Strengthening Routine Immunization through Subnational Partnerships The Experience in Sokoto State, Nigeria

The partnership aimed to establish sustainable financing for the Sokoto immunization program and improve vaccination coverage rates through improved coordination and accountability mechanisms. The partnership was formalized through a three-year quadripartite memorandum of understanding (MOU) that outlined the terms of the partnership. The MOU established a separate "basket fund" account to enable the government and the foundations to contribute to the full operational costs of the program. The foundations provided the majority of the funding in the first year of implementation, while the state increased its contribution over time. The partnership was designed to address the systemic challenges facing the routine immunization program in Sokoto, including a shortage of vaccines and supplies, poor quality health information system data, and the lack of trained health workers in rural areas. The MOU aimed to achieve its goals by assessing the costs of making the program fully functional at the state, local government area, and health facility levels and establishing a sustainable financing mechanism. The partnership was implemented through a series of activities, including the development of a diagnostic assessment to inform the MOU, the establishment of working groups to oversee the implementation of the MOU, and the provision of technical assistance and knowledge transfer support by USAID's Maternal and Child Survival Program. The MOU was designed to be a sustainable and effective partnership, with a clear rationale and goal for the partnership. The overall goal of the MOU was to generate sustainable financing for routine immunization with the aim to increase routine immunization coverage to 80% by the end of the MOU period. The MOU also aimed to address the poor state of routine immunization facilities and logistics management and weak capacity of health personnel to deliver routine immunization services. The partnership also demonstrated the benefits of subnational partnerships in improving health system performance, including avoiding duplication of investments and activities, sharing knowledge and resources to improve effectiveness, and creating momentum and attracting funding by building a common platform that gains legitimacy and support. The partnership's success can be attributed to the strong stakeholder engagement, clear definition of challenges and needs, and a clear rationale and goal for the partnership. The partnership also demonstrated the importance of advocacy and conceptualization in ensuring strong stakeholder engagement and a clear definition of challenges and needs. The partnership's implementation was overseen by a series of working groups, which provided a platform for stakeholders to share knowledge and resources and improve the effectiveness of the partnership. The partnership also demonstrated the importance of monitoring and evaluation in ensuring the effectiveness of the partnership. The partnership's transition stage was also successful, with efforts made to ensure that the partnership's gains were sustained beyond the end of the MOU period. The partnership's legacy can be seen in the continued improvement of routine immunization coverage in Sokoto, which has increased from 3% to 80% over the past few years. Overall, the Sokoto State government's partnership with the Bill and Melinda Gates Foundation, the Aliko Dangote Foundation, and the United States Agency for International Development demonstrates the benefits of subnational partnerships in improving health system performance and achieving sustainable development goals. The partnership's success can be attributed to strong stakeholder engagement, clear definition of challenges and needs, and a clear rationale and goal for the partnership.