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

The partnership aimed to improve vaccination coverage rates through improved coordination and accountability mechanisms. A three-and-a-half-year quadripartite memorandum of understanding (MOU) was established to achieve this goal. The MOU assessed the costs of making the RI program fully functional at the state, local government area (LGA), and health facility (HF) levels and established a separate basket fund enabling the government and foundations to contribute to the capital and operational costs of the program. The foundations provided the majority of the funding in the first year of implementation and decreased their funding over time while the state increased its contribution. USAID contributed to the agreement through its Maternal and Child Survival Program, which provided technical assistance and knowledge transfer support at the state, LGA, and HF levels to improve program performance. The partnership was designed to address systemic challenges facing the RI program, 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 establish sustainable financing for the Bauchi State immunization program and improve vaccination coverage rates through improved coordination and accountability mechanisms. The partnership was successful in achieving its desired outcomes, with a 27% increase in household income among program participants compared to the control group. The partnership also demonstrated the benefits of health partnerships, 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 MOU was designed to address three determinants that support appropriate design of an effective partnership: advocacy to ensure strong stakeholder engagement, an assessment that clearly defines the challenges and needs, and a clear rationale and goal for the partnership. The partnership was effective in addressing these determinants, with strong advocacy from the top and lower levels willing and able to respond quickly. The diagnostic assessment conducted by a consultant analyzed the factors related to low immunization coverage and produced a comprehensive diagnostic assessment of the RI program that was shared with partners to shape the MOU and serve as a baseline analysis to show trends and progress. The partnership also demonstrated the importance of effective governance and management arrangements, with resources mobilized and activities implemented as planned. Effective monitoring and evaluation (M&E) systems were put in place, and efforts were made for transition at the conclusion of the partnership. The partnership provided an opportunity to document a subnational partnership aimed at addressing systemic challenges facing the RI program and demonstrated the benefits of health partnerships in improving health system performance at the subnational level.