Title : Moving the needle for covid-19 vaccinations in Nigeria through leadership, accountability, and transparency
Abstract:
Background: The first set of vaccines arrived in Nigeria in March 2021. The National Primary Health Care Development Agency (NPHCDA) set out to vaccinate at least 70% percent of Nigeria’s eligible population i.e., 111,776,503 people, by December 2022. As of June 2021, only 3% had received at least one dose of the vaccine. This presented a threat to the achievement of NPHCDA’s goal. The low uptake was attributed to funding gaps in ensuring last-mile delivery of vaccines and challenges with accountability and transparency. Nigeria Solidarity Support Fund (NSSF) had consultative meetings with the NPHCDA, which resulted in a partnership that kicked off in September 2021.
Objective: Accelerate the uptake of COVID-19 vaccinations across Nigeria over 3 months.
Methods: Across Nigeria’s 6 geopolitical zones, 6 states were selected, namely: Adamawa, Edo, Imo, Katsina, Nasarawa, and Ogun states based on performance, political will, and absence of external resources. A 2-pronged approach was implemented: unrestricted funding to the sub-national level and providing technical support at the national level.
At the subnational level, there was a shortage in the supply of COVID-19 vaccines and NSSF worked with the NPHCDA to advocate for an increased supply of vaccines to the states. Healthcare workers were trained in best practices for vaccine delivery and waste management. Information gaps among the healthcare workers were addressed, to increase their confidence in the efficacy of the vaccine. Stakeholders and champions, including spiritual and community leaders, were mobilized in communities to debunk rumours and engage their community members on the importance of the vaccine. In addition, they linked community members to COVID-19 vaccination services.
At the national level, to promote accountability and transparency, indicators were set and each state set population-based targets, of which progress was reported weekly. Immunization data, validated by ad-hoc staff, was reported via the Electronic Management of Immunization Data (EMID) application. Data review meetings were held weekly for data quality checks, and states were ranked based on their performance. Low-performing states were provided additional support based on specific needs.
Results: 5 out of 6 states received unrestricted funding to ramp up vaccination coverage. These 5 states received adequate vaccine supplies. A total of 12,000 healthcare workers were trained on safe immunization practices and multiple communities were engaged across the 133 local government areas (LGAs) through religious and community leaders. After 6 months, there was an average of 35% increase in the uptake of COVID-19 vaccines in the 5 states. An indicator tracker was developed for weekly reviews at the national level and the total population vaccinated in Nigeria also increased from 6,186,647 to 11,985,336 at the end of the partnership.
Conclusion: Unrestricted funding, though not without its risks, can yield a significant impact on health. Although Nigeria is still one of the countries with the lowest COVID-19 vaccination coverage, leadership buy-in, accountability mechanisms, and unrestricted funding have moved the needle. One state didn’t implement due to internal leadership challenges, however, 5 states topped the chart and were motivated other states to source additional funding for last-mile delivery.
Audience take-away:
- The Federal and State governments owned the project and set population-based targets for each state. Hence the state teams were driven to work hard at achieving their targets.
- The funding provided was not tied to grant lines, which allowed flexibility in implementation and implementation research on the go.
- Vaccination uptake increased when single-dose vaccines (Johnson & Johnson) were introduced in Nigeria. This reduced the dropout rates that were experienced with the other brands of vaccines.
- The grant was not implemented as a parallel project, rather it was implemented in the principle of additionality. This allowed the NPHCDA and NSSF to geometrically increase impact.
- Electronic real-time data management was a key part of the success and a backbone for improving data quality, accountability, and transparency, which allowed gaps to be identified and bridged on time.
