Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening

Figures & Tables

Download figure
Open in new tab
Download powerpoint
FIGURE 1.
Logic Model of the Nigerian RI Consultant Program
Abbreviations: HSS, health systems strengthening; ISS, immunization support system; LIO, local immunization officer; LGA, local government area; RI, routine immunization; TA, technical assistance.
Download figure
Open in new tab
Download powerpoint
FIGURE 2.
Nigerian States Selected for Qualitative Data Collection

TABLE 1 State Selection and Criteria

State	2013 DTP3 Coverage^a	Urban/Rural	IVAC Relationship	Active Consultant	Airport Accessible	Security Concern
Kogi	High (75.9)	Rural	None	Yes	No	Low
Niger	Medium (67.3)	Semi-Urban	Strong	Yes	No	Low
Gombe	Low (36.0)	Rural	None	No	Yes	Medium
Kano	Low (18.9)	Urban	Strong	Yes	Yes	Medium
Imo	High (83.1)	Semi-Urban	Strong	Yes	Yes	Low
Edo	High (79.6)	Semi-Urban	None	Yes	Yes	Low
Oyo	Low (47.7)	Urban	None	No	Yes	Low

Abbreviations: DTP3, third dose of diphtheria-tetanus-pertussis; IVAC, Johns Hopkins International Vaccine Access Center.
↵a DTP3 coverage: Low: <50%, Medium: 50%–74%, High: ≥75%. Source of coverage data: 2013 Nigeria Demographic and Health Survey.

TABLE 2 Demographic Characteristics of Interview Participants

	All Interview Participants (N = 101)
Gender, No. (%)
Male	67 (66)
Female	34 (34)
Age, mean (SD), years	49 (5.6)
Employment level, No. (%)
National	7 (7)
State	53 (52)
LGA	41 (41)
Respondent Type, No. (%)
Director	13 (13)
Active RI consultant	5 (5)
Other consultant (e.g., WHO consultant)	17 (17)
Technical officer	64 (63)
Health worker	2 (2)
Years in position, mean (SD)	6 (4.9)
Years in immunization, mean (SD)	17 (9.1)
Years in health care, mean (SD)	23 (8.6)
Obtained postgraduate education, No. (%)	38 (38)

Abbreviations: LGA, local government area; RI, routine immunization; SD, standard deviation; WHO, World Health Organization.

TABLE 3 Findings From Quantitative Survey of Nigerian RI Consultant Program Leaders (N = 44)

	No. (%)
How useful are your interactions with RI consultants?
Very or somewhat useful	34 (77)
Neutral	10 (23)
Not very useful or not useful at all	0 (0)
Is the RI consultant visible and actively working on RI activities in your state?
Yes	32 (73)
No	10 (23)
I don’t know	2 (5)
To what extent is the RI consultant involved in decision making for RI at the state level?
Very involved	17 (39)
Somewhat involved	11 (25)
Not very involved or not involved at all	12 (27)
I don’t know	4 (9)
The work of the RI consultant has a large impact on improving RI services in my state
Strongly agree or agree	31 (70)
Neutral	8 (18)
Strongly disagree or disagree	5 (11)
Does the RI consultant have influence to facilitate the release and/or retirement of Gavi HSS and ISS funds?
Yes, release only	1 (2)
Yes, retirement only	2 (6)
Yes, both release and retirement	21 (48)
No	11 (25)
I don’t know	9 (20)
How much influence does the RI consultant have on the Gavi HSS and ISS funds?
A lot or some	20 (45)
Not much or none at all	13 (30)
I don’t know	11 (25)
Are there clear performance targets for the RI consultant in your state?
Yes	14 (32)
No	4 (9)
I don’t know	26 (59)
Do you or anybody in the state evaluate performance of the RI consultant?
Yes	9 (20)
No	30 (68)
I don’t know	5 (11)