Framework for Action

Strengthening immunization and PHC represents an important strategic priority in Nigeria, as reflected in the 2018 Strategy for Immunization and PHC Systems Strengthening. In response to low immunization rates in Nigeria, the Nigerian Primary Healthcare Development Agency declared a state of public health concern and established the National Emergency Routine Immunization Coordination Center (NERICC) in 2017. NERICC launched Optimized Integrated Routine Immunization Sessions (OIRIS) in the 18 lowest performing states to improve immunization service delivery. OIRIS aim to strengthen the operationalization of the Reach Every Ward (REW) strategy with the integration of PHC services, interventions and commodities with immunization services¹, thereby providing caregivers with a wide range of services and health commodities during RI visits. Integration with other services could also increase demand for RI.

Key pillars of OIRIS include:

  • Full optimization of REW to reach unimmunized children/communities.
  • Integration of RI with other services.
  • Intensified RI supportive supervision ownership – state PHC agencies drive improved RI performance and strengthened PHC.
  • Community engagement.

PHC levers:

Enabling factors: Political commitment & leadership (proactive governance with state level PHC agencies driving improvements and improved management and coordination of resources); models of care (RI integrated with other PHC services and commodities to attract caregivers and strengthen service delivery); M&E (emphasis on data use for action); systems for improving quality of care (enhanced and integrated supportive supervision).

Constraining factors: PHC workforce (limited quantity of HCW limits capacity to integrate multiple services); physical infrastructure (lack of integrated central supply chain for immunization and PHC); funding & allocation of resources (funding gaps for health commodities).

Added value:
Contribution to RI: 83 percent of urban PHCs, secondary, and tertiary institutions in 18 priority states offer daily vaccination, compared to 29 percent at the outset and 76 percent of planned outreach.

Contribution to PHC: Not measured but attention to RI and integration with other PHC services could increase utilization of those services.

When to consider this approach:

  • In contexts where there is strong momentum around strengthening PHC, coupled with financial resources for reinvigorating RI and/or PHC.
  • When developing national immunization strategies, Gavi full portfolio plans, and other policies and plans consider adding an objective committing to the integration of RI and PHC strategies, to be supported by specific interventions.