title: Transforming vaccines supply chains in Nigeria.
abstract: Nigeria is the most populous country in Africa and in 2012 was suffering some of the lowest vaccination rates in the World. A combination of factors had resulted in a dysfunctional immunization cold chain and supply chain. Recognizing that the number of unimmunized children contributed to high levels of under-5-mortality, and that health MDGs would not be attained, Minister of State for Health Mohammed Pate launched a vaccines transformation project in 2013. In partnership with BMGF, GAVI, UNICEF, WHO, other donors and implementing partners the transformation journey has so far taken three years and achieved impressive results. It has though faced challenges along the way and with the financial burden of GAVI graduation facing Nigeria, the economic downturn and the decentralized funding of health services, the results are far from sustained. This paper documents the work undertaken at the Federal level and then highlights specific work undertaken in partnership with Lagos State Government. It identifies the importance of taking an end to end approach and looking at the root causes of weak system performance. The strategy combined simple innovations in how data was captured, recorded and used to drive decision making. It included a comprehensive and systematic approach to cold chain procurement, installation and maintenance with a shift to a culture of active cold chain maintenance that is performing with higher levels of uptime. It also included supply chain redesign at both the Federal and State level. Finally, it involved an institutional transformation at the National Primary Health Care Development Agency (NPHCDA) to establish a data driven Department of Logistics and Health Commodities (DLHC) to manage the many challenges in immunizing 7.5 million children annually. While results have been impressive, there have been many challenges and lessons learned on the way. As Nigeria gets ready for its graduation from GAVI, a robust agile performing cold chain and supply chain will be essential for the good health of Nigeria's children and its economy. The necessary transformation journey has only just begun.
authors.affiliation: Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98102, United States. Electronic address: David.sarley@gatesfoundation.org.
authors.forename: David
authors.initials: D
authors.lastname: Sarley
authors.affiliation: Logistics and Health Commodities Department, National Primary Health Care Development Agency, Plot 681/682 Port-Harcourt Crescent, Off Gimbiya Street, Area 11, Garki, Abuja, Nigeria. Electronic address: drmahmudmz@gmail.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Mahmud
authors.affiliation: Lagos State Government, The Secretariat, Obafemi Awolowo Way, Ikeja, Lagos State, Nigeria. Electronic address: jide.idris@gmail.com.
authors.forename: Jide
authors.initials: J
authors.lastname: Idris
authors.affiliation: Lagos State Government, The Secretariat, Obafemi Awolowo Way, Ikeja, Lagos State, Nigeria. Electronic address: modeleosun@gmail.com.
authors.forename: Modele
authors.initials: M
authors.lastname: Osunkiyesi
authors.affiliation: Clinton Health Access Initiative, 11 Ganges Street, Abuja, Nigeria. Electronic address: onome2000@gmail.com.
authors.forename: Onome
authors.initials: O
authors.lastname: Dibosa-Osadolor
authors.affiliation: McKinsey and Company, 1 Murtala Muhammed Drive, 1st Floor, Ikoyi, Lagos, Nigeria. Electronic address: Peter_Okebukola@mckinsey.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Okebukola
authors.affiliation: Clinton Health Access Initiative, 11 Ganges Street, Abuja, Nigeria. Electronic address: owiwa@clintonHealthAccess.org.
authors.forename: Owens
authors.initials: O
authors.lastname: Wiwa
mesh_terms: D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D009549:Nigeria; D009934:Organization and Administration; D012034:Refrigeration / Q000379:methods*; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Cold chain equipment; End to end supply chain strategy; Vaccines supply chain transformation; Visibility