Stakeholder perceptions of political and economic factors influencing vaccination in two States with a high burden of zero-dose children in Nigeria

This peer-reviewed journal article explores stakeholder perceptions of political and economic factors influencing vaccination services in Kano and Lagos States, Nigeria, areas with a high burden of zero-dose and under-immunized children. The study used stakeholder mapping and key informant interviews with 84 state, local, and community actors to characterize the political, policy, and financing environment affecting routine immunization implementation and service uptake at multiple levels of the health system.

Key findings

• Stakeholders reported that political commitment from actors at state and local levels was mutually perceived as strong and supportive of routine immunization efforts.

• Local influencers — including traditional and religious leaders — were viewed as pivotal in reinforcing vaccination uptake in challenging settings.

• Knowledge of national immunization policies and confidence in their adequacy for addressing under-immunization was weakest among local and community-level participants.

• Bureaucratic delays in disbursement of funds, outdated policy frameworks, slow policy dissemination to operational levels, and inadequate local funding and staffing provisions were identified as key barriers to effective policy implementation.

• Improving equity in immunization coverage may require meaningful engagement of community actors in policy development, timely policy revision, mechanisms for expedited fund release, and strategies to address localised funding shortfalls.

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