Background
In 2001, the Federal Government of Nigeria (FGoN) partnered with Gavi to strengthen immunization coverage. Prior to the country’s transition, Gavi had financed vaccine procurement (71%, $518,008,692) and non-vaccine operations, including health system strengthening (29%, $214,121,634) for a total contribution of $732,130,326 [1]. The financing provided by Gavi supported the introduction of life-saving vaccines, including the Pentavalent Vaccine, IPV, and PCV, across Nigeria.
With the rebasing of the economy in 2018, Nigeria entered into an accelerated transition, having exceeded the Gross National Income (GNI) per capita threshold for support of $1,580 for three consecutive years. During this period, the FGoN committed to annually increasing vaccines’ co-financing by 10% until 2028. This was estimated to amount to $1,945,949,675.58 by 2028 [2]. Since this commitment, Nigeria has successfully met this financial commitment, despite global health challenges such as COVID-19, tighter fiscal space, and reprioritization of missed communities. This study explores how Nigeria has successfully increased the immunization program budget and documents lessons learned for other countries in transition.
Methodology
A desk review was conducted to assess the collective efforts of key stakeholders and the role of advocacy toward ensuring a stronger focus on sustainable immunization financing and increased budgetary allocation to health. An analysis of the FGoN allocation to health and PHC (2002-2022) was conducted to determine trends and sources of immunization financing. A review of novel processes and tools post-transition was also conducted to estimate their impact on the country’s financing success in the last four years in meeting its co-financing obligation.
Results
Nigeria’s sustained immunization co-financing benefited from the 92% increased allocation to health from NGN356bn in 2018 to NGN682bn in 2022 [3] achieved through advocacy to high-level stakeholders, including the office of the presidency. Additionally, optimized processes, such as including a budget line for vaccine financing in the National budget, the switch in forecasting methods, and a revision of the forecast timeline to align with national budget timelines, also play a significant role. The Inter-Ministerial Vaccine financing committee, a coordination platform led by the NPHCDA with membership cutting across MoH, MOF, Budget Office, and development partners, provided a platform for continuous stakeholder engagement. Finally, findings also show that introducing novel tools such as the vaccine financing plan, vaccine financing outlook, vaccine financing trackers, and vaccine financing process map provided visibility and contributed to change. The above-ensured efficiency in costing, budgeting, approvals, and timely disbursement of funds.
Conclusion
Since the transition, Nigeria has increased its co-financing for immunization by 32.4% [4]. Strong advocacy and political commitment played a vital role in making change happen. These processes have aided the institutionalization of immunization financing, built resilience into sustaining financing in light of COVID, and refocused on missed communities. Timely forecasting and developing an annual vaccine financing plan continue to guide stakeholders through this process. Lastly, a strong accountability framework reviewed annually aids the tracking of progress.