Financing Immunization for results in Nigeria: Who funds, who disburses, who utilizes, who accounts? Financing bottlenecks and accountability challenges

Abstract

Immunization is one of the most cost effective public health interventions to reduce child mortality. In Nigeria, vaccine-preventable  diseases account for approximately 22% of childhood deaths, per year. It is the policy of the Federal Government of Nigeria to provide immunization services and potent vaccines free to all population at risk of vaccine preventable diseases. However the cost of vaccines is  spiraling with new ones being introduced. Also current international financing for vaccines is not sufficient to sustain both progress in  coverage and the introduction of the new vaccines. Therefore it has become pertinent to explore how immunization is financed in  Nigeria.

Internet searches were conducted in Pubmed and Medline databases and Journal hosts including African Journal Online (AJOL)  and Health Inter Network Access to Research Initiative (HINARI) using specific search terms and strategies. Grey literature was obtained by soliciting reports from the federal Ministry of Health and major organizations involved immunization and from international reports.

The Nigerian health system is generally funded from federation account. Funding of immunization services is the collective responsibility  of all tiers of government through statutory budgetary allocation from the Federal, State and Local Government Areas. Other sources  include external donors, development partners, private sector and the community. However, these funds are disproportionately captured  by the rich at the expense of the poor and by the urbanites at the expense of the rural dwellers as depicted in measles immunization coverage. There are lots of financing bottle neck in financing immunization including inadequate funds, delays in release of  designated funds, inefficient use of funds, non-sustainable financing by donors, unintended consequences of Polio eradication  initiative and poor integration as well as non-profitability of vaccines. Furthermore, some accountability challenges exists and include  undefined roles and responsibilities within the routine immunization, unclear linkages across the different levels of government,  disconnect of responsibility and authority due to the concurrency of responsibility for health by all levels of government, lack of political  commitment, poor accountability among the workforce, lack of feedback to community and poor community engagement.

Strong  financial support for immunization is evident from Federal Ministry of Health, and donors. However, there are financing bottlenecks and  accountability challenges that need to be addressed to ensure adequate financing of immunization services in Nigeria.