Name: Uko Onyinye Doris

Registration Number: 20232495

Course Code: MPH 8201

Course Title: Principles and Practice ofPublic Health/Primary Health care

Assignment:Using the WHO health system framework, discuss the challenges of

immunisation program in Nigeria.

Date: November 2023

Introduction

The World Health Organisation(WHO) defined a health system as 'all organizations, people and

actions whose primary intent is to promote, restore or maintain health. This includes efforts to

influence determinants of health as well as more direct health-improving activities. A health

system is, therefore, more than the pyramid of publicly owned facilities that deliver personal

health services. It includes, for example, a mother caring for a sick child at home; private

providers; behaviour change programmes; vector-control campaigns; health insurance

organizations; occupational health and safety legislation. It includes inter-sectoral action by

health staff, for example, encouraging the ministry of education to promote female education, a

well-known determinant of better health (www.wikipedia.com).

Goals of Health System

● Good health fo the citizens

● Responsiveness to the expectations of the population

● Fairness of financial contribution

Key Components of a Well Functioning Health System

A well functioning health system responds in a balanced way to a population’s needs and

expectations by:

● improving the health status of individuals, families and communities

● Defending the population against what threatens its health

● Protecting people against the financial consequences of ill-health

● Providing equitable access to people centered care

● Making it possible for people to participate in decisions affecting their health and health

system

Immunization: Immunization is a critical public health intervention that has significantly

reduced the burden of infectious diseases worldwide. In Nigeria, however, the immunization

program faces numerous challenges that hinder its effectiveness and threaten to undermine the

country's progress towards achieving global immunization targets.

The Six Health System Building Blocks

To comprehensively examine these challenges, we will apply the World Health Organization's

(WHO) health system framework, which encompasses six building blocks: service delivery,

health workforce, information systems, financing, leadership and governance, and medical

products and technologies.

The World Health Organisation recommends The World Health Organization (WHO) health

system framework identifies six building blocks of a strong health system:

1. Service delivery: A good service delivery is one which deliveries effective, safe, quality

personal and non personal health interventions to those that need them, when and where

needed, with minimum waste of resources.

2. Health workforce: A well-performing health workforce is one that works in responsive

ways, fair and efficient to achieve the best health outcomes possible, given available

resources and circumstances. It consist of human resources management, skills and

policies

3. Health information systems: A well-functioning health information system is one that

ensures the production, analysis, dissemination and use of reliable and timely information

on health determinants, health system performance and health status.

4. Medical products and technologies: A well-functioning health system ensures equitable

access to essential medical products, vaccines and technologies of assured quality, safety,

efficacy and cost-effectiveness, with scientifically sound and cost-effective use.

5. Health System Financing: A good health financing system raises adequate funds for

health, in ways that ensure people can use needed services and are protected from financial

catastrophe or impoverishment associated with having to pay for them.

 6. Leadership and governance: This involves ensuring the existence of strategic policy

frameworks combined with effective oversight, coalition building, regulation, attention to

system design and accountability.

Source: WHO, Geneva 2007

Challenges of Immunization Program in Nigeria using the WHO Health System

Framework

1. Service delivery: One of the primary challenges to immunization in Nigeria is the

inadequate and inequitable distribution of immunization services. Rural areas often lack

access to healthcare facilities, trained personnel, and essential supplies, leading to lower

immunization coverage rates compared to urban areas. Furthermore, the country's

healthcare system is fragmented, with multiple providers and inconsistent service

delivery standards, making it difficult to track and ensure complete immunization

coverage.

● Inequity in access to immunization services: Immunization coverage rates in Nigeria

 vary widely, with children in rural areas and low-income households less likely to be

vaccinated. Also Factors such as mother’s literacy, region and location of residence, and

socio economic status significantly explain disparities in immunization coverage in

Nigeria.

● Weak supply chain management: Lack of vaccines and other supplies, as well as poor

storage and transportation infrastructure, can lead to stockouts and delays in vaccination

campaigns.

● Low demand for immunization services: Misinformation and vaccine hesitancy are

major challenges to immunization in Nigeria. vaccination coverage in many parts of the

country, particularly in northwest Nigeria, has not met the desired targets especially the

low demand for immunizations such as polio and measles in Nigeria this can be attributed

to several potential barriers, including rumors about vaccines, fears of adverse events

following immunizations, and lack of trust in vaccinations and health staff.

2. Health workforce:

● Shortage of healthcare workers: The Nigerian healthcare system faces a shortage of

adequately trained and motivated health workers, particularly in rural areas. This shortage

directly affects immunization services, as there are not enough personnel to administer

vaccines, conduct outreach activities, and educate communities about the importance of

immunization. Moreover, the lack of adequate compensation and poor working conditions

further contribute to workforce shortages and hinder the effectiveness of immunization

programs.

● Inadequate training: Some healthcare workers may not have adequate training on
 immunization procedures and best practices. One of the biggest impacts of lack of training

in healthcare system is the patient’s quality of care. Unfortunately, several healthcare

providers and managers are less interested in staff education, leading to compliance

negligence, patient safety at risk, low staff morale, reduced employee productivity and

legal issues may also occur..

3. Health information systems

● Weak data management systems: Nigeria has weak data management systems for

tracking immunization coverage and identifying children who need to be vaccinated. The

lack of skilled resources and poor understanding of data handling from disparate sources

also act as bottleneck towards taking better data management initiatives. Without proper

data management, the healthcare system may fail to ensure the security and privacy of data

that may result from cyberattack.

● Limited access to real-time data: Nigeria's immunization information systems are often

outdated, fragmented, and unreliable, making it difficult to accurately track immunization

coverage, identify gaps in service delivery, and monitor vaccine stockouts. This lack of

reliable data impedes effective planning, monitoring, and evaluation of immunization

programs, leading to missed opportunities to improve service delivery and address

emerging challenges. Healthcare workers often lack access to real-time data on vaccine

availability and coverage rates, making it difficult to plan and implement effective

immunization campaigns.
4. Medical products and technologies

● High cost of vaccines: The cost of vaccines can be a barrier to immunization for some

families in Nigeria.

● Lack of cold chain infrastructure: Despite significant progress in vaccine development

and supply, challenges remain in ensuring timely and equitable access to vaccines in

Nigeria. The country's cold chain infrastructure, which is essential for maintaining vaccine

potency, is often unreliable and inadequate, particularly in rural areas. Moreover, stockouts

of essential vaccines are not uncommon, leading to missed immunization opportunities and

increased risk of outbreaks.

5. Financing

● Inadequate funding: The Nigerian government allocates a significant portion of its health

budget to immunization, but these funds are often insufficient to meet the program's needs.

This underfunding is partly due to competing priorities within the health sector and the

country's overall economic challenges. As a result, the immunization program struggles to

procure adequate vaccine supplies, provide essential training to health workers, and

maintain adequate infrastructure.The inadequate funding of Immunization programs in

Nigeria can lead to shortages of vaccines and other supplies, as well as delays in

vaccination campaigns. Under the NPI’s the first mandate is to “support the states and

local governments in their immunization programmes by supplying vaccines, needles and

syringes, cold chain equipment and other things and logistics as may be required for those

programmes”. However, the supply of vaccines has always been problematic for Nigeria,

primarily because funds were not sufficient and were not released on time.

● Inefficient use of resources: Resources for immunization programs may not be allocated
 or used efficiently.

6. Leadership and governance

● Weak Leadership and Governance: Weak leadership and governance at both national

and subnational levels pose significant challenges to immunization programs in Nigeria.

Lack of clear and consistent policies, inadequate coordination between different

stakeholders, and a lack of accountability have hampered the effectiveness of

immunization efforts. Moreover, corruption and mismanagement of resources have

diverted funds from essential immunization activities, further undermining the program's

impact.

● Weak political commitment: Immunization programs in Nigeria may not have strong

political commitment from high-level decision-makers. This can lead to inadequate

funding and resources for immunization.

● Poor coordination: Immunization programs in Nigeria may be poorly coordinated

between different levels of government and across different sectors. This can make it

difficult to implement effective immunization campaigns.

Addressing the challenges

To overcome these challenges and strengthen the immunization program in Nigeria, a

comprehensive approach is needed that addresses the underlying issues within the health system.

This approach should focus on the following strategies:

● Strengthen service delivery: The Nigerian government is investing in expanding access

to immunization services, improving supply chain management, and addressing vaccine

 hesitancy, expanding access to immunization services in rural areas, improve

coordination among healthcare providers, and implement community-based approaches

to reach underserved populations.

● Invest in health workforce development: The Nigerian government is training more

healthcare workers on immunization procedures and best practices. It is Increase training

opportunities for health workers, provide adequate compensation and incentives, and

improve working conditions to attract and retain qualified personnel.

● Upgrade information systems: The Nigerian government is developing stronger data

management systems and improving access to real-time data for healthcare workers,

Implementing robust and integrated immunization information systems to track coverage,

monitor vaccine stockouts, and identify areas for improvement.

● Increase and sustain financing: The Nigerian Government should secure adequate and

sustainable funding for immunization programs through increased government

allocations, innovative financing mechanisms, and partnerships with international

organizations.

● Strengthen leadership and governance: The Nigerian government is working to

strengthen political commitment to immunization and improve coordination between

different levels of government and sectors, to enhance policy formulation and

implementation, improve coordination among stakeholders, and promote accountability

and transparency in resource management.

● Ensure access to medical products and technologies: The Nigerian government is

working to reduce the cost of vaccines and improve the cold chain infrastructure, improve

vaccine procurement and distribution systems, and implement strategies to prevent

 stockouts.

By addressing these challenges and implementing these strategies, Nigeria can strengthen its

immunization program, protect its population from preventable diseases, and contribute to

achieving global health goals.

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