This document discusses Nigeria's National Programme on Immunization (NPI), which aims to immunize children against common diseases. It was initiated in 1976 and covers organization, financing, management, strengths/weaknesses and possible reforms. The NPI is centrally managed but implemented locally. Coverage has increased from 15% to 80% since 1979 but challenges include inadequate funding, data collection issues, and appointing leaders based on political ties rather than merit. Reforms proposed include direct program funding, improved record keeping, and more transparent leadership selection.

1. A
AHMADU M.T.
07986814
MBA, I.H.C.M.

2.  INTRODUCTION
 ORGANIZATION AND FINANCING
 STRUCTURE IN PLACE-MANAGING COST, CARE
AND HEALTH
 MANAGEMENT AND LEADERSHIP
 STRENGTHS AND WEAKNESSES
 POSSIBLE REFORM, AND ITS
CHALLENGES
 CONCLUSION

3.  Expanded programme on immunization(EPI) was initiated in 1976
in Nigeria, based on the premises of the same programme by the
WHO.
 Aim was to immunize 0-2 year olds (and pregnant women) and
achieve >85% coverage, then to integrate immunization into
routine activities of all PHCs.
 Immunize against vaccine preventable diseases- Tuberculosis,
Poliomyelitis, Diphtheria, Tetanus, Measles, Whooping cough.
These diseases were identified as common causes of infant
morbidity and mortality.
 Name changed to National programme on immunization(NPI) in
19 to further show a government commitment to individualizing
the scheme..
 Current immunization coverage is about 80% in 2007, from just
above 15% in 1979.There has been some progress, though at a
slow pace .

4.  Centrally managed, with policies at the federal level
through the Federal ministry of health, then the NPI co-
ordinator, and field work carried out from the state level
to the local government level.
 Follows the 3 tier system of the constitution of
government in the country. However there is some level
of semi autonomy in each state, with states having their
immunization days .
 Financed majorly by public funding from the government
budgetary expenditure on health, and other sources of
from international donor organizations like the WHO-
especially during disease outbreaks..

5.  Currently immunization is carried out in fixed facilities ,
particularly primary healthcare centres in each ward in the
localities, with adjuncts from frequent outreaches/outdoor
sessions done on certain days ,either on a national level,
state, or local government level. This is done to increase
coverage of the immunization programme.
 Vaccines are stored via the cold chain storage and reverse
cold chain for unused vaccines, and this is done at each local
government level, up to the state, and finally the National
government.
 However, the Private sector too plays a role, though largely in
conjunction with the local government area in which it is
situated.

6.  Currently the programme is led by the National co-ordinator of
the NPI, and there are sub co-ordinators at the state and local
government levels. These work in conjunction with their
corresponding ministers of health to deliberate on policies,
implement programmes and give feedback to the government
and the people either way.
 This system though seems to be effective, is not without its
problems as most often than not, these posts are political
posts, occupied by those who have connections with the
powers that be, hence corruption seems inevitable in this
situation. Leading to poor programme implementation,
monitoring and evaluation.

7.  Central control of the programme from the National level,
allowing for better co-ordination.
 Adjuncts of community outreaches on specific days allows for
a wider awareness and coverage of the populace in the
immunization plan.
 In terms of managing care, the outreach helps to ensure
equity. Though the poor, who stay in very remote areas still do
not get covered.
 Managing cost
 In terms of managing health, there has been a considerable
increase in immunization coverage and eventual reduction in
incidences of the 6 diseases. Though there have been cases
of polio and *measles outbreaks of recent, due to political
issues( Northern Nigeria).

8.  The current method of choosing the co-ordinators based on
political ties, gives room for individuals not best suited for the
job taking up roles, hence allowing for lack lustre
performance, or no performance at all, and eventual corrupt
practices taking place.
 Financing of the programme is still not adequate, as funds are
disbursed from the National level, and budgetary allocation on
health as a whole is still a small 3.5% of the entire budget,
with education, security, and growth leading the lot. There is
also a lot of legislature involved, making changes in policies,
and implementation at the local level delayed due to
bureaucracy.
 Data collection and analysis for monitoring and evaluation is
poor and still archaic, as it involves paper work ; with data
likely getting lost in transit and or being incomplete.

9. The NPI will benefit from a reform in its current management, and
organization. Though this will come with some challenges;
 First of all, the programme should have its own means of funding
directly from the government, and this funding should be controlled
and disbursed by the programme itself, allowing for availability of
funds readily. E.g. Meningitis vs. Lassa fever.
 More community involvement in planning and implementation.
 Next the leadership of the programme should be selected through
transparent means and based on suitability for the job. However this
will prove very difficult in the current political terrain of the country.
 Current problems of unstable supply of electricity leading to vaccines
going bad, and losing potency , can be resolved with the creation of
alternate sources of power supply, and storage means. However
this will prove very costly, and is quite difficult to achieve in the
present Nigerian economic and political environment.

10.  There should be more intersectoral collaboration between
Ministries of Education, Finance, Transport, Power et al, to
ensure a wider coverage and implementation of the
programmes on immunization.
 There should be a Public-Private sector partnership with
regards immunizations and provision of vaccines, giving less
disparity in costs of vaccines, and even more wider reach of
the populace.
 Facilities should be upgraded, and there should be
recruitment of more workforce to ensure proper
implementation of the programme.
 Modern techniques of data collection and record keeping
should be instituted allowing for adequate monitoring and
evaluation of the programme. This can prove a bit tough
though as it will involve increase costs on acquiring systems,
and training of staff on the use of such.

11.  The NPI has fared quite well since its inception, though
this has been a rather slow progress.
 Coverage of immunization has still not reached 100%,
with disparities existing in various regions of the country.
 The leadership and management of the programme can
be modified, with better selection criteria and methods,
ensuring programme implementation, good performance.
 Corruption, is a hydra headed monster that needs to be
tackled first on a national level to ensure maximum
benefits of any reforms in the system.

12.  WHO: AFRICAN REGION; NIGERIA. Expanded
programme on immunization .www.who.int.com.sis.
 Jinadu, M.K.( August 1983). Perspectives in primary
care: A Case Study in the Administration of the Expanded
Programme of Immunization in Nigeria. Journal of
Tropical Paediatrics Vol. 29. Pg 217-219.
 Morley, D.C, Woodland, M, Martin, J.W.J. In: Morley DC.
Paediatric priorities in developing countries. Butterworth
Pub, 1973.