Abstract
BackgroundThe available data on routine immunization in Nigeria show a disparity in coverage between Northern and Southern Nigeria, with the former performing worse. The effect of socio-cultural differences on health-seeking behaviour has been identified in the literature as the main cause of the disparity. Our study analyses the role of supply-side determinants, particularly access to services, in causing these disparities.MethodsUsing routine government data, we compared supply-side determinants of access in two Northern states with two Southern states. The states were identified using criteria-based purposive selection such that the comparisons were made between a low-coverage state in the South and a low-coverage state in the North as well as between a high-coverage state in the South and a high-coverage state in the North.ResultsHuman resources and commodities at routine immunization service delivery points were generally insufficient for service delivery in both geographical regions. While disparities were evident between individual states irrespective of regional location, compared to the South, residents in Northern Nigeria were more likely to have vaccination service delivery points located within a 5km radius of their settlements.ConclusionOur findings suggest that regional supply-side disparities are not apparent, reinforcing the earlier reported socio-cultural explanations for disparities in routine immunization service uptake between Northern and Southern Nigeria. Nonetheless, improving routine immunisation coverage services require that there are available human resources and that health facilities are equitably distributed.
Highlights
Ever since the demonstration of the value of immunization by Edward Jenner in 1792, vaccination has increasingly become a key strategy in the prevention and control of infectious diseases globally
Human resources and commodities at routine immunization service delivery points were generally insufficient for service delivery in both geographical regions
While disparities were evident between individual states irrespective of regional location, compared to the South, residents in Northern Nigeria were more likely to have vaccination service delivery points located within a 5km radius of their settlements
Summary
The available data on routine immunization in Nigeria show a disparity in coverage between Northern and Southern Nigeria, with the former performing worse. The effect of socio-cultural differences on health-seeking behaviour has been identified in the literature as the main cause of the disparity. Our study analyses the role of supply-side determinants, access to services, in causing these disparities. Data Availability Statement: This study is based on data routinely collected in the Nigerian public health sector, most of which are publically available. Some data were accessed from the National Health Management Information System available online at www.dhis2nigeria.org.ng. Data not in the public domain were made available by the Federal Ministry of Health (FMOH) and the National PHC Development Agency (NPHCDA) upon request. These include data from Nigeria’s PHC reviews. Two of the authors (EE and SA) were part of the designing and coordination of the reviews, the data is owned by the Government of Nigeria and
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