EXPANDED PROGRAMME ON IMMUNIZATION IN NIGERIA

A

AHMADU M.T. 07986814 MBA, I.H.C.M.

OUTLINE INTRODUCTION ORGANIZATION AND FINANCING STRUCTURE IN PLACE-MANAGING COST, CARE

AND HEALTH MANAGEMENT AND LEADERSHIP STRENGTHS AND WEAKNESSES POSSIBLE REFORM, AND ITS

CHALLENGES CONCLUSION

INTRODUCTION Expanded programme on immunization(EPI) was initiated

in 1976 in Nigeria, based on the premises of the same programme by the WHO.

Aim was to immunize 0-2 year olds (and pregnant women) and achieve >85% coverage, then to integrate immunization into routine activities of all PHCs.

Immunize against vaccine preventable diseases- Tuberculosis, Poliomyelitis, Diphtheria, Tetanus, Measles, Whooping cough. These diseases were identified as common causes of infant morbidity and mortality.

Name changed to National programme on immunization(NPI) in 19 to further show a government commitment to individualizing the scheme..

Current immunization coverage is about 80% in 2007, from just above 15% in 1979.There has been some progress, though at a slow pace .

ORGANIZATION AND FINANCING Centrally managed, with policies at the federal

level through the Federal ministry of health, then the NPI co-ordinator, and field work carried out from the state level to the local government level.

Follows the 3 tier system of the constitution of government in the country. However there is some level of semi autonomy in each state, with states having their immunization days .

Financed majorly by public funding from the government budgetary expenditure on health, and other sources of from international donor organizations like the WHO-especially during disease outbreaks..

STRUCTURE IN PLACE

Currently immunization is carried out in fixed facilities , particularly primary healthcare centres in each ward in the localities, with adjuncts from frequent outreaches/outdoor sessions done on certain days ,either on a national level, state, or local government level. This is done to increase coverage of the immunization programme.

Vaccines are stored via the cold chain storage and reverse cold chain for unused vaccines, and this is done at each local government level, up to the state, and finally the National government.

However, the Private sector too plays a role, though largely in conjunction with the local government area in which it is situated.

LEADERSHIP AND MANAGEMENT Currently the programme is led by the National co-

ordinator of the NPI, and there are sub co-ordinators at the state and local government levels. These work in conjunction with their corresponding ministers of health to deliberate on policies, implement programmes and give feedback to the government and the people either way.

This system though seems to be effective, is not without its problems as most often than not, these posts are political posts, occupied by those who have connections with the powers that be, hence corruption seems inevitable in this situation. Leading to poor programme implementation, monitoring and evaluation.

STRENGTHS Central control of the programme from the National level,

allowing for better co-ordination. Adjuncts of community outreaches on specific days allows

for a wider awareness and coverage of the populace in the immunization plan.

In terms of managing care, the outreach helps to ensure equity. Though the poor, who stay in very remote areas still do not get covered.

Managing cost In terms of managing health, there has been a considerable

increase in immunization coverage and eventual reduction in incidences of the 6 diseases. Though there have been cases of polio and *measles outbreaks of recent, due to political issues( Northern Nigeria).

WEAKNESSES The current method of choosing the co-ordinators based on

political ties, gives room for individuals not best suited for the job taking up roles, hence allowing for lack lustre performance, or no performance at all, and eventual corrupt practices taking place.

Financing of the programme is still not adequate, as funds are disbursed from the National level, and budgetary allocation on health as a whole is still a small 3.5% of the entire budget, with education, security, and growth leading the lot. There is also a lot of legislature involved, making changes in policies, and implementation at the local level delayed due to bureaucracy.

Data collection and analysis for monitoring and evaluation is poor and still archaic, as it involves paper work ; with data likely getting lost in transit and or being incomplete.

REFORM IN THE PROGRAMMEThe NPI will benefit from a reform in its current management, and

organization. Though this will come with some challenges; First of all, the programme should have its own means of funding

directly from the government, and this funding should be controlled and disbursed by the programme itself, allowing for availability of funds readily. E.g. Meningitis vs. Lassa fever.

More community involvement in planning and implementation. Next the leadership of the programme should be selected

through transparent means and based on suitability for the job. However this will prove very difficult in the current political terrain of the country.

Current problems of unstable supply of electricity leading to vaccines going bad, and losing potency , can be resolved with the creation of alternate sources of power supply, and storage means. However this will prove very costly, and is quite difficult to achieve in the present Nigerian economic and political environment.

REFORM ( CONTD) There should be more intersectoral collaboration between

Ministries of Education, Finance, Transport, Power et al, to ensure a wider coverage and implementation of the programmes on immunization.

There should be a Public-Private sector partnership with regards immunizations and provision of vaccines, giving less disparity in costs of vaccines, and even more wider reach of the populace.

Facilities should be upgraded, and there should be recruitment of more workforce to ensure proper implementation of the programme.

Modern techniques of data collection and record keeping should be instituted allowing for adequate monitoring and evaluation of the programme. This can prove a bit tough though as it will involve increase costs on acquiring systems, and training of staff on the use of such.

CONCLUSION The NPI has fared quite well since its inception,

though this has been a rather slow progress. Coverage of immunization has still not reached

100%, with disparities existing in various regions of the country.

The leadership and management of the programme can be modified, with better selection criteria and methods, ensuring programme implementation, good performance.

Corruption, is a hydra headed monster that needs to be tackled first on a national level to ensure maximum benefits of any reforms in the system.

REFERENCES WHO: AFRICAN REGION; NIGERIA. Expanded

programme on immunization .www.who.int.com.sis.

Jinadu, M.K.( August 1983). Perspectives in primary care: A Case Study in the Administration of the Expanded Programme of Immunization in Nigeria. Journal of Tropical Paediatrics Vol. 29. Pg 217-219.

Morley, D.C, Woodland, M, Martin, J.W.J. In: Morley DC. Paediatric priorities in developing countries. Butterworth Pub, 1973.