IMMUNIZATIONbasics End of Project Report: Nigeria

"Through its series of publications as well as national and global dissemination meetings, the IMMbasics Nigeria project leaves a strong legacy of quantitative and qualitative information detailing the successful ground-level implementation of the Reaching Every District approach."

This document describes and evaluates the work of IMMUNIZATIONbasics (IMMbasics) in Nigeria, one of the 5 African and Asian countries in which the initiative operated (for a summary of this project in Nigeria, see Related Summaries, below). In brief, the project worked with government agencies at all levels (Federal, State, and Local Government Area (LGA) levels) and international partners in Bauchi and Sokoto states, with a focus on developing the human and organisational capacity needed to strengthen delivery of quality routine immunisation (RI) services. The project was financed by the Office of Health, Infectious Disease and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID).

As detailed here, USAID/Nigeria gave the project a mandate to strengthen the RI system rather than rapidly improve immunisation coverage. This allowed IMMbasics to work with each state on repairing underlying problems rather than taking short cuts to achieve ambitious coverage-related targets. The initiative was organised in such a way as to create a sustainable system that could serve as a model for rebuilding RI in the context of primary health care in Nigeria. IMMbasics worked to ensure that staff of the Ministries of Health or its agencies, such as the Primary Health Care Development Agency (PHCDA) and local governments, played leading roles in all it was doing. By so doing, the project sought to not only build their capacity but to also put them on a path to success with the hope that they would learn to follow it regularly. In addition, the project tried to ensure active participation of all concerned, thereby building a sense of ownership in the staff.

Table 2 on page 7 summarises project achievements by indicator. For example, from the inception of its activities in early 2007 to June 2009, a total of 289,604 children under one year of age were immunised with DPT3 (diphtheria, pertussis (whooping cough) and tetanus) against the target of 232,309. More broadly, selected project accomplishes, challenges, and lessons learned - with a focus on communication-related elements - include:

• An end of project review [PDF], conducted from March 24 to April 7 2009, found that, at the national level, there was praise for IMMbasics' contribution to strengthening RI, as well as coordination with partners. However, immunisation partners all agreed that the project's timeline was too short to firmly establish all of the REW components required to strengthen RI in each state. State health officials in both Bauchi and Sokoto praised IMMbasics' participatory and gradual step-by-step approach for planning and capacity building. They valued their newly developed cadre of RI Master Trainers and Peer Motivators, who can now carry forward with capacity building. Both states established committees for RI and increased financial support for RI services. However, financial support remained insufficient at the state level to adequately meet the needs for supervising RI services. At the state level, there is growing interest in integrating RI support supervision with other primary health care (PHC) activities, but also concern over the gap which will be left with the departure of IMMbasics.
• "The full participation of partners in field work as well as in state and national debriefings significantly boosted their interest in practical approaches being taken to rebuild the RI system. In Nigeria, it is often difficult for smaller projects to be heard at the national level, but the project was able to fully engage significantly at the national level with some change in staffing functions. Overall, the involvement of a globally recognized immunization expert, IMMbasics’ Technical Director Robert Steinglass, helped promote the project's profile and approaches with important international partners such as WHO [World Health Organization] and UNICEF [the United Nations Children's Fund]."
• State-level dissemination meetings in both Bauchi and Sokoto states provided the opportunity for the State Ministry of Health (SMOH)/State Primary Health Care Development Agency (SPHCDA) and the project to share practical lessons learned with respect to each REW component. "A unique aspect of both state level dissemination meetings was the range of representatives from various sectors within the broader public health field - not only immunization. This inclusion of non-immunization representatives was an important step forward to advocate for the REW as an approach that can be expanded to interventions beyond immunization."
• "At the beginning of this project many were skeptical that health workers and committee leaders, who are accustomed to receiving extra allowances for participating in mass immunization campaigns, would have interest in an effort to improve RI which did not include such monetary incentives. Disproving this myth is perhaps one of the greatest achievements of the IMMbasics Nigeria project."

Click here for the 40-page report in Microsoft Word.