Vaccine supplies and logistics are a fundamental component of any immunization system. In Nigeria, any hope of achieving the goal of 87 percent vaccine coverage by 2015 will remain out of reach unless vaccines and devices reach heath facilities on time and in the right quantity. The greatest difficultly lies in reaching the last mile—getting vaccines to those in the hardest-to-reach corners of Nigeria.
At national and sub-national levels, stock situations have been fairly adequate; the challenge is to ensure sustainable supply to the most remote local government areas (LGAs) and health facilities. With support from Gavi, the Bill and Melinda Gates Foundation, UNICEF and other partners, the Nigeria National Primary Health Care Development Agency (NPHCDA) recently created and rolled out a national vaccine stock performance management (VSPM) dashboard. This tool includes a visual wall chart and accompanying Excel file to record both actual and target stock levels.
The dashboard aims to:
- Ensure that antigen and device stock levels further down the supply chain are visible in real time to stock managers at higher levels;
- Encourage use of data for decision-making; and
- Establish dialogue between personnel at various levels of the supply chain that leads to a performance- and action-driven culture among cold chain staff nationwide.
At the beginning of the VSPM roll-out in April 2014, only 263 (34 percent) of the 774 cold stores in local government areas had adequate supply of all antigens—that is, quantities sufficient to address the needs typically presented in one week. Just four months after the introduction of the dashboard, however, the number of LGAs with adequate stock increased to 620 (80 percent).
This level has remained stable through December 2014, with reporting consistently exceeding 90 percent. Gaps in reporting are primarily attributable to conflict areas in the northeast of the country, where carrying out basic primary health care activities has become difficult.
These and other early successes have led to a scale-up of the dashboard to include additional routine immunizations and devices. The dashboard is shared on a weekly basis with key stakeholders and those responsible for policies and practices related to vaccine delivery. This has led to stronger governance and improved accountability in immunization systems at national, state and LGA levels.
Honorable commissioners of health, executive chairmen of State Primary Health Care Boards and other relevant stakeholders are using dashboard reports and related data to determine when restocking is required and to troubleshoot potential issues occurring in LGAs. At the national level, NPHCDA’s executive director has used dashboard reports to identify issues—and in some cases to assist poorly performing states, leading to positive dialogue and early action by state policy makers.
The dashboard and related follow-up surveys have enabled decision makers to identify and characterize barriers to full stock sufficiency in all LGAs, which include inadequate resupply quantities, funding constraints for transporting vaccines and devices, delayed release of funds, and lack of supervisory involvement in stock status and vaccine management.
The NPHCDA recently asked states to align themselves with the national recommendation to scale-up a “push” distribution system, in which states deliver vaccines directly to LGAs. The push system is intended to replace the current “pull” system, in which LGAs are responsible for picking up vaccines. This shift will ensure regular delivery and improve availability of vaccines and supplies.
Nigeria has taken important steps to overcome last mile hurdles to achieving an uninterrupted supply of life-saving vaccines in all states. Nigeria’s effort to improve visibility and reporting through these dashboards has been cited as a strong example of how better supply chain data and processes lead to increased access. Nigeria’s success should serve as a model for other countries looking to achieve vaccine stock sufficiency and better serve their populations.