Reaching Zero-Dose Children in Bauchi State, Nigeria

Background

This project, implemented from April 19, 2024 to April 26, 2024, was led by Alawiyatu Usman Ibrahim, a fellow of the second cohort of Sabin and WHO’s COVID-19 Recovery for Routine Immunization Fellowship Programs. As one of these fellows, Alawiyatu Usman Ibrahim led a short-term catalytic project focused on identifying and reaching zero-dose children in Bauchi State. Despite ongoing national and state immunization programs, many children — especially in hard-to-reach and underserved communities — remain unvaccinated due to limited tracking systems, gender barriers, and weak community engagement.

This project aimed to strengthen tracking systems, enhance the delivery of gender-responsive, child-friendly immunization services, and promote evidence-based governance through active community involvement and data use. In Bauchi State, disparities in immunization coverage remain stark, particularly in border communities and informal settlements. Traditional data systems often overlook children born outside health facilities or those whose caregivers have limited literacy or access to formal health structures. To overcome these challenges, this project embraced a grassroots approach, emphasizing local knowledge, simple tools, and culturally sensitive strategies to strengthen outreach and accountability.

Objectives

1. Strengthen immunization tracking through updated Maianguwa line listing and facility reconciliation registers
2. Improve the quality and accessibility of gender-responsive, child-friendly immunization services
3. Promote evidence-based decision-making across PHCDA, LGAHA, and facility levels

Implementation Strategy

• Baseline Assessment: Deep dive enumeration of children under one year in selected settlements to identify zero-dose children and defaulters
• Community Engagement: Sensitization sessions held with traditional leaders, religious groups, WDCs, women and youth groups
• Tracking Tools: Updated Maianguwa line listing and CE facility reconciliation registers used monthly to guide outreach and fixed sessions
• Empowerment Groups: Women’s caregiver groups were formed to discuss immunization dates, gender barriers, and savings initiatives
• Capacity Building: Routine immunization providers trained on gender-responsive child-friendly services
• Data Validation: Monthly validation meetings held to reconcile records and plan outreach

Challenges and Adaptions

• Expanded Scope: Originally not planned, a deep dive assessment was added after TWG consultation, requiring budget revision
• Limited Enumerator Capacity: Data gaps were encountered; project staff had to support on-site training
• Hard-to-Reach Terrain: Difficult terrain in Mun-munsal required creative transport solutions, including special motorbike crossings
• Personnel and Travel Budget Adjustments: Realignment of funds to accommodate in-kind government staff participation and high transport costs

Outcomes and Impact

“Caregivers used to wait for vaccine teams. Now they remind each other and bring their children early.” 

Table 1: Planned Activities and Timeline

A list of output indicators include:

• Number of community dashboards established and made functional
• Number of community discussion platforms established and made functional
• Number of women empowerment groups established and meetings conducted
• Number of missed communities identified
• Number of outreach services conducted targeting missed communities
• Number of health care providers trained on gender-responsive and child-friendly immunization services
• Number of gender barriers identified and their mitigation plan
• Number of community data validation meetings conducted
• Number of newborns register in the birth register
• Number of IMSS visits conducted

Outcome indicator 1: Availability of functional tracking system

Goal was to establish a community dashboard.

79 community dashboard/platforms were activated and made functional. Community Engagement MaiAnguwa line listing/community engagement facility reconciliation registers based on the 13 health facilities we have in the two wards, 23 registers in Melandige Ward while Mun-munsal has 56 registers
13 women (caregivers) economic empowerment group was established, 2 in Melandige Ward and 11 in Mun-munsal Ward. Bi-monthly meeting conducted in April.

Outcome indicator 2: Increased uptake of immunization services by missed communities

Output indicators

• 88 settlements were identified as missed communities
• 78 outreaches and 4 targeted outreaches were conducted
• 15 Routine Immunization service providers
• Myths and Misconception about vaccines and AEFI, community mobilization/sensitization conducted, and supported with Junior Paracetamol

Outcome indicator 3: Increased use of evidenced-based data for decision-making

Output indicators

• 2 Ward monthly validation meetings conducted (March and April)
• 2 IMSS visits conducted (by RIO1 and RI WFP, March and April)
• 300 newborns register in the birth register in Mun-munsal ward

The project reached 117 zero-dose and 181 defaulter with vaccination through tracking system (mai Anguwa line listing and facility reconciliation registers.

“Having women-led savings groups turned routine visits into social and educational gatherings.” 

Lessons Learned

• Field visits before proposal finalization improve design
• Terrain and lack of border harmonization increase risk of missed communities
• Involving local actors like village heads and caregivers boosts ownership and security
• Cash allowances are more accepted than delayed bank transfers in rural areas

Recommendations

• Scale up to other high zero-dose LGAs in Bauchi State
• Fully integrate gender barrier identification into routine immunization planning
• Strengthen linkages between HMIS and birth registration systems
• Continue using women’s groups for mobilization, reminders, and peer support

Conclusion and Future Directions

The project successfully demonstrated that community-driven systems can identify and reach zero-dose children efficiently, even in locations that are difficult to reach. With low-cost tracking tools, integrated planning, and gender-sensitive strategies, the project exceeded expectations. Plans are underway to share results with SPHCDA stakeholders and advocate for expansion to additional wards and LGAs across Bauchi State.