The UK Department for International Development (DFID) in Nigeria is supporting the Programme for Reviving Routine Immunization in Northern Nigeria (PRRINN) Consortium to implement a £20m project in four States of Northern Nigeria. It is anticipated that by the end of the project State and Local Government Authorities have significantly improved the coverage of child immunisation. This will be achieved through building the State’s capacity to plan, implement and monitor routine immunization activities, and by increasing access and uptake of immunization at community level. In this way ownership of immunization activities will be transferred from external agencies to the local communities.
Transaid responsibility within the consortium will be to support the implementation of an efficient transport system for the sourcing of vaccines, delivery of vaccines and the transport of health workers and community members.
Immunisation rates in Northern Nigeria are some of the lowest in the world. According to the 2003 National Immunization Schedule the percentage of fully immunized infants on the States to be targeted was less than 1% in Jigawa, 1.5% in Yobe, 1.6% in Zamfara and 8.3% in Katsina. As a result thousands of children are dying as victims of vaccine preventable diseases.
There are several reasons for such low rates. Firstly the primary health care services are highly ineffective and have deteriorated due to the lack of investment in personnel, facilities and drugs, and because of poor management of the existing resources. There is also a problem of confidence and trust by the public in the health services resulting from the poor state of the facilities and low standards of delivery. These problems have been exacerbated by “vertical” interventions undertaken by outside agencies which undermined the capacity of the local service providers to implement sustainable programmes. At the family / community level there is a low demand for immunization due to a lack of understanding of its value.
The PRRINN program will increase the vaccination rates through emphasising the need for capacity building among stakeholders at different levels, with work being undertaken with Ministry of Health employees at all levels, and work with the communities.
PRRINN is presently working with the federal government to promote the development of appropriate policies that will harmonise the intervention of different agencies supporting immunisation and clarify the resources available for the program.
During the first half of 2007 the Consortium will establish offices in the four states to manage the operations with three types of intervention taking place: improvement of the deliver system, training of health staff and engagement of the community.
Delivery support will be provided to strengthen the cold chain system, improve waste management, and improve logistics and transport systems. The existing health agents will be trained on best practices regarding the delivery of vaccination services. This includes strengthening planning and systems management, human resources development and training in financial management. Finally work will be undertaken with community leaders to increase awareness of the importance of vaccination.
Transaid’s role in the consortium is related particularly to logistics and the improvement of the cold chain necessary for the safe transportation of vaccines, and the movement of health personnel. Transaid will assess the condition of transport available to the project. This will lead to the development of operational guidelines for scheduling, maintenance, and overall management of transport prior undertaking training with the appropriate staff (see Transaid's Transport Management System). With this in place, Transaid will work with all stakeholders to find solutions to any shortfalls in transport to meet the demands of the programme.
Health Partners International, Save the Children, GRID Consulting, PATH, Johns Hopkins University Centre for Communications Programs and Institute of Development Studies, UK.
By the end of this program it is expected that 60% of the infants under one year old will have been fully immunized and 70% of women aged 15-49 will have had the appropriate Tetanus toxoid doses. These coverage rates will be sustainable because the capacity of the government, at all levels, to deliver routine vaccination and other primary health care services will have been improved.
A logistic system will be in place to allow a cost effective management of the available resources and, if necessary, alternative transport systems would have been identified (use of community volunteer schemes and private sector services will be considered).
Local communities will be brought into the programme to ensure an increase in demand for vaccination and related health services.
The increase of vaccination rates means that fewer children will be vulnerable to vaccine preventable diseases which will result in a drop in the infant mortality. The improvement of the government’s capacity to deliver primary health care will also improve the people’s confidence in the health system as a whole.
Putting in place transparent management systems, providing training in a wide range of skills, building community expectations and involvement will each contribute to the social capital of the whole region.