Since 2014, SCIDaR with support from the Bill and Melinda Gates Foundation, has been providing analytical, programmatic, and thought leadership support to the Primary Health Care Development Agencies (NPHCDA) of six Northern Nigeria states, including Kano state on Routine Immunization systems strengthening.
The rollout of interventions across these states commenced with a rigorous diagnostic assessment of the states’ routine immunization system to identify existing gaps that informed the RI strengthening strategies. The support to the states cut across the eight RI thematic areas, including program coordination/management, financial management, vaccine supply chain, data management, and supportive supervision, among others.
As part of the program management intervention to the states, we support the State Emergency Routine Immunization Coordination Centers (SERICCs) and technical working groups in their day-to-day program management to identify critical bottlenecks and way forward; towards improving RI coverage and reducing infant mortality caused by vaccine-preventable diseases. Solina also provides technical assistance to the Program Manager NERICC and heads of the top management teams (technical working groups) to identify program issues, propose solutions, and track progress.
To improve funding for RI, SCIDaR led the design and rollout of an innovative basket funding mechanism, which helped to pool government funding for PHC between 2015 and 2021. To support the States to optimize their value from the available government and donor funds, we revised the financial management system to ensure effective and transparent utilization of RI funds. Our team of consultants and finance analysts provided technical assistance to the SPHCDAs on budgeting, direct disbursement, expenditure tracking, and financial reporting. We also developed easy-to-use retirement tools and standardized the processes for end-users at all levels to enhance timely retirement of funds, supported the internal audit units of SPHCDAs to validate retired funds and flag irregularities to the leadership team and established the State finance working groups to manage the revised financial management system.
Across the six states, we designed a robust capacity building strategy to strengthen the institutional, program, and core-personnel components of the RI program in the states. In 2016, Solina conducted a baseline assessment of the leadership, management and technical competencies of the RI program staff in the six states including Kano Following the diagnostics, we rolled-out an integrated capacity building program for leadership, line managers and operations staff of the six states. The program aims to build institutional, program, and core staff capabilities across leadership and governance, and operations to ensure effective management of PHC programs sustainably; and improve access to, and coverage of quality primary health care services across the states.
Overall, through our support, innovative approach to resolve immunization challenges, and thought leadership in collaboration with the SPHCDAs, existing structures and systems have been strengthened, and new structures/systems have also been established as required. These efforts have contributed to NPHCDA and Nigeria’s achievement of notable increases in immunization coverage, as evidenced by the 2018 National Demographic and Health Surveys. Compared to 2013, Kano improved from 19% to 46%, Bauchi improved from 13% to 32%, Borno improved from 12% to 36%, Sokoto improved from 3% to 7%, and Yobe improved from 11% to 29%.
Under the leadership of the state-led SLWGs, vaccine stock out rates have reduced from over 30% to single digits across all states, with Kano State achieving less than 1% stock-out in the past 1 year. The technical and management tools of the SLWG in Kano state has been expanded to the states’ drug revolving funds (DRF) program, and the management of the state government’s free MCH drugs distribution program
In addition to the above, our capacity building program for the six states has supported the State to strengthen their institutional, program, and core personnel capabilities, as highlighted below.
- Institutional – All 6 states now have clarified mission and vision statements that are cascaded from NPHCDA’s vision and align well with the PHC Under One Roof policy, and functional human resource management, finance, and audit units with clearly defined staff roles, processes, KPIs and tools. Additionally, 5 of 6 states have completed administrative transfers of staff, facilities, and funds.
- Program – All 6 technical working groups set-up in the State are fully functional and manage program areas independently, with the SERICCS serving as the coordinating mechanism.
- Core personnel – Of the 50 program officers enrolled for the on-the-job coaching sessions, 60% (30 of 50) of enrollees now fully conduct their functions independently, while 16 of the 30 enrollees have backstops to conduct these functions in their absence.