Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria

ABSTRACT

Responsibility for immunisation in Nigeria is decentralised to sub-national governments. So far, they have failed to achieve optimal coverage for their populations. We evaluated a pilot intervention implemented between 2013 and 2014 to redesign a vaccine supply chain management system in Kano, Nigeria. The intervention included financing immunisation services from a designated pool of government and donor funds, a visibility tool to track vaccine stock, and a private vendor engaged to deliver vaccines directly to health facilities. The number of local government areas within the state with adequate vaccine stock increased from 21% to 98% after 10 months. To understand how the intervention achieved this outcome, we analysed immunisation coverage for the period and interviewed 18 respondents across different levels of government. We found that the intervention worked by improving ownership and accountability for immunisation by sub-national governments and their capacity for generating resources and management (of data and the supply chain). While the intervention focused on improving immunisation coverage, we identified gaps in the demand for services. Efforts to improve immunisation coverage and vaccine supply systems should streamline decentralised structures, empower sub-national governments with financial and technical capacity, and promote strategies to improve the demand and use of services.

KEYWORDS:

• Health system decentralisation
• immunisation
• vaccine supply chain
• realist evaluation
• Nigeria

Acknowledgements

The views expressed herein are of the authors; the funders had no role in the study design, data collection and analysis, decision to publish or preparation of this manuscript. The authors are immensely thankful to Mr Inuwa Yau Barau, Dr Muyi Aina, officials and researchers of the Departments of Immunization and Logistics at the National Primary Health Care Development Agency, Kano State Primary Health Care Board, and management and staff of Solina Health Nigeria who supported and participated in project implementation and the field work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The data collection for this study was partly funded by the London School of Hygiene and Tropical Medicine Msc Project Funding for academic year 2013-14 (2013-14 Trust Funds).