Assessment of the Political Economy Context Surrounding Evidence Use for Zero-Dose Programming and Policies in Nigeria

"This report underscores the critical importance of improving data integration and quality, enhancing coordination across governmental and organizational levels, and bolstering political commitment to effectively target and reduce the number of ZD [zero-dose] children."

Executive Summary
This Political Economy Analysis (PEA) examines the systemic, political, and economic factors influencing evidence generation and use for zero-dose (ZD) immunisation programming in Nigeria. Conducted under the Gavi Zero-Dose Learning Hub (ZDLH) initiative, the study provides insights into key challenges, stakeholder dynamics, and policy recommendations aimed at improving immunisation coverage, particularly for marginalised communities.

Key Findings

1. Fragmentation of Data and Poor Interoperability: The immunisation data landscape in Nigeria is highly fragmented, with multiple, unintegrated data sources across national and subnational levels. This situation limits the effectiveness of decision-making, planning, and implementation. Key data sources, such as District Health Information Software 2 (DHIS2), National Demographic and Health Survey (NDHS), and Performance Assessment for Programme Management and Action - Lot Quality (PAPA-LQAS), operate in silos, preventing holistic immunisation coverage assessments.
2. Political and Institutional Barriers: Immunisation financing remains inconsistent due to bureaucratic bottlenecks, shifting government priorities, and weak enforcement of accountability mechanisms. Political will is often directed toward donor-driven campaigns (e.g., polio eradication), while routine immunisation (RI) programmes lack sustained funding and government ownership.
3. Weak Coordination Among Stakeholders: Despite the presence of multiple actors - including government agencies, international donors, non-governmental organisations (NGOs), and private sector players - a lack of collaboration leads to duplicative efforts and inefficiencies. National and subnational governments do not always align priorities, and legislative-executive coordination remains weak.
4. Barriers to Data Use in Decision-Making: There is a gap in the accessibility, quality, and reliability of immunisation data. Inadequate capacity at the state and local levels, combined with political influences, undermines data-driven policymaking. Frontline health workers often lack incentives and training to collect and utilise immunisation data effectively.
5. Sociopolitical Factors Influencing Immunisation Coverage: Socioeconomic disparities and cultural resistance to vaccination contribute to persistent ZD populations. Women, often primary caregivers, face barriers in seeking immunisation services due to financial constraints, lack of education, and limited decision-making power in households.

Recommendations for Policy and Programmatic Action

1. Improve Data Integration and Standardisation
   • Establish interoperable platforms for real-time data sharing among government agencies and partners.
   • Strengthen data governance policies to ensure consistency across all levels.
   • Train local health workers on evidence-based decision-making using digital tools.
2. Enhance Coordination Between Government and Partners
   • Institutionalise multi-stakeholder platforms to align strategies among federal, state, and local actors.
   • Streamline decision-making by assigning clear mandates for immunisation data management and implementation oversight.
3. Sustain Immunisation Financing and Commitment
   • Increase domestic funding for RI, and integrate ZD strategies into primary healthcare budgets.
   • Advocate for direct line-item budgeting for vaccine procurement to reduce fund release delays.
   • Implement public-private partnerships for sustainable immunisation financing.
4. Strengthen Political Will and Accountability Mechanisms
   • Engage policymakers and legislators through evidence-based advocacy campaigns.
   • Monitor and report immunisation progress through accountability frameworks (e.g., Accountability Framework Implementation for Routine Immunization - AFRIN).
   • Encourage local government buy-in by linking funding to performance-based immunisation targets.
5. Address Sociocultural Barriers to Immunisation
   • Implement community-based outreach programmes to build trust in vaccination.
   • Integrate immunisation awareness into maternal and child health services.
   • Empower women and caregivers through incentivised health programmes and education campaigns.

Conclusion
The findings of this PEA provide a foundation for evidence-driven policymaking aimed at addressing systemic challenges in Nigeria's immunisation landscape. By enhancing coordination, strengthening data systems, and ensuring political and financial commitment, Nigeria can accelerate progress toward increased vaccine coverage. The recommendations outlined in this analysis are meant to serve as actionable strategies for stakeholders to effectively reduce ZD children and improve immunisation outcomes nationwide.