Women groups in Nigeria, and other stakeholders, met in Abuja for a 1-day dialogue to discuss the post-GAVI implementation plan as part of strategies to find sustainable ways of increasing domestic resource mobilization for funding routine immunization in Nigeria.
Organized by the National Council of Women Societies (NCWS), a subgrantee of dRPC’s Partnership of Advocacy in child and family health at Scale (PACFaH@Scale), the dialogue, also discussed ways  CSOs will ensure accountability in RI finance strategies at National and state levels in Nigeria.
Several women’s groups from Niger, Kano, Lagos, Taraba, Anambra, Enugu, and Kaduna states attended the dialogue, with representatives from the Federal Ministry of Health (FMOH), Budget Office of the Federation (BOF), Federal Ministry of Finance (FMF), and Center for Disease Control (CDC), as government stakeholders. Other GAVI transition stakeholders such as the BMGF, WHO, World Bank and AFENET also attended.
Dr. Garba Bello Bakunawa from the National Primary Healthcare Development Agency (NPHCDA) led the discussions on the implementation status of GAVI transition, potential domestic funding post-GAVI and development of a RI scorecard.
Then, the  Nigeria Strategy for Immunization and PHC System Strengthening (NSIPSS),which was  premised on the need to have a robust and ambitious plan to improve and sustain immunisation coverage and maintain quality PHC service delivery post-GAVI in light of the multiple transitions faced by the country between 2018 and 2028, was also discussed. As the most important and binding document between GAVI and the Nigerian government, participants want the document to be made public so that civil society can hold the government of Nigeria accountable over its promises. Women groups can also use the document to engage with government agencies during advocacies.
The other issue discussed was increasing domestic resource funding post GAVI, which the participants highlighted as a necessary step to sustain the funding of routine immunization in Nigeria.
Outcomes of the dialogue are: At the end of the 1-day dialogue, the following outcomes were achieved:

• Participants had a better understanding of the GAVI implementation status: as the goal of the NSIPSS is the attainment of 84% average national immunization coverage with all scheduled routine antigens by 2028.
• Participants agreed on key systems approach to address the gaps, taking immunization, not as a stand-alone programme, but as an integral part of a strong PHC system in the NSIPPS document.

The following key areas of focus are:

Leadership, Management ,and Coordination:
To strengthen the primary healthcare centers (PHC) management through PHCUOR, and technical support program by the NPHCDA to the states to improve the PHCOUR implementation and Task-shifting program within NPHCDA. This will improve the organizational capacity of the NPHCDA to manage the Immunisation programme. Establishment of SERICC in 18 low performing states and the recruitment of SERICC Technical Assistants. The country developed and signed the joint accountability framework with GAVI to institute an accountability framework for RI. The key challenge here is insufficient funding. This task is achieved but further strengthening is needed.

Service delivery:
Implementation of the optimized and Integrated RI sessions (OIRIS) in 18 priority states, rreduction of Missed Opportunities for Vaccination (MOV) in urban PHC facilities, secondary and tertiary facilities, and Introduction of new vaccines (MenA, MCV2) is on-going. Rota to be done by 2020, and reduction of missed opportunities for vaccination (MOV) by instituting daily fixed doses across high- volume PHCs, secondary and tertiary facilities of the 18 low performing states.

Demand creation:
The Multi-level coalition for RI advocacy which entailed the NPHCDA leadership and partners have continued to advocate to stakeholders (National Assembly, State governors, etc) and it is the only goal achieved in demand generation. The other goals like Engagement of state health educators and transition of structures and capacities, broader partnerships and engagement with the private sector and development of a national communication plan, Data for action, States specific approach are yet to be achieved.

Supply chain:
Supply chain system redesign like the 3-hubs, push plus, and National Supply Chain Integration Project (NSCIP), Data for the supply chain to improve visibility and accountability, accountability measures including vaccines physical stock count, state-specific forecasting, mandatory vaccine utilization report. This task is a work in progress albeit with a variable level of success across the 36 states and the FCT.

Data management:
Majority of the goals here are yet to be achieved like the, strengthening of data quality audit, assurance and assessment mechanisms, conduction of annual surveys to provide timely and reliable information for decision making, Strengthening Operations research mechanisms, introduction of electronic vaccine registry to capture individual immunization record, and Passage of enabling laws and policies are all not available due to poor funding and delay from GAVI approving the electronic data collection proposal. This task is a work in progress

Financial management:
Strengthening of financial management by Setting-up of the vaccine financing and accountability WG, leading to improved visibility and tracking of vaccine financing is currently not available. Also, key initiatives such as automation of the financial management processes have not been rolled out due to lack of funds. Increase in government funding for vaccine procurement by Inclusion of over 40% of vaccine procurement needs in the Service wide votes. Release of the funds is expected in coming days.
Other outcomes are:
Increased awareness on how to domestically source for funding post-GAVI
Improved knowledge and skill on RI scorecard development
Better understanding on the various roles CSOs can play in ensuring accountability in their states by tracking the Budget allocation, release and tracking of expenditure; and eventually use the information derived for further advocacy and engagement with the state governments.

Recommendations:
At the end of the 1-day dialogue, participants recommended for the government agencies, donor organizations, the private sector, etc to ensure the implementation of the NSIPSS goals and bring about strategies to mitigate the challenges or accelerate the implementation of 84% average National immunization coverage.
They want the federal government of Nigeria to explore other innovative means of domestic finance mobilization for RI through increasing its tax base revenue, imposing health-specific levies on telecom companies, PPPs with the organized private sector and improving accountability and transparency through effective utilization of its earnings.
The participants also called on the CSO to continue to advocate for demand generation of routine immunization services and to study the budget cycle to enable them hold the governments at all levels accountable
Next Steps:  The participants called for on the federal government to take the following measures regarding the NSIPSS document:
•      Review, prioritize and phase strategies outlined in the NSIPSS, incorporating findings from the Joint Appraisal.
•      Develop annual operational plans for prioritized immunization and PHC interventions, with clear accountability measures
•      Engage government and partners to source for adequate resources to address identified challenges
•      Continuously monitor and evaluate progress and impact of implemented strategies
•      The NPHCDA and other Government agencies should collaborate and work with NCWS-PAS to accelerate vaccine coverage and demand generation in the country.

The dialogue is a critical output towards the achievement of IPO 1, supporting the implementation of Nigeria’s RI financing strategy. For the full report click here