Health authorities and development partners have identified shortages of health workers as a major constraint to routine immunisation services in three northern states.
The issue was highlighted during a Joint States Stakeholders Meeting with New Incentives – All Babies Are Equal Initiative (NI-ABAE), held in Sokoto from 10 to 11 August.
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According to a communique issued at the end of the meeting, human resource shortages at health facilities remain a major constraint to routine and outreach immunisation across the three states.
The two-day meeting brought together 34 participants, including representatives of the Sokoto, Kebbi and Zamfara state ministries of health and primary healthcare development agencies, the National Primary Health Care Development Agency, the National Traditional Leaders Council and NI-ABAE.
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Health worker shortage
The stakeholders noted that Sokoto has 609 facilities providing routine immunisation services.
They resolved that more efforts should be made to recruit health workers to address the shortage and ensure adequate coverage of routine immunisation facilities.
According to the communique, Zamfara State said the government had received approval to recruit more than 3,000 workers across the health sector, while Kebbi State had recruited more than 2,800 health workers.
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PREMIUM TIMES reported in March that Sokoto, Kebbi and Zamfara were among northern states with one doctor or fewer per 10,000 people, according to the 2025 State of Health of the Nation Report.
The report also linked the shortage in northern states to insecurity, poor infrastructure and the migration of trained health workers, with community health practitioners increasingly serving as the backbone of healthcare delivery in rural areas and primary healthcare centres.
Vaccine supply, data gaps
The stakeholders also raised concerns about vaccine availability and management, with poor microplanning, weak forecasting, delayed requisitions and inadequate vaccine management identified as factors contributing to stockouts and wastage.
They called for improved routine immunisation microplanning to enable health authorities to estimate better the target population and the quantity of vaccines required for immunisation sessions.
The communique also highlighted discrepancies between data from NI-ABAE, health facilities, local government areas (LGAs) and the District Health Information System (DHIS).
It recommended regular capacity training for Local Government Cold Chain Officers on OpenLMIS, an electronic logistics management information system, and improved monitoring of data entry.
The stakeholders also resolved to ensure timely reporting of daily immunisation data and monthly harmonisation of data on the DHIS2 platform.
Cash support for caregivers
The meeting also reviewed the Conditional Cash Transfer for Routine Immunisation programme operated by NI-ABAE. Under the programme, eligible caregivers receive N1,000 for each qualifying routine immunisation visit to help offset transportation costs, waiting time and lost income.
Caregivers who complete all six routine immunisation visits are also eligible for an additional N5,000 livelihood grant.
According to the communique, the programme has supported immunisation services in 205 LGAs, 7,216 clinics and 60,983 settlements.
It has recorded more than seven million enrolments, 29.2 million cash disbursements across 1.65 million immunisation sessions and encouraged more than 111 million vaccinations.
The programme has disbursed N45.2 billion to eligible caregivers. In Sokoto, the programme has recorded 285,707 enrolments, 1,141,502 cash disbursements and 4,158,183 vaccines encouraged through supported routine immunisation visits.
Kebbi has recorded 333,035 enrolments, 1,380,984 cash disbursements and 5,384,599 vaccines encouraged, while Zamfara has recorded 392,535 enrolments, 1,654,041 cash disbursements and 5,426,843 vaccines encouraged.
Poverty, insecurity remain barriers
The Executive Secretary of the Zamfara State Primary Health Care Board, Hussaini Anka, said poverty and transportation costs remained barriers preventing caregivers in remote communities from accessing immunisation services.
“It is not necessarily because caregivers do not want their children vaccinated. Some cannot afford the transportation cost from their communities to the nearest health facility,” Mr Anka said.
He said the impact of the financial support was particularly visible among women in rural communities.
“The financial support may appear modest, but it helps women in underserved communities reach health facilities and obtain services for their children,” he said.
The stakeholders also called for stronger involvement of traditional and religious leaders in immunisation awareness, including the use of Friday sermons to promote vaccination.
The communique said that insecurity remained a major barrier to the delivery of immunisation services across the three states.
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Sokoto requested consideration of accessible areas within its remaining five uncovered LGAs, while Kebbi and Zamfara also requested expansion of the programme to their remaining LGAs.
Programme sustainability
The stakeholders also raised concerns about the long-term sustainability of the gains recorded through the incentive programme.
They also noted that the programme’s current enrolment entry points cover children aged 0 to 12 months, while the national routine immunisation schedule now covers children aged 0 to 23 months.
The meeting therefore recommended aligning the programme with the national immunisation schedule.
Stakeholders also proposed increasing the caregiver incentive from N1,000 to at least N1,500, citing rising transport costs.
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