By Lois Privor-Dumm. Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world. But even after a vaccine is introduced and money has been spent, some children never see even the first dose. With so much investment and effort, you wonder — how can that be?
Take Nigeria, the country with the second largest number of child deaths globally. Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%. But progress is fragile, and results uneven. Some areas have coverage rates above 80%; others are barely providing any vaccine. Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.
To find out, a team led by Dr. Chizoba Wonodi at our International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, worked with the government of Nigeria to interview 126 stakeholders in 8 states that best exemplify the successes and challenges in immunization coverage. Dr. Wonodi’s team found that often, it’s not the amount of money that’s the problem – it’s getting that money to the right places at the right times, from the federal government all the way down to the community level. When that doesn’t happen, children go unvaccinated. Conversely, innovative mechanisms can lead to success stories. In one northern state, Zamfara, leaders used a “basket fund” to pool funds at the state and local level, ensuring that resources go where they are needed.
Other non-monetary issues were important as well. Inadequate transportation was cited in the study as a near universal barrier to vaccine delivery. Transportation contracts are one solution—these contracts could even be preferentially awarded to female-owned business, empowering women while improving service delivery (I really like this one!). (more…)