Immunization has proven to be one of the most significant and successful advances developed by human species in diseases prevention. Immunization is a cost-effective public health intervention aimed at reducing morbidity and mortality associated with infectious diseases. Over the years, substantial government and development partners’ resources have been invested so as to reduce mortality rate. Though immunization coverage in Nigeria has increased, yet Nasarawa state remains one of the areas in Northern Nigeria that still recorded higher mortality rate as a result of vaccines preventable diseases. The administration of immunization in Nigeria is the responsibility of the three tiers of government; the actual delivery of immunization is the responsibility of the Local Government (community). Studies indicate that Local Governments (Community) service provisions in Nigeria have been ineffective in spite of reform measures and increasing funding from the federation account. The purpose of this study is to find out the extent to which Local Governments in Nasarawa state have been able to deliver immunization service to local communities and identify possible factors that contribute to low coverage in the state. To achieve this objective the study hypothesized that, Government efforts at immunization has produced positive outcome; the availability and competence of personnel affect the success of immunization program; the higher the level of funding and other support, the more likely the success of the immunization service delivery. Success of immunization delivery is a function of sociocultural factors; success of immunization delivery depends on effective management. Six Community were selected from the three senatorial districts in the state. Both primary and secondary sources of data were utilized. In the case of primary data, interviews and focus group discussion (FGD) were conducted with women and health personnels to elicit their views on immunization services delivery, while questionnaires were administered to staff respondents on the outcome of immunization. Existing literature related to immunization especially journals, CBN statistical bulletin, conference proceedings and PhD theses as well as unpublished documents were reviewed. Data gathered were subjected to correlation test using SPSS software. The results indicated a high level of peoples’ cooperation on the immunization exercise due to the increase of government and international organization’ commitment on the eradication of six killer diseases in the state. The results further indicated strong and positive correlation between Government efforts at immunization and positive outcome, funding, availability and competence of personnel, effective management, socio-cultural factor and the success of immunization service delivery. The study suggested the need to increase the number of health personnel at the community level and the level of funding of immunization so as to complement development partners’ efforts.

• Background to the Study
Local Governments are essentially created to deliver services at the grassroots level so as to ensure developments across all levels of society and these services cut across all parts of the country by bringing governed closer to the government. This division of governmental power simplifies governmental activities and serves as a viable incentive for good governance and development. It also serves as an effective avenue for delivering basic goods and services to local communities in faster, easier and efficient manner (Pradeep, 2011:4; Nwosu, 2011:118).

Local Government (community), as an institution for grassroots participation, services delivery as well as agent of development in Nigeria, has over the years passed through series of changes since the introduction of the Native Authority system by the British Colonial Administration. During the colonial era, Community in Nigeria were basically used as instruments for maintaining laws and order through the system known as „Native Authority‟ (NA) (FGN, 1998:1). In 1921, the system became more significant all over the country and was sustained until 1950‟s when it began to take part actively in legislative functions (Hassan, 2002:1; Eboh, 2010). Throughout that period, preservation of colonial law and order was the main focus of colonial government rather than welfare service delivery.

In the Northern Nigeria, the N.A. system recorded full success partly due to the presence of highly centralized traditional authority. While in the then western region, the system recorded partial success partly due to the presence of a number of educated elites and the semi-centralized nature of the traditional institution available. The 1952, Local Government Law in the Western

Nigeria adopted English multy-tier system which encouraged the participation of educated elites in the Local Government Administration (Hassan, 2002:1). However, due to absence of centralized authority in the then Eastern region of Nigeria and in spite of the introduction of the Warrant chiefs, the indirect rule system was unsuccessful which led to its abolishment in 1928.

With the attainment of Nigeria‟s independence from the colonial government in 1960; the focus of the Local Governments gradually shifted from being an instrument of perpetuating colonial dominance and exploitation of the Native people through the preservation of colonial law and order to service delivery (Igbuzor, 2007:4). This shift was necessary because the country inherited serious developmental challenges. One of such challenges was the need to expand service delivery to people. To this extent, the governments in the then three regions through the NA system embarked on social welfare delivery services including health, roads, education, and agricultural development and etc.

Nevertheless, as a result of the unsatisfactory and poor performance of local governments particularly on services delivery in the pre-1976 era, the federal government of Nigeria made effort at reforming the system so as to recognize and to place them in order to occupy its rightful position (FGN: 1976 community Reform). The reform recognized third tier status for Community in the country also included the reform measures in the 1979 constitution. In spite of the reform, the community performance in terms of service delivery is still unsatisfactory (Ohiani, 2004, Malhoho, 2012). Hence, many Local Governments in the country failed to justify their existence and many people were confronted with difficulties in accessing social services such as healthcare and agricultural services. To this end, many scholars acknowledged reasons behind the poor performance of Local Governments in service delivery. These include insufficient funding, lack of Local Governments autonomy and mismanagement (Odoh, 1998:2; Ohiani, 2004:3). This situation led President Obasanjo in 2003 to inaugurate a committee to review the structure of the Local Governments in the country.

On the 25th of June 2003, Ciroma/Ndayako Technical Committee was inaugurated to review the structure of Local Government Councils in Nigeria. And the Committee reported that, “apart from corruption and mismanagement of public funds, Local Governments in Nigeria had not been guided by any coherent vision, principle or set of ideas in their policy formulation, implementation and even service delivery‟‟ (FGN, 2004 as cited in Abubakar, 2008:7-8). This situation has posed serious challenge to the country‟s quest for development and effective Local Government service delivery at the grassroots level.

Also, on Monday, March 3, 2006, the federal government announced the position of the National Assembly Committee report on the review of the 1999 constitution. However, the committees after collecting public views found that the majority of Nigerians were in favor of an independent system of Local Government System. In 2012, Community in the country had received greater attention when the National Assembly embarked an effort to pass a “community autonomy Act”, so as to ensure adequate services (including health) at the grassroots level (Okpo, 2012; Shedrack, 2012). In July 2013, the Senate of the Federal Republic of Nigeria resolved to maintain the status of Community in the country as part of the state government and with state Community joint account system as enshrined in the constitution.

The 1999 Constitution of the Federal Republic of Nigeria placed health care service delivery on the concurrent Legislative list. By this arrangement, each of the three tiers of Government is vested with the responsibilities of health care service delivery. The constitution further stipulated that the Federal, State and Local Governments shall support in a coordinated manner, a three-tier system of health care. They are as follows:

• Primary Health Care Local Governments

• Secondary Health Care State Governments

• Tertiary Health Care Federal Governments

The community through the Primary Health Care system is mandated to provide general health services of preventive, curative and rehabilitative nature to the population as the entry point of the health care system. This implies that the provision of primary health care at this level (including immunization) is largely the responsibility of Local Governments with the support of state Ministries of Health and within the pivot of National health policy.

Immunization is provided mostly through the public health system with the three tiers of government (federal, state and Local Government) playing specific and sometimes duplicating functions. Among the responsibilities of the federal government include the setting up of the national health policies, coordinating and implementing of national health programs, evaluating and monitoring immunization in the country through the National Program on Immunization. The central government is also responsible for procuring vaccines and distributing them to zonal cold stores. Similarly the state government is responsible for distributing vaccines to Local Government central storage facilities and managing state health and other budgets. Based on the arrangement, the state also employs key officials responsible for immunization service provision and coordinates immunization activities within the state. While the actual implementation of routine immunization activities is done by the Local Government primary health care facilities (Feilden Battersby Analysts, 2005).

Immunization services in Nigeria are usually delivered through two main strategies namely Routine Immunization (RI) and Supplemental Immunization Activities (SIAs). RI is the regular provision of immunization services to infants through the administration of vaccines (antigens) in a scheduled plan program. The services are usually provided at fixed post at the community hospitals, clinics or health centers. RI services are also delivered to the population through Outreach, and Mobile strategies. SIAs are mass campaigns targeting all children in a defined age group with the objective of reaching a high proportion of susceptible individuals (REW, 2007).

In Nigeria, the National Program on Immunization (formerly Expanded Program on Immunization) targets eight main childhood diseases: tuberculosis; polio; pertussis; diphtheria; tetanus; measles; hepatitis B; and yellow fever (Feilden Battersby Analysts, 2005).

• Research Problem
Given the importance of Local Government (community) as enshrined in the Nigerian constitution and designed to be part and parcel of the federation, sections two and three of the 1999 constitution of Federal Republic of Nigeria placed the community as the third tier of government in the country. While the Fourth Schedule of the 1979, 1991, and 1999 Federal Government Constitutions and section 7(5) listed and empowered the Councils to perform essential function of service delivery. To make them functions effectively, the percentage of the community revenue from the federation account continues to increase from 10% to in 1989 to 20% in 1992, and finally to 20.60% in 2008.

In the past, most of the usual excuses raised by the community councils in Nigeria were lack of autonomy and inadequate funding. Hence, with the 1976 and 2003 community reforms and the eventual increase in Community share from the federation statutory allocation and the increase in Community‟ revenue under the present democratic dispensation, the expectation of many people was that such excuses supposed to have been resolved. Yet health and other services were often inadequate. National Health indicators in Nigeria are among the lowest in the world by almost all measurable indices (WHO, 2012; Jamo, 2013). Life expectancy in Nigeria as at the year 2012 was 48 years compared to 73 years in China and 83 years in Japan. Infant mortality rate was 114 per 1000, whereas less than five mortality rates were 269 per 1000 (WHO, 2012). In Nigeria, vaccine- preventable diseases account for approximately 22% of childhood deaths (amounting to over 200,000 deaths) per year. The maternal mortality rate was 1,100 deaths per 100,000 in contrast to 45 and 6 deaths per 100,000 in China and Japan respectively (WHO, 2012). One third of the world maternal death occurs in India and Nigeria with 20% and 14% respectively (WHO, 2012). In Nigeria, 52,000 women die every year and 150 pregnancy related cases with an average of death in every 10 minutes are recorded daily (UNICEP, 2012). This indicates poor performance of Community and other tiers of government in immunization and disease prevention in the country leading to 72% of deaths due to communicable diseases. Though Nigeria is a signatory to all global immunization targets of reaching 80% DPT3 coverage in 80% districts in developing countries by the year 2005 and with MDG4 target of reducing child mortality by two-thirds by the year 2024 (NPI, 2007). Meeting this target is still questionable in spite of the series of past efforts.

Funding of immunization services is the collective responsibility of all the three tiers of government, private sector and development partners. In 2003 Nigeria expended $12,906,678,018 to immunization and with total health expenditure from all sources to $73,764,508. The projected cost of vaccines per communityA in 2012 was $194,697. From 2010 to 2013 alone, Nigeria has received a sum of $230,168,552 from the development partners (CHEDECO, 2013; PHC Reform, 2013; Uzochukwu, 2014). However this increasing funding did not correspond with the mortality rate and other health indicators in the country.

Everyone expected that the return of Nigeria to democratic rule would improve development through adequate healthcare services provision, yet studies have shown the contrary, Mortality rate as a result of VPDs is on the increase (WHO, 2012). The problem of the study is to examine the extent to which Local Governments in Nasarawa state have been able to deliver immunization. To achieve this, this study attempts to answer the following questions:

• Research Questions
• What are the contributions of Community‟ funding and other support to the success of immunization program?

• What are the effects of availability and competence of Community‟ health personnel to success of immunization program?

• What are the effects of Community‟ efforts on the outcome of immunization?

• What are the contributions of effective management at the community level to the success of immunization?

• What are the effects of socio-cultural factor to the success of community immunization delivery?

• Objectives of the Study
The main objective of the study is to review the community based immunization in Nasarawa state. Other specific objectives include the following:

• to evaluate the contributions of community funding and other support to the success of immunization program.

• to ascertain the contributions of the availability and competence of community health personnel to the success of immunization.

• to examine the effects of community efforts on the outcome of immunization program.

• Determine the contribution of community effective management to the success of immunization delivery

• to assess the effect of socio-cultural factor to the success of immunization delivery at the community level.

• Hypotheses of the Study
• The higher the level of funding and other support at the community, the more likely the success of the immunization program

• community efforts at immunization has produced positive outcome.

• The availability and competence of personnel at the community level affect the success of immunization program.

• community efforts at immunization has produced positive outcome.

• Success of immunization delivery depends on effective management at the community level.

• Success of immunization delivery at the community level is a function of sociocultural factors.

• Significance of study
• The study assists government to protect children from killer diseases (particularly VPDs) and also saves million lives and provides economic benefits of averting economic loss of billions of Naira and also lifts millions of Nigerians out of the vicious circle of poverty and illnesses. It serves as a policy guide to governments and international agencies with a method for mitigating poverty, poor health status in the country through effective immunization delivery.

• It guides government on cost effective strategy and health intervention to curtail mortality rate as a result of VPDs.

• It assists government, development agencies (including WHO, UNDP, UNICEF) to determine areas that require urgent attention for adequate healthcare delivery at the grassroots level.

• The work also serves as a model for assessing the impact of immunization on development of a particular area, using health service rather than HDI,GDP, or per capital income (as used by Przeworski, 1990 ; Przeworski and Lamungi, 2007; Pel, 1990; and Ohiani, 2004) which are very abstract at the grassroots level.

• The study is also empirical using survey method including questionnaires and interviews to ascertain the extent to which Community in Nasarawa state delivers immunization services at the grassroots level. The study has filled this gap by providing empirical data in the body of existing literatures.

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