Commentary: How can Nigeria achieve sustainable immunization financing in the next decade? Government, business, and health leaders discuss the way forward

By Chizoba Wonodi, Nigeria Director, International Vaccine Access Center and Funmilayo Adewumi, Program Assistant, Direct Consulting and Logistics.

On January 1, 2018, Nigeria welcomed more than 20,000 babies, the third highest number of newborns born on the first day of the new year, behind only India and China. By 2050, Nigeria’s population is projected to exceed that of the United States.

As the population continues to grow, Nigeria’s Gross Domestic Product crossed an important threshold in 2014  and the country was slated to begin a 5-year transition out of Gavi’s support in 2017.  The loss of Gavi support implies that government’s responsibility for the immunization program is expected to rise progressively and significantly over the next few years.  Thus Nigeria, which has received funding support from Gavi to the tune of 0.7 billion USD since 2001 faces a huge immunization funding gap that could affect vaccine procurement, immunization campaigns, and health system strengthening efforts.

Advocates drew attention to these converging challenges—a  growing number of babies and children requiring more vaccines, a constrained fiscal space, and the prospect of decreasing support from donors at a critical juncture— and Gavi responded by mandating that its secretariat engage with Nigeria on possible flexibilities that will enable a longer transition out of support. However, this longer transition period from Gavi support depends on Nigeria demonstrating concrete commitments to improve immunization coverage and equity while considerably increasing immunization and for general health funding.

The Government’s Focus on Sustainable Immunization Financing

The National Primary Health Care Development Agency (NPHCDA) is the government institution responsible for coordinating immunization activities in Nigeria and leading efforts to engage key stakeholders on the transition of Gavi funding for immunization programs. In 2015, a National Immunization Financing Task team was launched by NPHCDA to develop a sustainable immunization financing advocacy strategy and provide periodic updates to NPHCDA. Financing solutions proffered include increasing the federal and state budgetary allocation to routine immunization, instituting co-financing by states into a central purse for vaccine procurement, and initiating a public-private-partnership to implement other feasible financing strategies. Last December, NPHCDA also inaugurated the Nigeria Gavi transition task team to develop Nigeria’s Strategy for Immunization PHC System Strengthening (NSIPSS)  on the roadmap to securing sustainable immunization financing as well as improved coverage and equity. NSIPSS is Nigeria’s long term strategy to sustainably improve immunization and broader PHC services. Its goal is to attain at least 80% equitable sustained national coverage of all antigens by 2028.

Her Excellency Toyin Saraki speaking as part of the panel discussion

A Call for All Hands on Deck

In partnership with the National Primary Health Care Development Agency, the Women Advocates for Vaccine Access (WAVA)—a national coalition of more than 50 civil society organizations based in all six geopolitical zones in Nigeria—convened a breakfast meeting on Monday, 12th March 2018 to explore practical solutions to achieving sustainable immunization financing, with over 70 participants from the legislature, civil society organizations, private sector, government, and the media. The meeting was chaired by Her Excellency Toyin Saraki, Wife of Nigerian Senate President, Founder of WellBeing Foundation Africa, and WAVA champion. In her opening remarks, she highlighted the need for Nigeria to demonstrate concrete financing commitments, to change its  ‘donor-narrative’ (where government is seen as taking the lead on immunization financing as the main financier in partnership with the private sector, multilateral and bilateral organizations), ensure greater accountability, and increase immunization coverage. Speaking in the same vein, Honorable Mohammed Usman, Deputy Chairman, House Committee on Health Care Services and WAVA champion chief host of the event, also stressed the need for sustainable immunization financing given the various challenges faced by the country.

On behalf of Dr. Faisal Shuaib, ED NPHCDA, Dr. Dorothy Nwodo, Director Disease Control and Immunization, NPHCDA, and chair of Nigeria’s Gavi transition task team , explained the immunization aid dynamics between Nigeria and Gavi in a keynote address. She shared results of preliminary projections showing that Nigeria will require 1.634 billion USD to fund immunization between 2018 and 2028. She also noted Nigeria’s co-financing with Gavi has been declining over the past years and has been supported by loans from the World Bank since 2015. Although Nigeria is expected to take full responsibility of  immunization funding, the country seeks for flexibilities and a possible extension of the transition period from Gavi due to economic challenges faced by the country. She recommended that the country works more with the private sector to support immunization financing, concluding that “advocacy is ongoing, but outcome is not yet effective”.

Representatives of government, legislators, civil society organizations, and private sector demonstrated that all hands must be on deck to ensure sustainable immunization financing in Nigeria

Panel Discussion Engages Public and Private Leadership

At the meeting, a panel discussion on options open to the federal government to sustainably finance the routine immunization program ensued. The panel was moderated by Dr. Kate O’Brien, Executive Director of the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health. The panel included:

  • Her Excellency Toyin Saraki, Founder of WellBeing Foundation Africa, Wife of Nigerian Senate President, and WAVA champion
  • Honourable Mohammad Usman, Deputy Chairman, House Committee on Health Care Services, Federal House of Representatives at the National Assembly
  • Chizoba Wonodi, IVAC’s Nigeria Country Director and WAVA Convener
  • Ekenem Isichei, Senior Adviser, Albright Stonebridge Group, Nigeria

Panel of discussants at breakfast meeting, from left to right, included Mr. Ekenem Isichei, Senior Adviser at Albright Stonebridge Group, Her Excellency Toyin Saraki, Founder of WellBeing Foundation Africa and WAVA champion, Honorable Mohammad Usman, Deputy Chairman of Nigeria’s House Committee on Health Care Services in the National Assembly’s Federal House of Representatives and WAVA champion, Dr. Chizoba Wonodi, Nigeria Director at the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health, and Professor Kate O’Brien, Executive Director of IVAC.

Options discussed included co-financing of vaccine procurement and immunization service delivery by state and local governments, exploring local vaccine production, and setting up a National Immunization Trust Fund.

Regarding the role of the private sector and civil society organizations, panelists said that the private sector must help in several key ways:

  • Ensure birth registration to help create access to immunization,
  • Plan vaccine logistics and delivery to hard-to-reach areas,
  • Invest in vaccine supply chain as part of their corporate social responsibility, and
  • Contribute towards covering vaccine operational costs.
  • In addition, Hon. Usman mentioned civil society organizations can contribute by demanding that the government demonstrate a commitment to immunization self-financing.

Professor Kate O’Brien concluded the panel by saying that Nigeria has a critical timeline to demonstrate concrete commitments and respond to Gavi in the light of transition. The imminent exit of Gavi requires all hands on deck to sufficiently fund immunization during the post-transition period and to avoid an increase in Nigeria’s child mortality rate.

 

Dr. Chizoba Wonodi is public health physician with over twenty-five years of experience on projects in Africa, Asia, and America. She is the Nigeria Country Director for IVAC and splits her time between Abuja and Baltimore conducting research and leading a portfolio of work to improve immunization service delivery and primary health care systems in Nigeria. Dr. Wonodi was recently appointed to the Steering Committee of the Gavi Civil Society Board.

Funmilayo Adewumi is program assistant at Direct Consulting and Logistics (DCL) Abuja, Nigeria. DCL is the management consulting firm through which IVAC implements its projects in Nigeria.