title: Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria.
abstract: Responsibility for immunisation in Nigeria is decentralised to sub-national governments. So far, they have failed to achieve optimal coverage for their populations. We evaluated a pilot intervention implemented between 2013 and 2014 to redesign a vaccine supply chain management system in Kano, Nigeria. The intervention included financing immunisation services from a designated pool of government and donor funds, a visibility tool to track vaccine stock, and a private vendor engaged to deliver vaccines directly to health facilities. The number of local government areas within the state with adequate vaccine stock increased from 21% to 98% after 10 months. To understand how the intervention achieved this outcome, we analysed immunisation coverage for the period and interviewed 18 respondents across different levels of government. We found that the intervention worked by improving ownership and accountability for immunisation by sub-national governments and their capacity for generating resources and management (of data and the supply chain). While the intervention focused on improving immunisation coverage, we identified gaps in the demand for services. Efforts to improve immunisation coverage and vaccine supply systems should streamline decentralised structures, empower sub-national governments with financial and technical capacity, and promote strategies to improve the demand and use of services.
authors.affiliation: a Direct Consulting and Logistics , Abuja , Nigeria.|b Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Shola
authors.initials: S
authors.lastname: Molemodile
authors.affiliation: c Solina Health Limited , Abuja , Nigeria.
authors.forename: Maruchi
authors.initials: M
authors.lastname: Wotogbe
authors.affiliation: d School of Public Health , University of Sydney , Sydney , Australia.|e National Primary Health Care Development Agency , Abuja , Nigeria.|f The George Institute for Global Health , Sydney , Australia.
authors.forename: Seye
authors.initials: S
authors.lastname: Abimbola
mesh_terms: D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007407:Interviews as Topic; D009549:Nigeria; D009936:Organizational Innovation; D010865:Pilot Projects; D036301:Qualitative Research; D000073887:Vaccination Coverage / Q000592:standards; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Health system decentralisation; Nigeria; immunisation; realist evaluation; vaccine supply chain