Molemodile Shola, Wotogbe Maruchi, Abimbola Seye
a Direct Consulting and Logistics , Abuja , Nigeria.
b Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine , London , UK.
Glob Public Health. 2017 May;12(5):601-616. doi: 10.1080/17441692.2017.1291700. Epub 2017 Feb 24.
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.
尼日利亚的免疫接种责任已下放到地方各级政府。到目前为止，他们未能为其民众实现最佳覆盖率。我们评估了2013年至2014年期间实施的一项试点干预措施，该措施旨在重新设计尼日利亚卡诺州的疫苗供应链管理系统。干预措施包括从指定的政府和捐助资金池中为免疫接种服务提供资金、一个用于跟踪疫苗库存的可视化工具，以及一家受雇直接向卫生设施运送疫苗的私人供应商。10个月后，该州内疫苗库存充足的地方政府区域数量从21%增加到了98%。为了解该干预措施是如何取得这一成果的，我们分析了该时期的免疫接种覆盖率，并采访了不同政府层面的18名受访者。我们发现，该干预措施通过提高地方各级政府对免疫接种的自主权和问责制以及它们（在数据和供应链方面）的资源筹集和管理能力而发挥了作用。虽然该干预措施侧重于提高免疫接种覆盖率，但我们发现服务需求方面存在差距。提高免疫接种覆盖率和疫苗供应系统的努力应精简分散式结构，赋予地方各级政府财政和技术能力，并推广改善服务需求和使用情况的战略。
