The issue
In 2005, Nigeria implemented a national immunization strategy that resulted in an overall increase in vaccination rates. A decade later in Ogun State, though, only 12 of the 20 local government areas (LGAs) had reached full immunization coverage. The other eight LGAs saw little improvement and continued to have large pockets of unimmunized children.
The research
To understand better what was occurring in these LGAs and to try to find ways of improving vaccination coverage rates, the Ogun Primary Health Care Development Board, local academic institutions, and the Royal Tropical Institute in the Netherlands (KIT) proposed an investigation of the issue in two wards in Remo North: Ipara and Ilara. The idea was to take a participatory action research (PAR) approach involving dialogue and action between community members, health workers and local government officials to improve access to and use of immunization services in these wards. The research project was embedded into the National Programme on Immunization in these focal wards and received funding and support from the Alliance, UNICEF, and Gavi, the Vaccine Alliance. These groups also provided technical support to design, undertake and share findings from the project.
The research found that certain vulnerable groups required special attention from health workers. It also found that men needed to be engaged, as they were typically household decision-makers and the research uncovered specific concerns that they had around adverse effects following immunization (AEFI).
The result
Percent of unimmunized children decreased significantly
Based on the team’s findings, health workers and community members focused on these particular populations, visiting households and community meetings to talk about vaccination, perceived barriers and ways to minimize AEFI.
The embedded research project helped bring together key stakeholders to understand and address this pressing issue. As the researchers and implementers were working together, it allowed them to adapt quickly and respond to the barriers identified. And the result was impressive: in the study area, immunization coverage for children above nine months, as assessed by a household survey of caregivers, went from 61% to 91%, and caregiver visits to health facilities for routine immunization services rose from 54% to 83%. The community dialogues also led to spillover benefits beyond the project, such as the return of maternal care services in Ilara.
In addition to supporting this project, the Alliance has helped to expand the networks of the policymakers and researchers involved in this project. They presented the findings as part of the policymaker cohort at the Symposium in Liverpool, and policymakers in other states and national-level policymakers in Nigeria garnered interest in the project and its unique approach – as did policymakers from other countries.