Joseph Vegher Akpera,
Department of General Studies Education, College of Education, Katsina-Ala, Benue State
This study investigated the determinants of the success of immunization programme in Katsina-ala and Kwande Local Government Areas of Benue state Nigeria. Three hypotheses were formulated to guide the study. The descriptive survey design was adopted. An instrument named Determinants of National Immunization Inventory (DNII) was administered on the respondents. The population of 1266 Health Workers was drawn from the two Local Government Areas. A purposive sampling technique was used to select a sample size of 379 respondents. In data analysis, the split-half method was used and chi-square (x2) at probability level of 0.05. it was found that both funding and attitudes of government officials played a significant roles in determining the success of immunization programme while education of mothers was not a significant determinant of the success of immunization programme in the study area. The researcher therefore suggested that, proper planning, adequate budgetary provision and supervision should be intensified in the health sector; and that mothers should also be encouraged by the Local Government Health Department to present their children for immunization, as at when due, to ensure the success of the programme.
One of the important factors for achieving health for all, is the ability of the individual and organization to recognize and respond to changes in advancing technology for health, maintenance and promotion, new pattern of disease and disability, new social policies, expectations and programmes for better health services. According to Basavan (2006), emphasis should be placed on preventive medicine principles of which one of the most cost effective health interventions is immunization which is considered the key to attain the goal of “Health for all” (HFA) which was to be achieved in 2015.
Awosika (2004), is of the view that, immunization remains the most effective tool to reducing child morbidity and mortality, occurring from vaccine preventable diseases, e.g. poliomyelitis, diphtheria, pertusis, tetanus, tuberculosis, measles, hepatitis B and yellow fever. These diseases mentioned above became a great source of concern to all stakeholders i.e. World Health Organization (WHO), and United Nations International Children Emergency Fund-UNICEF. As a matter of imperative, a possible solution to this tragedy was formulated in 1977 when the world health assembly adopted a resolution which stipulated that the main social target of government and UNICEF in collaboration with WHO should be the attainment by all, the world over, by the year 2000, a level of health that will permit them to live a socially and economically productive life.
In the views of Taylor, Green and Scout (2002), for vaccination to be effective and successful as a strategy, it must be administered to a great number of people as possible and must continue to be used until the disease is eradicated. In Nigeria, successive administrations accorded the health sector priority attention in varying proportions, with the sole aim of bringing qualitative and affordable health care to her citizens. This objective gave way to the expanded programme of immunization (EPI) which was designed to vaccinate and protect children aged between 0-2 years, against the six killer diseases namely: measles, tetanus, poliomyelitis, whooping cough, tuberculosis and diphtheria. This programme as earlier stressed by Nongo (1987), was launched in Nigeria, under the Primary health care approach which was a follow up to the resolution of the Alma-Ata conference of 1978 by member states of the World Health Organization (WHO). Its goal was universal childhood immunization (UCI) which was aimed at securing health for all by the year 2015, including nursing mothers. He further states that, EPI was launched on 29th November, 1984 and extended to all health institutions in the state, covering all the local government areas which in 1997 was renamed National Programme on Immunization (NPI), which has been incorporated in all health programmes and policy thrust. At the moment, the progress achieved in global immunization is attributable to the efforts of National Governments, WHO, UNICEF, United Nations-UN, United States Agency for International Development –USAID and United Nations Development Programme (UNDP) including bilateral agencies and Non-governmental organizations (NGOs).
The establishment and effective functioning of inter-agency coordination which is targeted at improving the coordination of donors in support of regional and national immunization programmes are useful in the planning and integrating activities aimed at sustaining the programme (Kaddar, Levin, Dorgherty and Maciera, 2000). In many advanced countries these interagency committees review programme performances at country level through periodic meetings and make adjustments to plans and their funding arrangements. This strategy promotes effective use of available resources by providing individual donors with the accountability and visibility needed for continuing support.
According to Battersby and Gruner (2003), priority activities to raise immunization coverage are: improving the management of health services, making health care services more accessible, informing and motivating the public, immunizing at every opportunity, reducing drop-out rates, using specific immunization activities. However, to correlate it all Euronet (2005), stresses the need for increased focus on disease surveillance as an “information for action” which helps direct immunization activities to areas of greatest need and is a prerequisite to achieving the specific disease control targets.
The role of parents especially mothers, to the success of NPI has been stressed by FGN/UNICEF (1984), that every Nigerian parent needs to understand the value of immunization and importance of vaccinating children before they fall ill of any disease preventable with immunization, and that every mother needs to understand why she must take her child to the clinic, not just once, but repeatedly to complete all the required doses, because it is only then that the child is fully protected. They advocate for the need to convince, educate and motivate mothers, to take advantage of the programme. Several researches conducted in Nigeria such as those of Babalola and Adewuyi (2005), Battersby and Gruber (2003) and Oluwadare (2009) show a strong positive correlation between mother’s socio-economic status, education and the willingness and ability to fully cover immunization schedule for a particular disease as most of them solely depend on oral polio immunization.
In the views of Babalola and Adewuyi (2005), the legal mandate of NPI as stated in Decree 12 of 1997 is to support states and local governments in their immunization programmes by supplying them with vaccines, needles, syringes, cold chain equipment and other logistics as may be required for the programme. With all the efforts of donor agencies in providing funds for the programme, Creese and Henderson (2001) are of the opinion that substantial increase in funds is required to provide immunization services, in spite of the systematic under-estimation of the benefits of immunization and that there in general evidence of positive and often very high returns for such investment. Obioha, Ajala and Matobo (2006) observe that budgetary allocation to the health ministry has been low over the years in Nigeria which is an indication of lack of political will and the negative perception of some people, who harbor the belief that immunization is a deliberate strategy for population control. This perception makes this study imperative.
The study specifically sought to find out if:
- Funding determined successful implementation of NPI in Katsina-Ala and Kwande LGAs of Benue state
- Mothers’ literacy level determined the success of NPI in Katsina-Ala and Kwande LGAs of Benue state
- Government officials’ attitudes determined the success of NPI in Katsina-Ala and Kwande LGAs of Benue State.
- Funding significantly determines the success of NPI in Katsina-Ala and Kwande LGAs of Benue State
- Mothers’ literacy level significantly determines the success of NPI in Katsina-Ala and Kwande LGAs of Benue State.
- Government officials’ attitudes significantly determines the success of NPI in Katsina-ala and Kwande LGAs of Benue State.
The study adopted the descriptive research design. The design was deemed fit for the study because relevant information to appraise the National Immunization Programme were sought and this design studies the entire population characteristics without manipulation or control by describing and interpreting existing practices, attitudes and policies which constitute the main thrust of this work. This is also suitable for large samples for which generalizations can be drawn.
The study was carried out in Katsina-Ala and Kwande Local Government Areas of Benue state, Nigeria using a population of 1266 health workers drawn from government and private health institutions in two local government areas (Katsina-Ala and Kwande). The two local government areas were chosen based on convenience as a result of availability of required secondary data and location. A sample size of 379 respondents was purposively selected based on convenience and interest. This was based on the fact that only health workers who engage in social mobilization exercise have in-depth knowledge about National Immunization Programme and can adequately appraise it.
The instrument used for data collection was the researcher’s self-structured questionnaire titled; Determinants of National Immunization Inventory (DNII) which is a modified four point Likert scale type based on the continuum of Strongly Agree to Strongly Disagree. The questionnaire was validated for both face and content validity by two experts in Health Education and one in Measurement and Evaluation at the Benue State University, Makurdi. The instrument was trial-tested and the split-half technique was employed to determine the reliability which gave a coefficient of 0.83, which is high enough for the instrument to be used for data collection (Emaikwu, 2014). The data collected were analyzed using descriptive statistics and Chi-square.
Funding will not significantly determine the success of NPI in Katsina-Ala and Kwande LGAs of Benue stat
Table 1: Chi-square Test of Funding and Success of Immunization Programme
ᵪ2 =53.06, df=3, p=0.05
Table 1 above shows the calculated chi-square value(ᵪ2cal) = 53.06 while the tabulated value(ᵪ2tab) at 0.05 alpha level is 7.53, since the calculated ᵪ2value was greater than the table value of ᵪ2, the null hypothesis which states that funding will not significantly determine the success of NPI in Katsina-Ala and Kwande LGAs of Benue state is rejected.
Mothers’ literacy level will not significantly determine the success of NPI in Katsina-Ala and Kwande LGAs of Benue state.
Table 2: Chi-square Test of mother’s literacy level and Success of Immunization Programme
Table 2 above shows the calculated chi-square value(ᵪ2cal) = 0.23 while the tabulated value(ᵪ2tab) at 0.05 alpha level is 7.92, since the calculated ᵪ2value was greater than the table value of ᵪ2, the null hypothesis which states that mothers’ literacy level will not significantly determine the success of NPI in Katsina-Ala and Kwande LGAs of Benue state is retained.
Government officials’ attitudes will not significantly determine the success of NPI in Katsina-Ala and Kwande LGAs of Benue state.
Table 3: Chi-square Test of attitude of government officials and Success of Immunization Programme
Table 3 above shows the calculated chi-square value(ᵪ2cal) = 37.43 while the tabulated value(ᵪ2tab) at 0.05 alpha level is 6.74, since the calculated ᵪ2value was greater than the table value of ᵪ2, the null hypothesis which states that Government officials’ attitudes will not significantly determine the success of NPI in Katsina-ala and Kwande LGAs of Benue state is rejected.
The study sought to determine whether funding was a determining factor to the success of the National Immunization Programme in Katsina-Ala/Kwande L.G.As of Benue state. The findings of the study revealed that the availability of funds could greatly enhance logistics support, transportation and timely release of allowances to better motivate field personnel for greater efficiency and results leading to success. This is affirmed by calculated value (ᵪ2cal=53.06), which is greater than the tabulated value (ᵪ2tab=7.53) at 0.05 alpha level.
The study also sought to determine if the literacy level of mothers could play a significant role to the success of the National Immunization programme in the study area. It was found that the calculated value of chi-square (ᵪ2cal =0.23) which is less than the tabulated value (ᵪ2tab=7.92) at 0.05 alpha level showed that mothers’ literacy level was not a significant factor to the success of NPI in Katsina-ala and Kwande LGAs of Benue state. However several researches carried out in the Northern Muslim-dominated area such as those of Babalola and Adewuyi (2005), Battersby and Gruber (2003), Oluwadera (2009) and Gage, Sommer and Piani (1997) showed a significant relationship between mothers’ literacy level and success of the immunization programme. This disagreement could be as a result of the fact that, in Katsina-Ala and Kwande LGAs, illiteracy level is low and greater awareness is always created by government officials, community and religious leaders on the need to embrace and participate in the programme accordingly.
The study further sought to establish if government officials’ attitudes determined the success of the national immunization programme in Katsina-Ala and Kwande LGAs of Benue state. The attitudes of government officials hamper the success of NPI in Kwande and Katsina-Ala Local Government Areas. This was affirmed by the calculated value of chi-square (ᵪ2cal=37.43) which is greater than the tabulated value (ᵪ2tab=6.74) at 0.05 alpha level.
Conclusion and Recommendations
The following conclusions based on the findings are presented:
That funding is an important factor towards the success of the national immunization programme in Katsina-Ala and Kwande LGAs. The inability of attaining a reasonable level of successful achievement in immunization programmes in the study area could be attributed to poor financing by the relevant stakeholders. This could be through a poor pay package for field workers who are employed on adhoc basis, late release of funds and lack of transparency on the side of social mobilization workers, at various levels of government.
Lack of health education, inadequate information on ante-natal and post-natal care were found not to significantly impact on the success of immunization programme in Katsina-Ala and Kwande LGAs. This is due largely to the fact that greater awareness and enlightment using various media both print and electronic, as well as sensitization by traditional rulers, religious leaders and in some cases, town criers in spreading the message.
The attitudes of government officials will also go a long way in enhancing the success of the immunization programme in the two local government areas. This is due largely to poor health policies, frequent changes in personnel coordinating the programme in the local government areas, as well as lack of political will and trust among the stakeholders involved in coordinating the programme in the Local Government Areas.
Based on the findings, the following recommendations were made: For proper planning, effective budgeting and control become imperative. All relevant stakeholders should ensure that enough funds are set aside for the immunization exercise. More so, government at all levels should ensure adequate budgetary provisions for the health sector and also ensure timely release of such funds.
Even though the education of mothers was found not to significantly impact on the success of the programme in the study area, awareness should be intensified among mothers by the Local Government Health Departments to see the need of immunizing their during immunization days.
Workshops, seminars and conferences should be conducted on a regular basis, for all categories of people involved in the programme, so as to develop positive attitudes, hard work, dutifulness and the political will needed for the success of the immunization programme.
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