Kano’s innovative tripartite agreement to strengthen its routine immunization program
The routine immunization (RI) program in Nigeria has under-performed in recent years, with low immunization coverage rates and high numbers of unimmunized children. A weak vaccine supply chain, inadequate funding, weak financial management systems, poor coordination and information sharing among stakeholders are a few of the major challenges that have plagued the RI program. The Government of Nigeria and its partners are supporting implementation of innovative initiatives to address the systemic challenges faced by the RI system, with a view to improving the coverage rates, and reducing under-5 death due to vaccine preventable diseases
One of such initiatives is the 3-year tripartite Memorandum of Understanding (MoU) signed between the Kano State Government, the Bill and Melinda Gates and Dangote Foundations to innovatively finance the transformation of the vaccine supply chain management and other RI system improvements in Kano. The expectation is that over the agreement years, all partners will contribute to a basket fund, with the state government increasing its funding share each year and assuming complete financial responsibility for the project in the last year.
The MoU has facilitated significant investments in the purchase of cold chain equipment, vehicles for vaccine distribution and increased funding for logistics. These investments have led to improvement in vaccine stock availability at service points, and consequently positive trends in immunization coverage rates.
The successes of the Kano initiative has led to the setup of a similar MoU arrangement in Bauchi, and a proposed scale up to 4 additional states in 2015.
Leveraging CHMI’s learning exchange program to foster peer-to-peer learning on the innovative MoU arrangement
Working in line with its vision “for health systems around the world to better utilize private organizations to deliver quality, affordable and accessible care, especially for the poorest and most vulnerable”, CHMI supported the Kano State Strengthening Routine Immunization Project to facilitate learning partnerships with 2 of its peer bodies (Bauchi and Borno State Primary Health Care Development Agencies), and provided a platform for knowledge sharing on the tripartite MoU.
The Learning Exchange program aims to establish a sustained knowledge sharing and collaboration between the Kano state RI team and its peers from other states. The program also intends to improve the quality of the routine immunization programs and other PHC activities in the states by adopting innovations, which are scalable across various segments of health care service delivery.
The two-day learning exchange program took place on the 6th and 7th May 2015. Both program days utilized different learning approaches, with the first day consisting of a workshop at the Polio Emergency Operating Center Kano. Lots of useful information was generated during this workshop and some of the most pertinent themes and excerpts are included below:
Factors responsible for the success of Kano’s tripartite MoU to strengthen routine immunization.
Partner commitment was described as crucial to keeping the RI implementation team focused on the targets and objectives at all times. In the words of Dr Shehu Abdullahi, Executive Secretary of the Kano State Primary Health Care Management Board (KSPHCMB), “The commitment of the government who has been driving the process judiciously and also the commitment of the partners who always put down their contribution of the basket funds early enough”.
The group also discussed the importance of a strong management team at KSPHCMB in making the program a success. Dr Shehu stated that the changes made to the management team, including involvement of technical consultants, creation of new roles related to the program and the decentralization of RI management to zonal levels.
Innovative systems put in place to foster accountability on the RI program.
The direct funds disbursement system has promoted accountability of funding, by ensuring all budgeted RI funds reach every level of service delivery directly. There was also discussion about the role of information technology in driving accountability of the RI system. One example of such system deployed in Kano is the Kano Connect closed user group (CUG) platform which uses GPS capabilities of the smart phones issued to health workers to track implementation of supportive supervision visits.
Sustainability of RI funding after the MoU period
The panel deliberated on potential sources of RI funding after the MoU period. Recurring themes in the deliberations included reprogramming of polio eradication funds to RI, positioning all State Primary Health Care DAs to take advantage of the National Health Fund, and exploring the National Health Insurance Scheme. Commitment of the partners (BMGF and Dangote Foundations) to the RI program beyond funding after the MoU period was also highlighted as key to ensuring sustainability.
On the second day of the learning exchange program, the participants were taken on a field tour of the state cold store, one state satellite store (in Dawakin Tofa) and one health facility (Dr Wada Waziri Primary Healthcare Clinic in Makoda Local Government Area).
Over the course of the field tour, the participants were able to observe activities related to the entire vaccine chain from management and storage practices at the state cold store, distribution process, vaccine receipt, storage and utilization at routine immunization sessions at health facilities and finally vaccine stock management and reporting procedures at state store, satellite store and facility levels
By the end of both days of the knowledge exchange, partners expressed positive opinions regarding the program and their participation.
“The interaction created an avenue to learn more about the partner’s methods, interact with people from various backgrounds, learn what works and what doesn’t, take precautionary measures to avoid challenges Kano State faced while implementing the MOU” – Executive Director; Borno State Primary Health Care Management Board.
“I found the program very interesting and educating” – SIO; Bauchi
“It gave me pleasure to interact with various personalities. I shared knowledge, innovations and skills on how to reposition and rebuild the states R.I services” – SIO; Borno
“We will conduct a step-down to inform relevant stakeholders at the state and LGA levels of what we learnt” – SLO; Bauchi