Before now, parents in Northern Nigeria never regarded immunisation as an important aspect of healthcare delivery. However, on the strength of an intervention by the Global Vaccine Alliance (GAVI), in partnership with UNICEF, WHO and Nigeria Governors’ Forum, a mindset change in favour of child immunisation has gained significant traction. With $50 million in funding, the MoU aims to drive the message of immunisation and strengthen primary healthcare in eight states across Northern Nigeria. ABDULGAFAR ALABELEWE reports.
With over 2.2 million children with zero vaccination, Nigeria is rated as having the second highest number of un-immunised children globally, contributing mostly to the 12.4 million children who had received no vaccines in 2020, among lower and middle-income countries. Of these horrid statistics, states across Northern Nigeria contribute the most.
However, the Global Vaccine Alliance (GAVI), in partnership with United Nations Children’s Fund (UNICEF), World Health Organisation (WHO), and Nigeria Governors’ Forum, has moved to change the narrative, with the aim of strengthening Primary Health Care (PHC) in eight states across Northern Nigeria, including Taraba, Bayelsa, Jigawa, Katsina, Kebbi, Niger, Zamfara and Gombe.
The partnership, in recognition of the fact that immunisation is crucial in safeguarding children’s health worldwide, and that zero-dose children account for a substantial portion of preventable deaths in children, has set aside $50 million in funding to drive this campaign.
The GAVI intervention is not just strengthening PHC facilities through improved infrastructure and resources that make them more capable of delivering vaccination services and antenatal care effectively across the selected states. It is also building the capacity of health workers at the facilities to enhance their skills in immunisation practices as well as traditional birth attendance.
Under the programme, midwives were trained and provided with befitting accommodations to ensure they deliver 24-hour service to health seekers, expectant mothers and caregivers who bring their children for immunisation.
Aside supporting the logistics of vaccine distribution by ensuring that PHCs have a reliable supply of vaccines and necessary equipment, the intervention has succeeded in raising awareness about vaccination, addressing myths and resistance as well as promoted the importance of immunisation in local communities.
Two years into the programme’s implementation, our correspondent, who was part of its impact assessment tour to Jigawa, one of the beneficiary states, observed that beyond the investment at the primary healthcare facility and training of health workers, a group of locals called Jekada Lafia, otherwise known as health ambassadors, are the real game changers.
The health ambassadors traverse communities, most of which are hard to reach, to educate and enlighten parents and caregivers on the importance of immunisation, to ensure that their children receive life-saving vaccines.
Though the Jekada Lafia initiative had been around before the GAVI MoU, the coming of GAVI had supported their work. Before the initiative, immunisation coverage in Jigawa State was alarmingly low at seven per cent, according to the Multiple Indicator Cluster Survey (MICS).
The development worried the Jigawa State Government; hence the Health Ambassadors were recruited to change the narrative of poor immunisation status. They were initially engaged to record the names and immunisation status of all new born children in their areas.
After every immunisation session at the health facility, they update their registers and identify children who have missed out on their routine vaccinations and get them immunised. Under the GAVI intervention, they were trained and empowered to carry out enlightenment discussions among caregivers.
On the impact of the GAVI intervention, the Permanent Secretary of Jigawa State Ministry of Health, Dr. Kabiru Ibrahim, said: “Routine immunisation coverage has been jerked up by 700 per cent due to the Jekada Lafia initiative and the GAVI MoU.”
Represented by Dr. Shehu Sambo, the Permanent Secretary said based on the Multiple Indicator Cluster (MIC) survey of 2016, the immunisation coverage in Jigawa State was seven per cent, but it has recently risen to 49 per cent and still aiming higher as it awaits the 2026 MIC survey.
He further explained that the initial poor immunisation statistics made the state government to enter into the GAVI Memorandum of Understanding (MoU), which, according to him, is yielding positive results with the successes recorded in the routine immunisation coverage in the state.
“Our coverage for routine immunisation before the MoU was very low. In 2016, Multiple Indicator Cluster Survey (MICS) conducted showed that the state has Penta 3 coverage of seven per cent. So, the agency, which was established around that period, was saddled with the responsibility to come up with initiatives to change the narrative.
“Along that period, the MoU came with funding. And so we came up with numerous initiatives such as Jakada Lafiya innovation and the state outreach of immunisation, among others to help us reach those children assessing the fund from GAVI,” the Permanent Secretary said.
Explaining further on the Health Ambassadors, the Permanent Secretary said: “In each village or settlement, one person is nominated to serve as Jakada Lafia. We did that through the five Emirates of Jigawa State. Their duties are to record any childbirth that occurred in the communities and link them up to the service provider of routine immunisation, to record any usual pattern of disease occurrence as well as any maternal mortality in the community. They also cooperate with health workers, and every month, they sit down with the health workers to compare notes and reconcile their records.
“So, the Jakada Lafia platform is the demand creation platform for us in Jigawa State that is unmatched anywhere in Nigeria. Luckily for us, when the 2021 MICs were published, we had jerked up to 700 per cent increase. We moved to 49 per cent from seven per cent.
“Although for us as an agency, we were a bit disappointed because we thought we will reach like 70 per cent or 80 per cent because of the rigour of how we were working in the community.
“But 700 per cent increase is an addition in Jigawa State. We never had double digit immunisation coverage in Jigawa not until we had all these funding from partners. So, we are trying to build on the 49 per cent leveraging on the MoU.”
Explaining how the magic was done, which makes not only caregivers, but even expectant mothers to troop to the hospitals, one of the Health Ambassadors in Sakwaya in Dutse Local Government Area, Suleiman Badaru said as a way of building the confidence of mothers against any form of myth, misconception and misinformation about the routine immunisation, they also avail their children of the immunisation.
Continuing, Badaru, who is also the Village Head of Yarsadauje, explained: “Before we were engaged as Jekada Lafia, we, as traditional leaders, do educate our wards on their well-being and that of their children. We go about spreading the gospel of immunisation in places such as streets, house to house, naming ceremony venues, wedding ceremony and Mosque, among others.
“Before now, we use to record issues around misconception that when people bring support of this nature it has a purpose and side effect. But we are able to change their mindsets and you now find people struggling to get their child immunised. This is because we avail our own children for the immunisation as well to build the confidence of the caregivers that the immunisation is safe.
“As Health Ambassadors, we usually go and register our entire new born children and ensure they are up to date in immunisation. We do have a monthly review meeting between us and the routine immunisation providers to compare our notes to ensure no missing child.
“We also collaborate with the Traditional Birth Attendants (TBAs) who take delivery of new born babies in their houses. So, we check for children who skip the immunisation and go from house to house in search of such caregivers to sensitise them on the importance of immunisation.
“Some of them in the rural areas are not educated and most of their husbands prevented them from bringing their children for immunisation. So, we educate them on the importance of immunisation to prevent their children from diseases such as meningitis and yellow fever, among others. They are now giving us maximum cooperation.”
Confirming the Health Ambassadors’ efforts, a caregiver, Zakiya Nasiru, who travels several kilometers on motorbike from a hard-to-reach Jandu Village to Andaza PHC in Kiyawa Local Government Area of Jigawa State to get her four-month-old baby immunized, said she got to know about the importance of immunisation through their Village Head.
She noted that having realised the importance and benefits of immunisation to the health of her baby, she never forget immunisation days for her baby. Zakiyya said: “I came from Jandu; I traveled about 6kms and over one-hour-thirty minutes ride on motorcycle from the hard-to-reach area. I spend up to N1, 000 as transport fare.
“I knew about the immunisation through our Health Ambassador (Ward Head). When the day for immunisation draws nearer, he comes around to remind us about it but I hardly forget about the day because of the importance and benefit to the health of my child.”
She also said: “A non-governmental organisation (NGO) is supporting us by giving us N1, 000 any time we bring our babies up the fifth time and on the last round we will be given N5, 000.
“I don’t come because of the money, but because of the health and well-being of my child and myself. We still find people who don’t bring their babies for immunisation but they are very few. A lot of caregivers are now enlightened and make their children available for routine immunisation.”
One of the trained health workers, a Registered Nurse, Eucharia Anyansi, who gave insight into the services they render at the PHCs, said: “As they now receive more caregivers who bring their children for immunisation, they counsel them on the importance of follow up for the benefit of their children.”
On behalf of UNICEF, which is the key implementing partner of the GAVI’s PHCs intervention, the Chief of Health, UNICEF, Nigeria, Dr. Eduardo Celades Blanco, described the PHC MoU project as a game changer in addressing the age-long challenge of poor vaccination and other health challenges, stressing that PHC is important because 90 per cent of diseases can be treated at the PHC.
He stressed that based on the importance attached to strengthening primary healthcare in Nigeria, particularly in Jigawa State, over N2 billion has been invested to support government’s efforts to extend primary healthcare services to underserved communities.
He said: “Primary healthcare is the foundation of a country’s healthcare system, providing essential services to millions of people. In Nigeria, primary healthcare is the cornerstone of the health sector, treating 90 per cent of diseases and preventing others through services such as vaccination and immunisation.
“However, despite its importance, primary healthcare in Nigeria is weak, facing numerous challenges that hinder its effectiveness. One of the biggest challenges facing primary healthcare in Nigeria is insufficient funding. The government’s investment in primary healthcare is limited, resulting in inadequate resources, including health workers, equipment, and infrastructure.”
Blanco said this shortage of resources makes it difficult for primary healthcare centres to provide quality services, leading to poor health outcomes. “Another challenge facing primary healthcare in Nigeria is poor data collection and management. Accurate data is essential for planning and decision-making in healthcare, but in Nigeria, data collection is often inadequate, making it difficult to track progress and identify areas for improvement,” he added.
The Chief of Health at UNICEF, Nigeria also said shortage of health workers is also a significant challenge facing primary healthcare in Nigeria, as the country faces a brain drain, with many health workers leaving to work in other countries. This shortage of health workers according to him, makes it difficult for primary healthcare centers to provide quality services, leading to poor health outcomes.
Blanco, however, said “UNICEF is working to strengthen primary healthcare in Nigeria, particularly in Jigawa State. The organisation has invested over N2 billion in Jigawa State in supporting the government’s efforts to extend primary healthcare services to underserved communities.
“One of the key areas of focus for UNICEF in Jigawa State is immunisation. It is a critical component of primary healthcare, preventing millions of deaths yearly. In Jigawa, UNICEF has supported the government’s immunisation programmes, significantly increasing immunisation coverage.
“In addition to immunisation, UNICEF supports other primary healthcare services in Jigawa, including maternal and child health services.”
