from the United Kingdom and are now stronger to steer the ship of governance.
59: Great Lofty Heights Unattained
Beyond the celebration, let us imagine that Nigeria is a 59-year-old woman named Wazobia. This is a fair assumption because a society’s level of development is measured by looking at the status of women and the level of their empowerment. What has been the state of Wazobia’s health since Nigeria’s independence in 1960?
Preventing pneumonia must involve more than tech tools
But as promising as Butterfly iQ may be, it can be constrained in the impact it can make in the prevention and treatment of pneumonia and should not be treated as the ultimate solution. Tech is great — resource-poor settings often require simpler solutions to health challenges.
Human-centered plastics recycling interventions can help combat climate change
It is snowing plastics in the arctic — a team of German researchers found more than 10,000 micro-plastics in one liter of snow. This is a wakeup call to anyone who ever doubted the harmful effects of climate change.
Want to prevent vaccine deaths? Show people the consequences of unvaccinated nations
People’s confidence in the safety and efficacy of vaccines is greater in poor than rich countries, according to Wellcome’s recently published Global Monitor, a survey of 140,000 people from over 140 countries.
Institutionalized racism is keeping black Americans sick
More African American men and women aged between 35-64 are dying due to heart failure compared to people the same age in other racial groups, the Journal of the American College of Cardiology said this month.
Angela Merkel has Done Much to Help Africa; Her Successor Should Continue the Relationship
Indeed, now is the time for the African continent and Germany to cement the great relationships Merkel has fostered, build on the initiatives she has championed and leverage on the network she has brought along.
Let Plants be Thy Medicine – You Are What You Eat
While 45 percent of deaths in children are from nutrition-related causes, mainly malnutrition, diet-related non communicable diseases like obesity is a fast-growing problem across the world causing low- and middle-income countries to face a double burden of malnutrition.
Three Ways to End HIV Stigma and Discrimination
As a Public Health Doctor, I often meet people who experience stigma simply because they live with HIV. One person who still haunts me is a woman who is HIV positive and when she was in labor, a midwife would not help her.
Tapping into Mobile Phones to Advance Africa's Intelligence on Global Health and Food Security
It is official: With 9.3 billion mobile connections, the number of mobile devices on earth now surpasses the 7.6 billion people population. This creates huge opportunities to advance global health and food security through mobile phones.
Five Interventions for Treating Multidrug-Resistant TB
Today TB infects 25 percent of the world’s population, killing 1.6 million people every year. And as I saw firsthand years ago, it is becoming increasingly resistant to conventional drugs. This infectious disease must be taken seriously: it kills more people than HIV and malaria combined.
Rwanda's Lessons on Universal Health Coverage
Rwanda has come a long way in 25 years and their health statistics are among the best in Africa. For instance, above 96% of Rwandans have health insurance, qualifying it as universal health coverage; routine immunization coverage is 99%; and under five mortality rate is 37.9 per 1000 live births.
African Leaders Need to Develop Sustainable Ways of Financing Healthcare
In the face of this, current health spending per person in sub-Saharan Africa is person is $198 a year, versus $1,288 in North Africa and the Middle East. It is clear that sub-Saharan African governments are spending too little on health.
World Health Organisation’s New Effort Can Help End Neglected Tropical Diseases
NTDs disproportionately affect 1.6 billion poor people worldwide. Most of the burden is in Africa, Asia and Latin America. Africa accounts for more than 50% of the global burden of NTDs. South East Asia has the second highest burden of NTDs – the region accounts for 74% of reported cases of leprosy globally.
How good urban farming can combat bad eating
Unhealthy diets pose a bigger global health risk than unsafe sex, alcohol, drug and tobacco use combined. This is according a new report that estimates 820 million people are underfed and that many more consume low-quality diets that substantially increase the risks of cardiovascular disease, stroke, diabetes and obesity.
Remittances could be a gamechanger in the quest for UHC. Here's how
At an estimated 15 million people, the Nigerian diaspora is large and growing. One cent on each dollar remitted would have yielded $220 million toward health insurance in 2017 alone. Other African countries would have likewise received significant boosts to health resources: $22 million in Ghana; $8 million in Ethiopia; and $9 million in South Africa.
Don't Call Me Chief: The Need to Redefine Respect in Nigeria's Medical Community
Nineteen years ago, I graduated as a medical doctor. Throughout medical school and during my housemanship training, I was compelled to address my senior colleagues as “Chief” at ward rounds, in clinics and even outside the hospital premises. It was taboo to call your senior colleagues by name. Nineteen years later, it remains a taboo.
African Expertise Key to Stopping Ebola - Then and Now
I was a member of the EpiAFRIC team that evaluated the response of the African Union (AU) to the West African epidemic. The AU had recruited over 800 volunteer medical experts from across the continent to combat the epidemic raging across Guinea, Liberia and Sierra Leone.
How tech can help win the fight against neglected tropical diseases
Fabiano suffers from river blindness, or onchocerciasis, one of twenty Neglected Tropical Diseases (NTDs) that affect about 1.5 billion of the world’s poorest. That’s more than one-sixth of the global population. Caused by a variety of bacterial, parasitic, viral and fungal infections, these diseases can lead to blindness, disfigurement, malnutrition, growth failure and cognitive impairment.
Should The Health Sector Be Tasked With Road Safety?
There is hardly anyone in Nigeria who does not have a personal tale of road crashes to tell. In 2007, my mother died due to complications of a head injury sustained from an ‘‘okada” (commercial motorcycle) crash. It was a painful and an avoidable death. A report by the CLEEN Foundation showed that in 2013, 47% of road crashes in Nigeria were due to okadas.
Making Sense of a Young Doctor's Death
Ahmed Victor Idowu was a young medical doctor with a passion to reform health care in Nigeria. A recent graduate of the University of Nigeria, in January 2018 he was at the start of his in-hospital clinical training when he examined a seven-month old baby with an abnormally high fever. He was the only doctor on duty.
Only 1 percent of Nigerians have health insurance. Here’s how to change that
How do we ensure that no Nigerian family suffers the kind of catastrophic health expenditure that risked driving my family into poverty? To be sure, there are major challenges ahead in implementing UHC. But after 12 years of inaction, it is time to recommit to the principle of health for all.
Universal Access to Education is Social Justice
I grew up in poverty, within a disadvantaged community much like the ones where Nigeria’s out-of-school children live. Yet my story is a testament to how education can improve one’s station in life – it very literally lifted me out of poverty.
Nigeria Interrupts Polio, But The Fight Is Not Over
In recent months several innovative approaches have been used to increase the effectiveness of polio immunisation in the “frontline” states. One of these have been mechanisms to ensure accountability of vaccination activities; e.g. using GPS devices to ensure that the there is greater certainty that vaccinators actually reach communities that they are responsible for reaching.