The development Research and Projects Center (dRPC) is organising a “one day high level strategic dialogue” on advocacy and accountability on routine immunisation in Nigeria.
The dialogue is being organised in conjunction with the National Association of Community Health Practitioners of Nigeria (NACHPN).
The event will have in attendance the Executive Secretary, National Primary Healthcare Development Agency, Faisal Shuaib; Senior Technical Advisor, dRPC-PACFaH@Scale, Emmanuel Abanida; community health workers and other development partners working on routine immunisation in the health sector.
The aim of the dialogue is to strengthen the accountability framework for routine immunisation service delivery at national and state levels.
The meeting is part of the continuous efforts towards attaining the objectives of Nigeria’s Strategy for Immunisation and Primary Health care system strengthening, (NSIPSS) 2018 – 2028.
This is expected to address some of the challenges facing routine immunisation in the country. Effective routine immunisation is a key challenge facing the health sector. Many children under the age of five often miss some vital vaccines which is meant to immunise them against some deadly diseases such as polio, yellow fever, tetanus, measles among others.
This has been a major source of concern for health experts, development partners and the international community.
The dialogue, supported by the Bill and Melinda Gates Foundation, is set to to explore the mechanisms for civil society engagement and to examine and create an understanding of the new roles and expectations for states under the NSIPSS project.
PREMIUM TIMES will bring you live updates from the event.
9: 19 a.m. – Its a cloudy morning in Abuja metropolis, the temperature is about 22 degrees celsius.
The event is being held at the Blu Cabana restaurant in Mabushi area of the Nigerian capital.
9:26 am- Participants are just arriving the venue
The meeting is yet to begin, participants in the hall are still exchanging greetings.
One of the lead speakers and senior technical advisor at dRPC, Emmanuel Abanida, is already at the venue.
9:40 am- Arriving now is Judith-Ann Walker, the Executive Director, dRPC.
Currently in the hall are Ibrahim Yisa, European Union – Support to immunisation Governance to Nigeria (EUSIGN); Paul Bassi, John Snow International (a USAID group); and Femi Oyewole JSI.
9: 50 am – More participants are still entering the hall. Registration is ongoing for participants while some are seated in groups discussing.
The programme is divided into two sessions.
The MC apologised to the participants saying the event is yet to start because they are waiting for the representative of the ES, National Primary Healthcare Development Agency (NPHCDA) Faisal Shuaib.
Topics to be discussed include: Building dynamics in advocacy to support Routine Immunisation (RI) in Nigeria: dRPC-PAS Model; by Mr Abanida
The keynote address is expected to be delivered by Mr Shuaib of the NPHCDA
10: 02 am – Just entering the hall is the representative of the NPHCDA chief, Abdullahi Bulama, who is the Director, Planning Research Statistics.
The event has been declared open by the facilitator of the dialogue, Umar Kawu
On the high table is Ms Walker, Mr Bulama and Mr Abanida
10:10 am – The event commences with participants introducing themselves. In the hall are participants from Lagos, Niger, Abuja, Kaduna among other states .
The welcome address is given by Ms Walker. She specially welcomed the delegates from Niger, Kano, Lagos and Kaduna.
She said the organisation would have loved to have participants from all over the country but unfortunately they can not.
She said the delegates and participants are repository of knowledge which will guide the Routine Immunisation (RI) discussion.
Ms Walker said they are here to address the gaps in RI in Nigeria.
She said though the gaps are not anyone’s making, there is much still to be done.
“These are to be done in terms of policy making, implementation and funding.”
Ms Walker said the government will be needing $3.6 billion in the next ten years for immunisation and the federal government will be contributing $2 billion.
She said state governments are meant to contribute the remaining fund.
“We are speaking of accountability, it is our mission, our mandate. To understand the accountability it is the responsibility of CSOs, media and civil servants.
The CAPs have a critical role to play and the framework is implemented in this document, she said.
She wished the participants a fruitful deliberation.
10:46 The representative of the ES, NPHCDA. Mr Balama, declared the meeting open.
He apologised for coming late and said the ES could not come because he had to be in Kaduna.
There are over four million unimmunised children in Nigeria. NPCHDA has introduced mechanisms & innovations to improve coverage – Keynote speech by Abdullahi Garba, Director, Research & Planning
Mr Bulama said RI is very important for the country. He said the Director General of the WHO, Tedros Ghebreyesus, emphasised the importance of RI and the work to be done during the meeting in Geneva.
Mr Bulama said CSOs have the opportunity to talk because they do not work for the government and as such cannot be compared to civil servants who are gagged by their job.
He said the resources does not always maters but the rule of the game does. The MICS reports makes it clears that the resources do not match the result, he said.
He said part of the effort the agency has been taking in improving RI is that every department in NPHCDA conduct meetings every week
10: 50 am Bulama said the agency is also working on how the nation can start local vaccine production.
“We are looking at how we can be on our own feet. Tis we are doing by seeing how we can start local vaccine production. But with vaccine creation, the resources is limited. This is why GAVI has extented the date for vaccine funding in the country.”
GAVI has some concerns that is why they are giving us additional support at the this time till the next ten years, hopefully our economy and resources might have improved, he said.
He said the PHCs are also being given funds to run their facilities to make it more functional to attract more clients
He said the agency is doing everything to reduce the large noise of Nigeria having the largest number of unimmunised children.
“The agency is doing everything possible to reach all children with immunisation,” he said.
Mr Bulama said the emergency of RI is aimed at ensuring that we prioritise immunisation in our homes so that we can close the gaps.
“We will do everything to ensure that it reaches at least 80 per cent of children in the country.”
He also acknowledged the importance of accountability in the federal and state level saying it would ensure that RI goes a long way to reaching all Nigerians.
He said some of the problems facing RI is that some states do not know how many facilities they have.
He said states like Jigawa, Kebbi, FCT among others do not have an accurate record of the PHCs in the states. He said in the north-central, there is no facility that is five star, meaning having a doctor, nurses, CHEW, J-CHEW and working laboratories.
He said the agency is trying to correlate all these data and have a score card for every state governor on their facilties and how they fare.
The agency expects to have a geo-location of every PHC facility in the country, he said.
Mr Bulama said his agency admits that there is a problem.
He said a recent report by the agency that shows routine immunisation was not effectively covered across Nigeria was an example of them admitting a lot still needed to be done.
11:00 am Mr Abanida in his presentation titled ‘Building dynamics in advocacy to support RI in Nigeria; dRPC-PAS Model’ gave an insight into what dRPC has been doing in the health sector especially in routine immunisation and capacity building
Mr Abanida said said the organsation is a non-governmental organisation and as such what they do is advocacy especially in RI, family planning and capacity development.
He said RI is very important and needs revival. He said dRPC is not working in vacuum. We are an organisation that has gotten a grant and are working in the country, he said.
Mr Abanida said one of the problems facing the PHCs is the lack of manpower.
He said there are 86 training institutions in the country for community health workers and so far over 200,000 workers have been trained between 1997 and 2017, while only 122,000 are engaged either in private or public facilities.
“The question now is why are the rest not engaged? Is it that the government does not have enough money to do so?”
11:20 am – We are now at the question and answer session.
A delegate from Kaduna State asked the NPHCDA who monitors the PHCs in the states. She cited a case of a newly renovated PHC in Jere, Kaduna State which she said is very small. Yet there is a bigger and empty facility belonging to the federal government around the area, she said.
Mr Bulama said state governments are in charge of most PHCs in their states. He said unfortunately, most states do not have an accurate record of facilities in their states. He said there are about 900 health facilities across Nigeria which are yet to be completed.
Mr Bulama said most of the health facilities that are not completed are part of the constituency projects by lawmakers. He said some are still at foundation level, some at construction level, while some have gotten to roofing stages but not completed or handed over to the agency.
He said the agency would need about N10 billion to complete these facilities.
“We have informed the president that we will be needing about N10 billion to complete these facilities. Most of the money allocated for the facilities were returned to the government after the end of the fiscal budget year when the facilities were budgeted because they did not finish building. We do not pay contractors for unfinished projects. Most of the scattered unfinished facilities are so because most of the lawmakers who proposed the project did not follow up or were not voted back to power.
Mr Bulama answering question of manpower from Kano State said he knows that manpower for the PHCs is still a challenge.
He said this remains difficult because most midwives and community health extension workers are not willing to be transferred to rural areas where their services are needed most.
He said the agency has been trying to solve the problem and they are expecting funding to do so, but they are yet to take off. This, he said is because they are still doing an understudy of the problem and how to address it
12: 00 pm A halt in the dialogue as participants go for tea break; to reconvene in 30 minutes.
Others on the panel are Ibrahim Yisa, European Union- Support to immunisation Governance in Nigeria; Paul Bassi, JSI; Muyi Aina, Solina Health
The first speaker, Ahmed Garb, speaks on the NSIPSS document saying the document is a road map of what the government intends to achieve in the next ten years as regards immunisation in Nigeria.
He said the document was drawn up by the federal government, state governments, GAVi and other developmental partners working in immunisation sector.
Mr Garba said for the agenda stated in the document to be achievable and fully implemented, state governments need to get involved and take it as their own.
He said the government would be needing at least $ 3.6 billion Nigeria for routine immunisation in the next ten years. About $2 billion of the fund will be provided by the federal government and $1 billion by GAVI.
He said what is delaying the take off is some issues the country had with GAVI in terms of misappropriation of funds and non-eligibility of some issues.
“We have that under control. Some of the issues such as misappropriation, the FG has assured that they will return the funds. But this is not the case, we need to be able to show visible progress during the implementation.”
Aside this, Nigeria is ready to implement the document. Nigeria is ready to work and in a short time this will be done and there will be a proper rollout. NPHCDA will be engaging all its partners soon, he said.
Mr Garba however emphasised that state governments will take ownership of routine immunisation to be able to have a sustainable outcome.
He said the states need to step up their games. We want to see them take full responsibility and ownership of the PHCs, he submitted.
1: 00 pm- The second panelist, Muyi Aina, a public health practitioner of 20 years and working with Solina Health is speaking on the possible advocacy “ASKS” in RI services.
Mr Aina, founder and managing partner with Solina Health, said there is a need for CSOs to help the government especially the states understand where the problem is; because most times the increase and release of funds are not the major problems in achieving effective routine immunisation.
Mr Aina said there is a need for advocacy to the federal, state and local governments in order to make them understand the importance of Immunisation.
He said the biggest elephant in the room is funding.
“The federal government is trying its best to provide vaccine procurement. Even if we have GAVI agreement to continue to fund routine immunization, we still need to put in more pressure to ensure that we can afford and fund vaccine procurement without external help.”
Mr Aina said there is a need for the government to put immunisation at the top of the agenda.
The two panelists have finished presenting and the facilitator has opened the floor for questions and answers from the participants.
1: 35 pm
Some of the questions raised was on how to involve beneficiaries in the advocacy programme.
How can advocates get politicians to understand and imbibe some of the health projects knowing full well that most of them want to campaign with visible projects such as roads which can be seen and used for campaigning and win them a re-election?
Another question raised was how advocates can ensure funds are released for immunisation?
Why is it difficult to compel partners to buy into government project? a participant asked.
1: 40 pm _ In answering some of the questions, Mr Garba said there is no crime involving beneficiaries in advocacy of immunisation, but that is only if the people involve understand the issue at stake.
He said the release of funds at times is not often the problem of the state but executing the project for which the funds was budgeted.
Mr Garba gave an example of Bayelsa State where he said fund was released for immunisation. But three months after the fund was released, it was not utilised, he said.
He said further investigation revealed that the money had been released by the government but was kept in a private account of one of the officials in the state.
“So the release of funding might not necessarily be the issue; but monitoring how the money is being disbursed and used. This is where accountability comes in. Every Nigeria needs to be accountable and not just the politicians.”
Mr Aina while answering some of the questions said the advocates in the health sector need to learn the act of advocating because every other sector seems to understand the act more than the people in the health sector.
He said the advocates need to learn how to present their issues to the politicians in an appealing manner that they can also use for their campaign. This he said will make it appealing to them to key into the programme.
Mr Aina condemned the act of not being able to get donors or partners to key into the goals of the government.
This, he said, has been difficult because there is really no agreed leadership in intervention agenda.
1: 50 PM
He said because Nigeria loves “Awoof”, it does not say no to any intervention programme proposed by development partners.
Mr Aina said there is a need for the government to prioritise intervention agenda to be able to get maximum results and not just take on everything available without a direction.
“We have gotten to a stage in Nigeria where we tell people to hold their money. We also need to gather ourselves and elect smart people who know how to generate resources,” he added.
1:55 PM – The facilitator has closed the question and answer session
He starts the second session by introducing the next panelist/presenter, Ibrahim Yisa.
Mr Yisa, an health economist, is discussing fresh perspectived from stakeholder on governance/ accountability for RI.
Mr Yisa said Nigerians should not think about financing and funding health care in monetary terms alone, but should always try to analyse the implication of what the money will translate to within the country.
He said the funds should be interpreted in terms of the quality of care and what it would stand to change in the space at which it was released.
He said when advocating with the politicians, more appeal should be done to the conscience and this is a way of looking at accountability to the health sector. because this will be more effective than waiting for the outcome of the government’s non-releast of funds.
“When we talk about government we mean accountability, transparency and responsibility.”
He said there is a need to also educate the populace to know what their leaders promised and to make them know if they have delivered on it or not. He encouraged the CSOs to know how to focus their advocacy.
As stakeholders, there are new perspective we should look at when talking about accountability.
“RI is the fist opportunity for survival for a little born. Immunisation contributes significantly to the economic growth; as such we need to make sure the funds released for it are maximised fully. Before we talk about politicising issues, we need to think about the children.”
2:00 pm – Speaking now is Paul Bassi, a professor of public health, Bingham University and Director Child Health and Special Duties JSI . He said there is a need for CSOs to do more in the implementation stage of routine immunisation as this will help reduce the wastage of vaccines at community level.
“What i am advocating is to allow CSOs to be at every levels across the states and levels of implementation.”
Mr Bassi said CSOs need to also factor in local community based professionals in their advocacy and also listen to them and not always rely on the knowledge of foreign partners or donors to solve immunisation and other health issues.
Mr Bassi said CSOs are meant to agree on how to solve problems and how to contribute their quota and improve the quality of lives. Every child that is vaccinated is protected and becomes a better child, he said.
He tasked each participant from different states to think back to when they were formulating their programmes, look for their objectives and re-strategise. He said it is time to start thinking of the vulnerable population.
He said routine immunisation is an entry point of the primary health care. He said whatever is achieved at the immunization point will translate to the quality of the primary health care.
Giving an example, he said they were able to get cooperation from barbers in Bauchi State which assisted in identifying newborns for vaccine coverage. He said they had been having problems identifying them, but the barbers who were not considered to be CSOs came in to save the day.
Mr Bassi said for a long time, the voices of the CSOs in Nigeria have been neglected, but thanks to the polio disaster, it forced the Nigerian government to listen to the CSOs.
CSOs need to monitor what is being done, how policies evolve from creation to implementation. This will translate to how polices are formulated from the state and then translated to the LGA and the LGAs to the wards and the communities.
” There is a need to engage private organisations. We have religious bodies, education bodies to work to create a milestone,” he added.
Speaking now is the third panelist for this session, Abdul Garba, from Save the Children .
He is speaking on advocacy and roles of non-state actors in options for funding RI in Nigeria.
He said the CSOs should be seen as partners and should be allowed to contribute to whatever the government is doing. The NPHCDA needs to encourage and include CSOs, NGOs in their agenda, he said.
Mr Garba said there is a need to bring everyone together to make progress in the health sector.
He said this is the only way there can be an effective implementation of policies in the sector
2: 45 pm – we have come to the end of the panel.
The facilitator has opened the floor for questions from participants.
Some of the questions raised are on accountability for RI in practical terms.
How can we encourage adequate data collection? a participant said.
Responding to some of the question is Dorothy Nwodo, Director Disease Control and Immunisation, NPHCDA. She said she wants states to participate more in vaccine implementation and contribute to buying of vaccines.
Ms Nwodo who is one of the authors of the document, NSIPSS, said the states and some CSOs were engaged while drafting the document.
She explained that after the first draft which was done in September was submitted to GAVI, some CSOs complained that they were not engaged in the process and as such GAVI said they should go re-convene and engage them.
We had to engage them and the engagement was sponsored by GAVI and the federal government.
Explaining how they carried out the engagement, she said they engaged through the the governors forums, the 36 speakers of the states and the National Assembly before they submitted the document.
“We have submitted the final document and we have already gotten a provisional approval and we are waiting for GAVI on how to implement.”
Ms Nwodo said Nigeria had to beg GAVI not to pull out. because the nation only has 33 per cent immunisation coverage and this is very low.
“We need to get more children covered and the economy of Nigeria is still not buoyant to do it alone. I am happy that this session is taking place because we need to engage CSOs to know what to do and how to go about it.
“GAVI has a platform for CSOs. And they fund it because they said if you galvanise all the effort of the CSOs, we know where your strength lies. So that as the exit Nigeria, We can know how to work together to achieve our goal.
Immunisation financing is a big issue that we need to look into. We need to understand where is the private sector’s stand in this. The private sector has been doing a lot especially in the north were we have Dangote and Bill and Melinda Gates Foundation in collaboration with the state governments to set immunisation moving.
The document is all about how to use the vaccine to strengthen the primary health care and the health system
3: 30 pm – The session has gone on launch break.
It would be re-convened at 4:10 pm
4: 20 PM : The session has re-convened. There is a break-out session, the participants have been divided into four groups.
They are to discuss options for CSOs building in and support accountability in states’ immunisation within the context of the NSIPSS: Advocacy for leadership/governance,Funding and policy implementation.
The group will re-convene after 30 minutes of deliberation.
The groups are meant to report back and present to the house.
5:02 pm – The groups have been suspended and everyone has re-convened.
The facilitator has called on the first group to present what they deliberated – the group deliberated on leadership and governance
The presenter for group A said there is a need for the mapping out of CSOs and to develop terms of references.
CSOs were also suggested to be made members of local government health agencies and state primary health care development agencies.
They also proposed that CSOs should monitor budget performance and preparation
5 : 10 pm – Group one also advocated strong advocacy for the implementation of RI strategies to the state executive, house of assembly and local government executives.
Encourage traditional and religious debates to be strong advocates by giving them information on budgeting and implementation.
Help ensure TSA is deployed for the disbursement of funds.
They also asked for publicising erring government officials and reward impactful officials.
– Group Two while presenting on policy implementation said there is a need for the state to make its commitment towards the RI financing strategy.
They agreed that there is also need for a sharing formula for RI financing prior to the end of the transition plan to be divided among the federal government, state and local governments.
They said the deduction should be based on the sharing formula to be done from source.
The group also said there should be a legislation centred on RI financing to be captured in the National Health Act. This will improve awareness in the community and promote community participation.
This will also increase demand for policy implementation by CSOs for continuous advocacy.
CSOs should advocate for states to sign into “Open Government Partnership” .
CSOs should also engage their government through the open partnership state steering committee on RI accountability.
5: 20 pm – Groups three and four said there should be an RI strategy plan for five years and the government should provide a a robust disbursement, expenditure plan
5:20 pm- The presenters have finished presenting and Ms Walker has taken over the stage.
She thanked all the participant for coming.
She noted that the participants from Lagos seem to be distant in the discussion as much references were not made to Lagos as compared to the northern states.
She asked if it was because Lagos seems to be doing better in RI programmes than states in the north.
Ms Walker also said the Lagos State participants will be having a bi-lateral meeting with the NPHCDA so that they can have an in depth understanding of the issue.
Ms Walker noted that most of the participants seem not to have seen the document before coming to the meeting. This she observed because of their level of interaction with the panel while discussing.
She advised CSOs to make use of the opportunity and send in their proposals. She said dRPC is ready to support CSOs.
5:36pm – The meeting was brought to an end.