By Fatima Adamu
A comprehensive Routine Immunization (RI) program is critical to ensure health security for any population. RI helps to prevent and eradicate diseases, support surveillance, and strengthen preparedness and response to health emergencies. Every year, the Federal Government of Nigeria spends millions of U.S. dollars on the national immunization program. As of 2015, the estimated total expenditure on vaccination was US$302,103,133.
A mother and child at the Immunization Clinic at Nuhu Bamalli Hospital, Kano State
With so much money being spent, decision-makers at various levels need to ensure that they are getting value for money. Various partners, including eHealth Africa, support the government in various capacities to strengthen the capacity of Nigeria’s health system to provide quality immunization services and thus, reach all eligible children. eHealth Africa has been working with the Kano State Primary Health Care Management Board (KSPHCMB) to answer the following questions:
What resources (infrastructure, human resources for health) are available and what is the status of these resources?
What is the level of knowledge of the health workforce?
What is the quality of services provided at the facility level? Do the services provided conform with set standard operating procedures?
What challenges prevent health workers from providing immunization at the highest quality?
These questions represent the gaps that existed in Kano State’s RI program before 2014 when the Kano Connect project was launched. KSPHCMB was riddled with poor reporting, communication, and data management systems, making it difficult for them to have a clear picture of what was taking place at the facility level. The Kano Connect platform embedded supportive supervision to increase accountability and RI service quality.
A Routine Immunization session at Nuhu Bamalli Hospital
Supportive Supervision and Monitoring in RI
Supportive supervision fosters program improvement by imparting knowledge and skills to health workers through a hands-on approach. During supportive supervision visits or activities, supervisors go to the health facility to observe and assess the services provided by health workers using checklists or set indicators. Based on the results of their observation, they can correct errors and note any challenges with supply and resources. It also allows supervisors to measure and monitor trends in vaccination coverage and other immunization systems indicators like safety and vaccine management by reviewing reports and data.
In Kano State, the Kano Connect project/platform provided mobile phones, Closed User Group (CUG) platform, airtime and internet access to Kano state health workers across the three levels (state, zonal, and LGA) in the state, to enable them to send RI Supportive Supervision reports through their mobile phones and communicate with their colleagues for free. The Kano connect platform allows RISS officers to send action points from supportive supervision visits as well as the geo-coordinates of the health facilities.
A RISS Program Officer conducting a supportive supervision visit to Dala Maternal and Child Health Clinic
The RISS reports are submitted near-real-time (as soon as the sessions are conducted) as soon as sessions are conducted by both the RISS officer. This helps the state to monitor and track all RISS reports across the three levels.
Additionally, through the use of our designated Kano Connect online dashboard, managers are able to visualize the RISS data for action. Similarly, LGA level staff in the routine immunization system are also able to see both their individual performance and the data collected. By visualizing more granular-level information, the data becomes more useful for decision-making within the sector which drives solutions towards improving RI coverage rates across the state.
The Kano Connect dashboard
Kano Connect has supported the Kano state government to verify locations of over 1,000 RI health facilities across the state using our expertise in Geographic Information Systems. This has led to an evidence-based geolocation update of the database and has helped to aid planning to reach all eligible children in the state. Additionally, the platform has made HWs more accountable in conducting RI sessions as planned and provided a system for managers to track action points in the state.
Since the uptake on the use of the Kano Connect dashboard in 2016, the RISS submissions at the state, zonal and LGA levels have reached 98%, 100%, and 96% respectively; this has improved data quality of routine immunization supportive supervision in Kano State.
Finally, in the last five years, the Kano Connect platform has provided an accountability path for the entire RI program in Kano by improving data quality and frequency and by highlighting key gaps and action points for tracking and follow up. The continuous real-time effect of the Kano Connect platform helps managers to correctly identify issues and act promptly which in turn helps to increase the RI coverage among target populations of children across Kano State. Supportive supervision as a strategy in the delivery of public health services promotes quality at all levels of the health system through the development of professional competence among the health workforce.