Nigeria has developed a 10-year strategy to improve routine immunisation as support from the Global Alliance for Vaccine and Immunisation (GAVI) winds down.
The goal of Nigeria’s Strategy for Immunization and PHC System Strengthening (NSIPSS) is to ensure at least 84 in 100 children get routine immunisation across the country by 2028.
Only 33 in 100 children get immunized around the country, according to a survey released in 2016.
And up to 4.3 million children have never been immunized in the last two years—the largest cohort of unimmunized children anywhere in the world, according the National Primary Health Care Development Agency (NPHCDA).
“We were outraged by the low coverage figures released in 2016,” said NPHCDA executive director Faisal Shuaib.
Dwindling funding
GAVI has historically helped fund routine immunisation. The 2014 rebasing of Nigeria’s economy changed the country’s economic status from a developing country, making it ineligible to continue receiving GAVI support.
Ongoing GAVI support lasts until 2021, when Nigeria is expected to bear total cost of funding immunisation.
Conversations and meetings have been on about making Nigeria’s graduation out of GAVI support “flexible,” said Shuaib.
Documentation on the NSIPSS has been submitted to GAVI.
“If GAVI board approves, the period of graduation could extend by seven years. It provides us more time to plan for graduation from GAVI,” said Shuaib.
GAVI chief executive Seth Berkeley visited Nigeria early March, insisting the country needed to show “commitment” and “improvement” in efforts to close gaps in immunisation coverage and funding.
“The decision that will be made on whether GAVI can continue to provide support after 2021 will be based upon the commitment that’s being shown by the government and the improvement that it’s done,” Berkley told Daily Trust in March.
“Many stakeholders have invested huge amounts of money—so far $732 million, and I think people want to see that results are occurring from that. That will decide on whether further support is provided.”
Pooling resources
The overall cost of NSIPSS is put at $2.72 billion (around N979.2 billion) over the 10 years in question.
Vaccines for routine immunisation and special mop-up campaigns are estimated to cost $1.95 billion. GAVI support will provide $773.2 million within the period.
The cost of vaccine procurement is estimated at $295m a year when Nigeria finally exits GAVI support, according to the plan.
This year’s immunisation cost is put at $186 million (around N66.9b)—split evenly between Nigeria and GAVI.
Nigeria’s contribution to the pool is expected to rise steadily over the next 10 years until 2029 when it will solely fund its immunisation requirements.
The only guaranteed source of funding to finance NSIPSS is the immunisation budget of both the federal health ministry and NPHCDA, but they are inadequate.
Total health allocation proposed for health in 2018 is N340.4 billion. All vaccines—for routine immunisation, sub-national immunisation, emergency, outbreaks and hajj—get around N12.3b in funding allocation from NPHCDA 2018 budget as proposed.
Current allocation is only a third of what is required, said Chizoba Wonodi, country director for International Vaccine Access Centre (IVAC).
She presented an investment case for immunisation seeking support from civil society groups and private sector to increase funding for immunisation at a breakfast meeting in Abuja.
Wonodi calls the NSIPSS a “testament to one plan” reached by various stakeholders to have a unified voice in seeking more financing for immunisation.
“We are not asking for a bigger piece of the same pie. We are baking a bigger pie by increasing government revenue,” she said.
Beyond the budget, potential funding sources include the Basic Health Care Provision Fund, equivalent to a minimum 1% of consolidated revenue, but that is yet to be implemented.
Talks are also on about making immunisation a “first-line charge” item in the budget—essentially freeing it from any debate or delayed release of funding.
Loans, contributions from states, taxes and some innovative financing are also potential sources—alongside matching grants. Some N2.4b is proposed as counterpart funding to match grants from UNFPA, USAID, UNICEF and BMGF.
“We need a voice to engage the private sector,” said Samuel Usman, of the CORE Group Partners Project.
The investment case for improving financing cites research showing huge return on investment—$44 in return for every dollar invested in vaccines.
“Nigeria is rich in people. For us to harness that capital, our people have to be smart,” said Wonodi.
“Enough is enough”
“We are trying to move away from a situation where we go cap-in-hand to donors to pay for vaccines that our children need,” said Shuaib.
The NSIPSS considers hindrances beyond just finance.
“For the first time, we are saying, enough is enough,” said Shuaib. “We have to fix all the problems that prevent our kids from getting the vaccines they require.”
An implementation planned around Africa Vaccination Week starts next week—the first of several phases targeted at the 18 states with the lowest immunisation coverage.
Called Optimised and Integrated Routine Immunisation sessions (OIRIS), it will bundle immunisation alongside services as Vitamin A supplementation, family planning, malaria and diarrhoea treatment, de-worming, health talks—anything that brings children to health facilities.
A survey by the agency, which coordinates primary health care, found 43 in 100 caregivers were not aware of routine immunisation; they only knew of campaigns.
“A lot of it is hinged around traditional leaders mobilizing from the grassroots, creating awareness about the importance of vaccines,” said Shuaib.
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