Pathways to improved Routine Immunization in Lagos State

Our routine immunization coverage in Lagos State is very low. This is a major cause of concern for me firstly because, with low RI coverage, it is safe to assume that other data from service delivery in the Phc department will be low too.   The bone of contention was that funds were being released by UNICEF to help in improving our RI coverage. Unfortunately, this has not produced the required results. As public health specialists, this is an issue that we all need to proffer solutions to.  

Service strengthening & integration, as against the present approach of service disintegration/silos, is the way to go.
Covid-19 pandemic came & scattered the PHC system, not much about the infection & resultant killings, but much about our approaches & methods at tackling it.
Our present approach constantly reminds us of our very weak system & our vulnerability. 
Our story presently can be likened to the proverbial man that chases 2 rats at the same time; he risks losing the two. Losing them is even a lesser evil, the confusion that results is even of more concern…
We focus on Covid-19, at the risk of being killed by deadlier but less notorious diseases.

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The solution to our problem; let’s routinize Covid-19 vaccine so that we can increase our capacity to put our house in order!

Too much focus, attention, resources (money and human resource) have been given to the Covid pandemic and the resultant effect is that our other services have taken a back seat.
We need to fully integrate the Covid Vaccination into our routine services and the process of covid Vaccination need to be simplified. This will help us to fully focus on our other activities.
The issue of human resources for health should also be quickly tackled, our current workforces are tired and are getting depleted by the months.
Also as MOHs and the entire LGA Team, we need to be more regular supervision and monitoring of all the activities going on in our PHCs.

Funds are released for expenditure that is not tied to results

1. RIIP 

2. ACSMThose days are far gone.

Strategic Purchasing and Performance-based Financing are the way to go following robust Analysis of previous performances and an Analysis of Gap (BottleNeck) between the Observed and Expected *BottleNeck = Expected – Observed*Demand Creation that leads to uptake outcomes (coverage figures) vs Supply provision of Services 
Must be analysed for better understanding at LGA and ward levels then plans made to address this.
*Demand Determinants* Use of service,(in)direct cost of care,  KAP about service*Community involvement**Intersectoral Collaboration*

Supply Determinants 

1. Commodities

2. HR Quantity vs Quantity

3. Facility (Fixed/Outreach)4. Quality of care (including attitude)

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Unfortunately, both determinants are largely controlled by Leadership/Governance Community – CDAs, Residents Association, CBOs/CSOs, press etc Ward – WHC, Residents Association LGA – MoH, LGHA, LGA?? State – Monitoring & Supervision is weak by us and others
Finance (strategic) Social Health Insurance or other Performance-Based Finance BHCPFPartners (performance-based – Allocate areas to WHCs and PHCs workers and pay per child vaccinated based on target reached not of the population by CBOs/CDAs after verification not before!
We should speak to data disaggregated towards in our LGA, not generic knowledge of what we fairly understand. Evaluation is weak too
When we are ready we will be alright las las.
_*People do what is inspected Not what is Expected*_- Louis Gestner (Former IBM CEO

Way forward


1. Urgent address of manpower shortage at the LGA.
2. System strengthening. The pandemic is a golden opportunity.
3. Sincerity of purpose. It’s like there is a deliberate effort to weaken the PHC system.
4. Leadership and governance at all levels must improve.

1) Manpower shortage is being addressed. The employment of staff by PHCB should be concluded in January.

2) System Strengthening: How do we go about doing that?

3) Sincerity of purpose: How is the PHC system being weakened and what can we do as MOHs to change the narrative?4) How do we improve leadership and governance at our level: then perhaps at the PHCBOARD level?

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