Africa’s immunisation programme: A roadmap to improved outcomes

One thing the Covid-19 vaccination campaign has taught us is that with strong political will and an equally strong accountability system, immunisation targets can be set and achieved. How else can the rapid progress in Covid-19 immunisation coverage of many African countries to over 50% per 100 people (Nigeria 56%, South Africa 64% and Sudan 51%) in just two years be explained?

Africa has made much progress in improving access and uptake of routine immunisation in recent years as evidenced by the increase in pentavalent immunisation coverage over time. But countries like Nigeria, Central African Republic, Chad and Somalia still have pentavalent coverage ranging between 40% and 55% with under five mortality rates of greater than 110 per 1 000 live births. Also in 2021, more than eight million additional children in Africa did not get immunised as a result of reduced programmatic services for childhood immunisation during the pandemic, according to the World Health Organisation. 

The Immunisation Agenda 2030 has set an ambitious target to leave no one behind, meaning that everyone is fully immunised regardless of age, location and socio-economic status, within seven years. African heads of states have agreed to key measures of this immunisation agenda. But, plagued with an increasing population, poor nutrition, poverty, and low educational background, Africa faces significant challenges in ensuring this target is met. 

One way to accelerate progress is by borrowing from the lessons learned from the Covid-19 vaccination campaign to strengthen leadership and governance of national programmes on immunisation. It is through leadership of immunisation programmes that policies are developed and implemented, resources mobilised and allocated, stakeholders engaged and a supportive supervision and accountability feedback mechanism is implemented. Without multi-level leadership, these processes cannot be effective, and lapses will remain. Immunisation strategies must address both demand and supply challenges to immunisation. This means that for governance to be effective, a multi-pronged approach must be deployed. It is therefore important that the capacity of leaders and service providers must be built to carry out their functions at the relevant levels. In addition, each level on the leadership rung must hold the others accountable in a bidirectional manner.

In addition to the immunisation and health teams holding themselves accountable, an often-missing component for strengthening leadership and governance is the active role of the public. Citizen engagement in the health sector appears to be low in Africa. This may be because the average Nigerian, for example, has other critical problems such as dealing with the battle for basic needs such as food, shelter and water. But it may also be linked to the fact that access to information on health sector performance isn’t so readily accessible. For instance, a casual electronic search for monthly performance data on routine immunisation in a country like Nigeria is unlikely to yield much. In a world where artificial intelligence is gaining traction and in a country that has become an IT hub, one wonders why more digital solutions have not been embraced to increase citizen participation.   

To improve leadership and governance in immunisation programmes in Africa, several strategies can be employed. 

First, there is a need for increased political will to prioritise routine immunisation programmes. Sustained discussion with political leaders at all levels will be vital in achieving this. It may be through immunisation champions — community leaders, civil service organisations — or increased participation of the public.  

Second, there is a need for improved coordination and collaboration between different levels of government, as well as other stakeholders such as NGOs and the private sector. 

Third, there is a need for increased investment in health infrastructure, human resources, and technology to support immunisation programmes. 

Fourth, there is a need for improved data generation, demand and use, information sharing and learning. 

Last, community involvement is needed to increase awareness about the importance of immunisation, dispel myths and rumours and improve demand for immunisation services. 

All of this should be done with the backbone of transparency and accountability while leveraging technology for improved efficiency.

Effective leadership and governance are critical for the success of immunisation programmes in Nigeria. While progress has been made in recent years, there is still much work to be done. A strong immunisation programme signals hope for universal health coverage in Africa — a goal we will love to see achieved.

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.