The people’s scorecards developed by PAS sub grantees in Lagos, Kaduna, Kano and Niger States showed recurring stock-out of vaccines, poor funding and non-timely releases of funds for the RI activities in all the states.

In the Kaduna State, although the 2019 scorecard revealed success in most of its set targets, however issues relating to non-release of funds, poor funding and high stock-out still persists. Summary of the findings indicate the following:

• In 2019, The non-timely releases of government budget for immunization activities poses an operational threat.
• Kaduna State experienced stock-out of vaccines at health facility levels due to distribution issues or inadequate and poor access to operational funding.
• SERICC and LERICC were established to improve coordination and management of RI activities, including accountability. Hence, engagement of CSOs in SERICC and LERICC should be actively promoted for improved accountability.
• The immunization coverage status is the product of the quality of service delivery. Efforts to improve service delivery should be prioritized.
• Community engagement activities should be actively promoted to improve coverage, and reduce drop-outs.

In 2020, the scorecard showed that Kaduna State has achieved most of the set targets at State level, however issues still persist at LGA and HF levels. Some of the issues as follows:

• The non-timely releases of government budget for immunization activities has persisted. This may have implications on the operationalization of implementation plans.
• Vaccine stock-out experienced at health facility level in Kaduna State persisted, and requires concerted efforts at all levels. This is important for sustenance of coverage momentum and the reduction of missed periods.
• Health Facilities should be supported to conduct community engagement activities to improve coverage, and reduce drop-outs.
• Vaccine coverages experienced at the LGA and health facility level were not optimal. Efforts to improve supportive supervision should be prioritized.

In Kano State, the 2019 scorecard showed that the State has performed admirably to improve routine immunization. However, issues that remain are as follows:

• Processes and controls should be considered and enforced to address the issues of retirement of funds and weak or poor documentation.
• Logistics issues that resulted from non-functional Vaccine delivery van should be addressed to improve vaccine security.
• Funding for printing and distribution of data capture tools should be included in the annual RI budget for Kano State.
• Poor service delivery was reported at the LGHA level, which was attributed to poor documentation. Printing and distribution of data capture tools to health facilities should be prioritized
• Community partners should be engaged to sensitize caregivers on the need for RI card retention

In 2020, the scorecard showed that there is a need to increase regular supportive supervision visits to LGAs and health facilities and follow ups on agreed implementation action point.

• There is a need to increase funding for RI by Kano State Government.
• The costed action plan implementation should be properly coordinated to provide seamless flow of information.

In Lagos State, the 2020 scorecard showed that the Lagos State Government should be commended for targets met, however, issues persist.

• The lack of alignment between funds appropriated and the costed implementation plan could result in inadequate implementation of RI activities and should be addressed
• Failure to operationalize fund for immunization activities at the PHC level will affect service delivery especially outreaches.
• Vaccines stock out at the health facility level points to gaps in logistics support which should identified and addressed.
• SERICC and LERICC were established to improve coordination and management of RI activities, including accountability, hence, engagement of CSOs in SERICC and LERICC should be actively promoted for improved accountability
• Occasional LERICC Meetings suggested that decisions at the LGA and health facility level are not made in real time. Timeline for LERIC meetings should be suggested and adhered to.
• Poor immunization coverage is the product of poor service delivery. Efforts to improve service delivery should be prioritized.
• Community engagement activities should be actively promoted to improve coverage, and reduce drop-outs, especially at health facility level.

In Niger State, findings indicated irregular releases of government budget for immunization activities still remains an issue as non-timely release of RI finances was a challenge across all LGAs and should be addressed for sustained coverage.

• Niger State experienced stock-out of vaccines at LGA and health facility levels due to distribution issues or inadequate and poor access to operational funding. The lack of functional cold-chain capacity across all LGAs should be addressed for improved vaccine security.
• SERICC and LERICC were established to improve coordination and management of RI activities. The engagement of CSOs in SERICC should be actively promoted for improved accountability. Although LERICC was inaugurated in all LGHAs assessed, meetings were not held.
• Poor immunization coverage is the product of poor service delivery. Hence, efforts to improve service delivery should be prioritized.
• Community engagement activities should be actively promoted to improve coverage, and reduce drop-outs.