Breathing new life for immunization programme
Nigeria is one of the fastest growing nations in the world. With a current population of over 190 million people, the population is estimated to reach 263 million by 2030, overtaking countries like the United States of America. Yearly, 6 million children are born in Nigeria. Unfortunately, 1 in 15 of these children will die before their first birthday and only 1 in 8 will survive to see their fifth birthday due to diseases that can be easily prevented by a shot of vaccine.
Immunization, a process whereby you are injected with a vaccine, to develop immunity against a disease is one of the safest and most cost-effective public health interventions till date; saving millions of children everywhere from life-threatening childhood illnesses. According to the World Health Organization (WHO), 2 to 3 million deaths are averted yearly around the world as a result of immunization. Beyond its impact on health, immunization also averts medical costs and time spent by parents to care for sick children, allowing them more time to be productive and contribute to national economic growth. For every US $1 investment on vaccination, US $16 is yielded in return.
Unfortunately, immunization coverage remains very low in Nigeria. NDHS 2013 reported only 21% of 12 - 23 monthold children received all the required vaccines before their first birthday. In addition, the report from the Ministerial Conference on Immunization in Africa (MCIA) held in 2016 in Addis Ababa ranks Nigeria among the lowest, with only 66% coverage on immunization with the diphtheria-pertussistetanus vaccine (DPT3) - a strong indicator for immunization strength in a country. Countries like Gambia (96), Ghana (98) and Rwanda (99) were among the highest on immunization coverage. The poor coverage of immunization in Nigeria stems from so many reasons, including weak primary healthcare system, inadequate funding, and minimal or no local production of vaccines. However, to improve coverage to every eligible child and maximise the health and economic impact of immunization in Nigeria, the government needs to increase its spending on vaccines and immunization programmes.
Like many countries in Africa, Nigeria has enjoyed tremendous financial support from Gavi both in the areas of vaccine support and non-vaccine support such as health system strengthening, accruing to over US $690 million since 2001. But the time has come for us to increase ownership and re-strategize on how to self-finance and sustain immunization in Nigeria, as the country has entered its 5-year transition phase out of Gavi support beginning 2017. As of June 2017, Nigeria will need to spend US $1.644 billion between 2017 and 2020 to meet her immunization targets. In addition, a funding gap of about US $855 million needs to be realized for the same period.
As pledged by the Health Ministers at the MCIA in 2016, it is time for Nigeria to increase and sustain its domestic investments and production of vaccines, increase funding allocations and adopt innovative financing mechanisms to fill the gaps in vaccine procurement and operational implementation of immunization activities. The time has come for the government, non-governmental organizations, civil society, communities and individuals to come together and map a course to finance immunization and increase its coverage.
As an integral part of the health system, strengthening all the building blocks of the primary health care system and in particular, the human resource for health which is at the core of the building blocks - is essential to improving coverage and uptake of routine immunization. Traditionally, midwives and nurses play the pivotal role in advising parents about immunization especially during the antenatal period, when mothers and families are educated on the importance of maternal immunization against tetanus and childhood immunization until the child is 5 years. Supporting them and maximizing their skills in educating families and delivering routine immunization is essential to effective delivery and coverage of routine immunization. The Wellbeing Foundation Africa, Mamacare Antenatal and Postnatal Curriculum is currently taking the lead in ensuring mothers and families attend antenatal care, are well equipped with information on the need for routine immunization in children, and are further followed up in the postnatal period to ensure babies are vaccinated timely.
Finally, monitoring data at both the local and national level is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps. The client-held Personal Health Record (PHR) introduced by the Wellbeing Foundation Africa, is a vital tool held by mothers and families to empower them with information they ought to know about their child’s care including tracking and recording of the child’s immunization history. Beyond this, it also serves as a data collection tool that can be used during surveys.
Mrs. Saraki is the Founder of the Wellbeing Foundation and Chair of the Primary Healthcare Revitalization Support Group.