COVID-19: How to tackle challenges of routine immunisation financing

By Ojoma Akor

Nigeria ranks the highest in the number of under-five deaths as a direct result of vaccine preventable diseases.

 According to UNICEF, about three out of 10 under-five deaths are caused by diseases for which there are preventive vaccines, such as pneumonia, diarrhoea, and tetanus.

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Routine immunisation coverage still remains low in Nigeria. The COVID-19 pandemic in the country further caused disruptions in routine immunisation and other vaccination programmes.

Vaccination is the process of administering vaccines to a person, either through oral drops or by injection while immunisation refers to the protection that is acquired after vaccination.

Funding of immunisation services is the responsibility of all tiers of government through statutory budgetary allocations.

Other sources include development partners, external donors, private sector and the community. States also fund routine immunisation through the Basic HealthCare Provision Fund (BHCPF).

The funds for routine immunisation are used to procure vaccines and for storage of vaccines, transportation of vaccines to state Central Medical Stores (CMS), maintenance of cold chain, immunisation outreach to hard-to-reach areas, programme management for immunisation, advocacy, communications and social mobilisation.

However, while the federal government’s routine immunisation budget has witnessed an increase over the years, the situation has not been the same at the state and local government levels.

Daily Trust reports that the budgetary allocation for routine immunisation in some states have either been grossly inadequate, or suffer from late and poor releases.

Findings revealed that there are also concerns about the sustainability of the donor-funded or supported immunisation programmes.

Experts say inadequate and untimely releases of funding to immunisation related activities could lead to non- vaccination and under-vaccination of children under- five.

This, they said, could in turn create a potential risk for the outbreak of some other preventable diseases in the country. 

All vaccines given via the routine immunisation programme in Nigeria are free in government owned or public health facilities across the country.

The free vaccines include BCG (against tuberculosis), polio, Pentavalent vaccines (against diphtheria, whooping cough, tetanus, Hepatitis B and Haemophilus influenza type B – HIB), pneumococcal conjugate vaccines, measles and yellow fever.

The concerns around financing routine immunisation in Nigeria came to the fore recently during a session organised by the Partnership for Advocacy in Child & Family Health at Scale (PAS) project  at the 52nd /53rd Annual General Meeting and scientific conference of the Pediatric Association of Nigeria (PAN)  in Uyo, Akwa Ibom State.

Experts on immunisation and the executive secretaries of primary healthcare boards of Kano, Kaduna, Niger and Lagos states, PAS focal states brainstormed on ways to sustain routine immunisation financing beyond the context of COVID.

According to Prof. Enobong Ikpeme, a pediatric nephrologist at the University of Uyo, and a consultant pediatrician at the University of Uyo Teaching Hospital, there is need for increased coverage of routine immunisation across the country particularly in rural and hard to reach areas.

Prof Ikpeme, who is also the chairman local organising committee of the conference, said, “Government needs to do more by not just allocating the funds but also by ensuring that it is timely released.”  

Chairing the session, Dr Olufemi Mobolaji Lawal, a consultant pediatrician explained that costs are incurred for every vaccine delivered to children.

He said, “Financing is crucial and it has to be sustainable, reliable and infact be able to expand when necessary, as is the case of COVID-19 for instance.

 The moderator of the session, General Shina Ogunbiyi, a consultant anasthesiologist and Project Director of the Alumni of the National Institute- PACFaH@Scale project in Lagos State, said as a result of COVID-19, some essential health services including routine immunisation were reportedly disrupted in some states due to the lockdown and distribution of resources to states.

He said the PACFaH@Scale project is a Bill and Melinda Gates Foundation investment in health and social accountability project which aims to advocate to the executive and legislators at federal, state and local government levels to fulfill their services and social contract to the citizens.

He said Kano, Kaduna and Niger states on their  part signed Memorandum of Understanding (MOU) with the Bill and Melinda Gates Foundation on strengthening PHC and routine immunisation.

The executive secretaries of the primary healthcare boards of the various states, while saying that the MOU helped strengthen Primary Health care (PHC) services and routine immunisation,  outlined the challenges still bedeviling  them admist the pandemic as well as opportunities to harness  to ensure improved financing and quality health service delivery.

They lamented the poor financing from the local government tier for routine immunisation in particular.

Dr Hamza Abubakar, Executive Secretary Kaduna State Primary Healthcare Development Agency, said, “We hope the economic situation in the country will improve so we can have better performance when it comes to cash back. We need to plan better, budget better and actually target routine immunisation a bit more specifically as well as raising awareness and motivating parents and care givers to bring their children to the hospital for immunisation.”

While saying partnership is very important, he added that routine immunisation and health in general has to be multi-sectoral.

Dr Ibrahim Dangana, the Executive Secretary, Niger, State Primary Healthcare Development Agency, said one of the principal challenges is that Niger State constitutes 10 per cent of the landmass of Nigeria.

He said, “There is  a logistics challenge in reaching well over 6,000  communities with majority being hard to reach communities. 

He said the MOU helped to rejuvenate the healthcare system and provide crucial funding.

However, he said local government autonomy has affected financing for routine immunisation.

“We are doing everything we can in our advocacy to our local government areas system to understand that pooling resources together gives a better economic scale and allows you to plan and achieve results together,” Dr Dangana said.

He said transportation of vaccines to the local government areas, putting them in cold stores, electricity to maintain them all cost a lot of money.

Dr Tijjani Hussaini,  Executive Secretary, Kano State Primary Healthcare Management Board, said Kano was the first state to sign the MOU in 2016.

He said  before the intervention, Kano had 19 per cent  routine immunisation coverage but with the intervention it has now increased to 46 per cent.

He said, “Over the years there have been awareness creation about routine immunisation, and the issues of resistance are gradually coming down.”

He said the Basic Healthcare Fund (BHCPF) is an opportunity to ensure that health services are sustained at state and facility levels.

 Dr Mustapha Ibrahim , the Permanent Secretary, Lagos State Primary Healthcare Board, said as a result of the focus on COVID-19 vaccination,  the health seeking behaviours of mothers dwindled and many of them stopped bringing their children for routine immunisation for fear of getting infected.

Represented by Dr Benedicta  Adejola, director medical services at the board, there was need to harness the private sector for routine immunisation as was done for COVID-19. 

He stressed the need for the country to be wholly responsible for routine immunisation instead of relying on external donors.