WHO supported vaccination teams traveling from far and wide to bring lifesaving vaccines to children in hard-to-reach areas during an integrated immunization campaign in Niger State, Nigeria. Credit: WHO/Ogbeide E.
Immunization remains the mainstay for protecting the health of children around the world, but achieving universal immunization is a critical global challenge. More than 12.4 million children in low- and middle-income countries were unvaccinated in 2020. These vulnerable children, known as ‘zero-dose children’, account for a significant proportion of preventable child deaths. Nigeria faces a particularly alarming situation among these countries, with more than 2.2 million children estimated to be living with zero doses in 202111. To address this pressing issue, the signatories of the Global Plan of Action for Healthy Lives and Well-being for All (SDG3 GAP) are: We are working with the Nigerian government to provide immunization services to all children. Through joint efforts, SDG3 GAP partners embrace a collaborative approach as the most effective way to achieve this important goal.
Working together to find zero-dose children and missing communities
A WHO traveling health team supports eligible children in a nomadic setting in Borno State, Nigeria. Credit: WHO/Eromosere
To support children with zero doses, we need to find and engage the communities they belong to. These communities often include remote rural areas, urban poverty areas, or conflict-affected areas that face various forms of deprivation; , cross-disciplinary cooperation is needed to support them. Starting in 2020, SDG3 GAP partners and the Nigerian government collaborated to create a data system to identify communities with zero doses. The initiative, led by the National Primary Health Care Development Agency (NPHCDA) and supported by UNICEF and WHO, draws on data from a variety of sources, including immunization records, health facilities, surveys, and subnational community data. has been integrated.
Joint workshops and stakeholder meetings were organized resulting in pinpoint identification of 100 Local Government Areas (LGAs) in 18 states representing 1.5 million of Nigeria’s 2.2 million zero-dose children. A detailed analysis was conducted. This analysis informed the design of zero-dose priority actions in the National Strategy for Strengthening Immunization and PHC Systems (NSIPSS) and provided a comprehensive framework to improve immunization coverage. It also provided the basis for collaborative efforts and planning among partners to reach these communities.
NPHCDA and partners, including WHO and UNICEF, have developed a 2022-2025 Immunization Recovery Plan that includes a big catch-up plan specifically targeting zero-dose children. Through the GAVI-HSS project, GAVI worked directly with eight priority states to address low immunization rates and high burden of zero-dose children with $50 million in PHC and immunization grants. The World Bank is partnering with 16 priority countries through the Immunization Plus and Malaria Progress by Accelerated Coverage and Transforming Services (IMPACT) project to strengthen vaccine supplies, cold chain facilities, and surveillance systems to reduce under-five mortality rates. is focused on. In addition, financial channels and technical assistance from the Global Fund, WHO, and UNICEF supported 17 states to reach identified zero-dose local government areas.
Expanding the reach of zero-dose children
Children eligible for vaccination during immunization campaign in Borno State, Nigeria Credit: WHO
With the aim of reaching zero doses to children across Nigeria, SDG3 GAP partners will leverage previous investments in polio eradication and COVID-19 response to expand immunization coverage across the country. I am. These investments have not only established valuable infrastructure and skilled human resources, but also fostered strong community networks with trusted relationships with local leaders. Leveraging these networks, partners are now facilitating the delivery of zero-dose immunization services to children across the country.
With support from UNICEF, GAVI and WHO, these networks are being transformed into formal Community Health Influencers, Promoters and Services (CHIPS) as part of the Nigerian government’s community engagement strategy. Launched in 2018, the CHIPS program promotes community ownership and engagement and employs community-driven case-finding strategies to identify zero-dose children within a national community engagement framework. and administer vaccinations. Through a joint effort, SDG3 GAP partners, the National Primary Health Care Development Agency (NPHCDA), and other stakeholders will develop national implementation guidelines for the CHIPS strategy to ensure effective community engagement and access to lifesaving vaccines for all children. We have ensured progress in delivering.
As of January 2023, more than 4 million eligible children have been vaccinated since March 2021, with 70 More than 10,000 people have received the Penta-3 vaccine. NPHCDA will continue to work with the 100 priority zero-dose LGAs to design and implement customized and effective strategies to reach zero-dose children in each community/LGA-specific setting.
“We have seen improvements by partnering with other agencies. We have changed our approach and moved from the national level to the state level with targeted strategies to reach children in vulnerable communities and populations. We are now able to move forward and more efficiently and effectively deliver services to those who need them most,” said Dr. Walter Kazadi Mulombo, WHO Representative in Nigeria.
Building sustainable financing for immunization and PHC
A life-saving drop of oral polio vaccine administered to a child during an immunization campaign in Maraba, Nasarawa State. Credit: WHO/Ogbeide E.
SDG3 GAP partners and the Government of Nigeria are committed to sustainable financing and strong primary health care as key drivers of continued progress to reach every child in Nigeria. The Nigerian government has demonstrated strong political commitment and leadership in these areas, leading to active engagement and coordinating approaches with SDG3 GAP signatories and other partners to drive important reforms. Recent reforms, such as the National Health Insurance Authority Bill and the Essential Healthcare Provision Fund, have been implemented across the country to ensure financial protection and sustainable financing of primary health services, including immunization. An accountability framework is also in place with state governments to secure incremental state funding for immunization and primary health care, with the goal of achieving full state funding by 2028. Additionally, the President’s Commission on Healthcare Reform has prioritized revitalizing PHC to address gaps in vaccination coverage.
Under the leadership of the United Nations Resident Coordinator, coordination and collaboration with country-led initiatives within the United Nations system has been strengthened, as seen in the Nigeria-United Nations Sustainable Development Cooperation Framework (UNSDCF) 2023-2027. Collaboration with other partners is also being strengthened through continued multilateral cooperation. -Intervention in partner’s medical finances. Through these collaborative approaches, the Nigerian government, SDG3 GAP partners and other stakeholders are establishing sustainable financing mechanisms to strengthen primary health care in the country and effectively close the immunization gap. Masu.
To ensure that SDG3 GAP support remains aligned with country-led priorities and approaches, SDG3 GAP partners have established a monitoring framework through which governments can develop and develop strategies for better collaboration. We provide feedback on ongoing collaborative work, including opportunities. Feedback from Nigeria in 2022 highlighted improved coordination, alignment with national planning and budget priorities, utilization of national monitoring systems, and effective coordination mechanisms with support for SDG3 GAP. Although significant progress has been made, feedback from governments suggests that the promotion of good practices such as national compacts between development partners, increased resource inputs and co-creation of partner implementation plans with local stakeholders, in particular with development partners. This highlighted areas where further action is needed. sub-national level.
What is the SDG3 gap?
The Global Plan of Action for Healthy Lives and Well-being for All (SDG3 GAP) aims to help countries accelerate progress on health-related SDG targets by linking 13 institutions with key roles in health, development and humanitarian responses. A series of commitments made by The added value of the SDG3 GAP lies in strengthening collaboration across government agencies to take collective action and provide support that is more tailored to country-owned and led national plans and strategies.
Multi-Indicator Cluster Survey/National Immunization Coverage Survey (MICS/NICS) Report, Nigeria, 2021.
