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Authors: Dr. Faisal Shuaib, Akachi Mbogu, Muhammed Sheriff, Dr. Bassey Okposen, Dr. Murtala Bagana, Dr. Garba Bakunawa, Fatima Ambashair Kyari, Dr. Owens Wiwa, Dr. Sebastian Ilomuanya
Nigeria, like most low and middle-income countries, is supported by donors to fill the gaps in the health system. This support ranges from technical and managerial assistance to reach global and country strategic goals, to financingThe resources required to deliver public health functions to populations, the impact of those resources on the health of those populations, and the procurement of critical equipment, supplies, and activities for an equitable and sustainable health system. For instance, Gavi, the Vaccine Alliance, has provided over $732,130,326.00 to Nigeria since 2001 for vaccines and cold chain procurement, technical assistance, immunization campaigns, and health systems strengthening. However, with Nigeria’s Gross National Income (GNI) per capita exceeding the current Gavi threshold of support[1] of $1,580 GNI for three consecutive years, Nigeria entered the accelerated phase of the Gavi transition in 2018 with the expectation of becoming fully self-financing by 2028. To succeed in this transition, Nigeria’s immunization program will need to navigate several financial and programmatic risks to its sustainability.
There are four major “shocks” that could affect the country’s ability to sustain high coverageA proportion (%) that reflects the number of people receiving (an) intervention(s) divided by the total number of people eligible to receive and equityEquity in the context of public health campaigns refers to providing high-quality interventions uniformly and in a fair and impartial manner to during a transition from Gavi support[2]. The shocks include A) loss of Gavi subsidies for vaccines, often the most significant cost driver of the immunization program, B) loss of Gavi cash support for immunization system strengthening, which includes operational costs, C) loss of guaranteed accessThe ease in reaching health services or health facilities in terms of location, time, and ease of approach. to Gavi vaccine prices and procurement channels, and D) loss of technical and managerial support; performance management incentives and support; and political support from Gavi or other partners. If not adequately prepared, Nigeria may lose the gains made in strengthening immunization and the entire health system.
To sustain the country’s gains and maintain the quality of primary health care service deliveryAn immediate output of inputs placed into a health system, such as health workforce, procurement, supplies and finances. following Gavi’s investments, the Government of Nigeria, through the National Primary Healthcare Development Agency (NPHCDA), developed Nigeria’s Strategy for Immunization and PHC System Strengthening (NSIPSS) in 2017. The NSIPSS is a 10-year strategy document that defines the country’s plan to transition from Gavi support. This plan, which was developed in collaborationCollaboration involves the sharing of specific campaign components between vertical health programs and can be thought of as collaborative delivery or partial with partners, highlights the financial and programmatic decisions that Nigeria will need to make to attain at least 84 percent equitable and sustained national immunization coverage for all antigens by 2028. The transition plan initially started as a 5-year strategic plan (2017 – 2021) but eventually became a 10-year plan following negotiations with Gavi.
This piece shares some of the critical lessons from Nigeria’s experience in developing a Gavi transition plan, which could help countries plan for the transition and transition extension from one donor support or the other.