One of the major priorities of the National Routine Immunization Strategic Plan (2013 – 2015) was to “guarantee 100% adequacy of bundled quality vaccines for safe immunizations at all times”. For this to happen, the Push System for vaccine distribution was introduced. The system gives the responsibility for vaccine delivery to the higher governance level: federal delivers to state and state delivers to the local government level. This replaced the old unreliable method in which poorly resourced staffers were required to assume responsibility for collection of vaccines from the higher level source. The Push System has been supported through the use of the national vaccine stock dashboard which provides visibility on stock sufficiency down to local government area (LGA) level.
Building on the success of the Push system and dashboard, the National Logistics Working Group (NLWG) secured approval from the Core Group and the Interagency Coordination Committee (ICC) to commence direct delivery of vaccines to health facilities that have functional cold chain equipment: the “Push-Plus System”. This was intended to reduce the number of nodes along the vaccine distribution chain.
The role of NPHCDA
The department of Logistics and Health Commodities – in collaboration with departments of Disease Control and Immunization; Planning, Research and Statistics; and the Procurement Unit – is leading on this project.
In each state targeted for Push-Plus, we coordinate NPHCDA activities in the following areas:
- Advocacy to engage with the state and to sign a memorandum of understanding for state counterpart funding in the initial months, and sustained financing at the end of NPHCDA support;
- Training of the state team on technical and contract management aspects of Push-Plus, especially regarding engagement of third party logistics firms;
- Support with the procurement processes for engagement of third party logistics firms. The initial procurement process for the engagement of the services of the logistics firms is led by NPHCDA with the state participating fully to ensure transparency.
- Monitoring and evaluation of the vaccine delivery process.
Push-Plus has led to remarkable progress in elimination of vaccine stock-out at service delivery points. This new method has led to a consistent increase in the number of children and women of child bearing age immunized in the states where it has been adopted. Having first become operational in Kano, Bauchi and Lagos states, we are now scaling up Push-Plus nationwide.
In 2014 – 2015, we raised LGA stock sufficiency from 34% to approximately 90% within 18 months through the Push System supported by the dashboard. The Push-Plus pilot in Kano State led to a doubling of facility stock sufficiency from 44% to 87%.
To help track results against plans, we are measuring the following:
- Proportion of health facilities with sufficient stocks of all antigens;
- Proportion of health facilities with cold chain equipment that have not reached temperatures outside the range of +20 to +80C;
- Proportion of scheduled deliveries that are completed;
- Number of vaccines lost or damaged while in the care of the distributor.
Project completion timeline
Engagement and onboarding of states is scheduled to end by 2018. Implementation support to states will be sustained thereafter.
UNICEF Nigeria is responsible for funds disbursement. Technical support is provided by CHAI, McKinsey, PSHAN, EU-SIGN, CHAN, TYDF, and Solina Health.
For further information please contact:
Bello Abdulkadir Aladie