Investigating Nigeria’s Progress Towards Self-financing: Political economy analysis of routine immunization vaccines financing

Abstract

Background: Globally, about five million children under the age of five years old die each year, of which Nigeria accounts for roughly eight hundred and fifty thousand. Despite the alarming number of deaths, persistent financial barriers hinder immunization efforts, with a central focus on the low budgetary allocation for routine immunization, which fosters a dependence on external funding and a lack of attention to developing sustainable domestic financing strategies. Methods: I conducted a problem-driven political economy analysis to explore the interplay between political dynamics, economic considerations, and internal and external contextual factors that impact Nigeria's ability to sustainably finance vaccines beyond its partnership with Gavi. This PEA involved 14 key informant interviews across actors from national government organizations, developmental partners, and civil society organizations. Results: I found that a significant challenge in the vaccine payment pathway arose from delayed approval and release of funds. Furthermore, participants identified other central challenges to vaccine financing including the lack of prioritization by the government, limited fiscal space, and Nigeria’s adverse macroeconomic conditions such as currency devaluation and high debt financing. To tackle some of the challenges, participants reported that exhaustive stakeholder engagement, enhanced state government involvement in decision-making, excise taxes, private sector involvement via local vaccine manufacturing, and internal accountability by CSOs and private entities were some opportunities for change. Conclusions: These findings underscore the need for robust institutional processes to streamline and optimize vaccine financing mechanisms. Furthermore, comprehensive engagement and representation across all stakeholder groups are imperative to foster ownership and commitment to immunization initiatives. Addressing the identified challenges in the vaccine financing landscape would ensure the sustainability of the National Program on Immunization and drive improvements in public health outcomes.