Challenges in Kano and Gombe's Immunisation Efforts

Under the hot April sun, the heat was intense in Fagge Local Government Area of Kano State. But 56-year-old Uma Usman kept moving from one compound to another, calling out names she knows well, gently knocking on half-open doors, and asking about children she has known for years.

She does not work for the local Galadima Primary Health Centre. Her name is not on any government salary list. Still, she has become one of the most crucial parts of the community’s immunisation efforts.

Her job is to find children who missed their routine immunisation appointments.

"I know the community very well, so I follow them house by house," Mrs Usman told PREMIUM TIMES. "If the parents don’t come, we check the register and trace the households."

For Mrs Usman, there is always a story behind every missed appointment.

Sometimes a child is sick. Sometimes a mother cannot afford transport. Other times, parents are busy with work or family duties.

"When you reach a house, you find it is not that they don’t want to come," she said. "Something just stood in the way."

Mrs Usman’s daily routine shows a bigger picture found in a PREMIUM TIMES investigation in Kano and Gombe states.

Many believe vaccine shortages are the main problem for routine immunisation, but frontline workers in these states pointed out a different issue. Vaccines are often available. The real challenge is getting children to complete their immunisation schedule.

For many families who spoke with PREMIUM TIMES, the issue is not acceptance but access. Long distances to health facilities, transport costs, delayed outreach, and the daily struggle to earn a living often disrupt follow-up visits. Because of this, many children get their first vaccine but do not finish the doses needed for full protection.

This situation has serious effects beyond individual families.

This investigation looked into routine immunisation efforts and challenges in Kano and Gombe from 2023 to 2026. It used field visits, interviews, official records, and data from health authorities and partners.

The period highlights the ongoing fight to reach children who have never received a vaccine, as well as those who start their vaccination but do not finish it.

According to UNICEF, Nigeria has one of the largest populations of zero-dose children, who have never received a routine vaccine. Their latest data shows that only about 67 percent of surviving infants get the third dose of the diphtheria, tetanus, and pertussis (DTP3) vaccine, while around 35 percent receive the second dose of the measles vaccine.

While routine immunisation coverage has improved in recent years, many children still receive no vaccines or fail to complete their schedules.

Behind those national statistics are thousands of personal stories like the ones Mrs Usman encounters every week.

But the investigation revealed another, less visible truth.

In many communities in Kano and Gombe, routine immunisation continues largely because health workers, volunteers, and community mobilisers fill in gaps caused by delayed funding, tough terrain, and stretched primary healthcare services.

Many spend their own money to reach far-off areas. Volunteers without formal jobs trace children from house to house. Outreach continues even when funds arrive late.

Different communities, same struggle

The pattern seen in Fagge is not unique.

In Takai LGA of Kano State, reaching children who miss vaccination appointments often requires long travels across scattered settlements. Health workers say regular clinic sessions are not enough; repeated outreach visits are crucial to find children who do not return.

"There is never a time when people come and we do not have vaccines," said Muhammad Ali, the officer-in-charge at Gamawa Health Post.

Records reviewed by PREMIUM TIMES and interviews with frontline workers showed that children scheduled for follow-up are not always reached as planned.

Health workers explained that outreach teams often face transport issues, limited time, and tough terrain, making it hard to visit every household listed for follow-up during one outreach.

"We don’t refuse to go," one health worker said. "But sometimes the list is longer than what we can physically cover in one outreach."

Many children miss vaccine doses because follow-up visits could not be completed.

In Billiri LGA of Gombe State, the situation is the same.

Health workers and volunteer mobilisers spend nearly as much time looking for children who missed appointments as they do administering vaccines.

Across these areas, the same pattern shows: children often begin immunisation but do not finish due to family challenges.

A system sustained by people

For Ignatius Essien, general manager of eHealth Systems Africa, the challenges families face in getting to health facilities explain the start of the Zero Dose Support Programme.

Mr Essien said the programme provides transport support to caregivers bringing their children for immunisation. This applies to children coming for either their first or subsequent doses.

"The funds are not tied to routine immunisation outcomes," he said.

He explained that the idea came from what health workers often see: families wanting to vaccinate their children but living too far from health facilities or unable to afford the fare.

"Some say they cannot even afford transport fare to the clinic," he said. "That is what stimulated the stipend."

The support began at N500 but has increased from N1,000 to N2,500 depending on the vaccine type as transport fares and living costs rose.

At Sansani PHC in Billiri LGA, routine immunisation sessions usually attract between 30 and 45 caregivers.

But behind those clinic days is another routine that often goes unreported, tracing children who do not return.

The facility’s Head of Immunisation, Elias Ezekiel, said health workers use immunisation registers to find children who miss appointments from the catchment seven communities.

"From the register, if anyone misses, we follow up," Mr Ezekiel told PREMIUM TIMES.

This work relies on outreach funding.

The health centre gets about N35,000 monthly for outreach, but the money is released quarterly by the State Primary Health Care Development Agency.

When PREMIUM TIMES visited, over three months had passed without any release.

Mr Ezekiel said the delays are regularly reported to local government health authorities.

"If we stop outreach, the children will miss their vaccines," he said.

So, staff members pay for fuel and transport from their own pockets while waiting for funds.

His story is similar to those of many frontline workers interviewed in Kano and Gombe.

Vaccines are usually available, they said, but getting them to children in remote areas often relies on health workers covering costs when operational funding is late.

This challenge is harder for facilities serving scattered settlements.

A quiet crisis in the North

The issues facing health workers in Kano and Gombe reflect a larger crisis across northern Nigeria, where hundreds of thousands of children are still not reached by routine immunisation.

In April 2025, UNICEF estimated that around 53,000 children in Gombe State had never received a routine vaccine. More than half of them lived in five high-risk LGAs, including Akko, where health authorities faced poor access to healthcare, low awareness, and vaccine hesitancy.

To tackle the issue, the Gombe State Primary Health Care Development Agency, with help from UNICEF, started the Fathers’ Response Team in 2024 to promote greater male involvement in child health and immunisation decisions.

Even so, many children still miss life-saving vaccines.

The issue is even bigger in Kano.

UNICEF estimates that over 300,000 children are zero-dose, making up half of the burden across Kano, Katsina, and Jigawa states.

UNICEF’s Chief Field Officer in Kano, Rahama Farah, said more than 600,000 children in the three states have yet to receive their first routine vaccine dose.

Many of these children live in far-off or underserved communities where access to healthcare is still a problem.

"This is a basic fundamental child right," Ms Farah noted.

She warned that missed vaccinations make children more vulnerable to outbreaks of preventable diseases and urged caregivers to complete immunisation schedules.

Why Kano and Gombe tell different stories

Though Kano and Gombe face similar immunisation challenges, the reasons behind them differ.

In Kano, the biggest issue is scale. With a population of over 17 million and more than 600,000 births each year, health facilities are always under pressure.

The 2021 Multiple Indicator Cluster Survey (MICS) found that about 30.2 percent of children in Kano are zero-dose, while only about 48 percent complete the full immunisation schedule by their first birthday. National estimates show dropout rates of up to 31 percent between the first and third doses of routine vaccines.

In Gombe, where the population is less than a third of Kano’s, geography plays a bigger role. Communities are more spread out, distances are longer, and getting to health facilities often takes a lot of time and effort.

Estimates show Gombe’s zero-dose rate is between 18 and 22 percent, with only about 36 percent completing full immunisation in some reports.

Where the system weakens

The investigation found that the biggest weak point in routine immunisation is not getting children into the system.

It is keeping them in it.

Across health facilities in Kano and Gombe visited by PREMIUM TIMES, workers often described a system that does okay at giving first doses but struggles to keep children on track for full vaccination.

Nationally, dropout rates early and later in the vaccine doses range from about 12 to 30 percent, depending on where you are.

At the Galadima PHC in Kano, Hauwa Isa, the assistant head of the facility, pointed to a solar-powered vaccine fridge filled with vaccines.

"We have complete vaccines in the fridge," she said. "We conduct immunisation three times a week and spend other days on outreach."

"The real issue is not availability. It is continuity."

That continuity relies on a governance system where responsibility is shared, but accountability often gets unclear.

Primary health centres fall under local governments, while state Primary Health Care Development Agencies oversee much of their staffing and operations. The federal government sets national policy and supports key immunisation programs with development agencies.

Health workers told PREMIUM TIMES that when outreach funding is late or operational gaps arise, it is hard to know where the responsibility lies.

Money, priorities and the field reality

In the past five years, both Kano and Gombe have seen significant increases in their budgets.

Official budget documents reveal that Kano State’s budget rose from N221.24 billion in 2022 to N1.47 trillion in 2026, while Gombe’s increased from about N154.96 billion to N617.95 billion during the same time.

These numbers suggest that governments have more money to provide public services, including primary healthcare.

But interviews with frontline workers in both states tell a more complex story.

For them, the budget size does not matter when operational funds do not arrive when needed.

Outreach funding shows that gap.

It is the money that helps get vaccines to children in remote areas. Health workers say when those funds are delayed, outreach activities depend on staff members improvising.

In Fagge and Takai LGAs of Kano State, workers said each PHC gets about N7,000 a month for outreach transport.

Many months' allocations are often paid together at the end of a quarter, long after most outreach visits.

In Gombe State, PHCs receive N35,000 a month for outreach transport, but that money is also paid quarterly.

The situation is even tougher at health posts.

Unlike PHCs, they get no dedicated transport allocation, according to workers interviewed by PREMIUM TIMES. Yet they are responsible for tracing children who miss appointments and bringing vaccination services to far-off areas.

When priorities compete

Funding issues go beyond the health sector.

Budget documents reviewed by PREMIUM TIMES show that both Kano and Gombe have made large allocations to debt servicing in recent years.

In the 2026 fiscal year, Kano budgeted about N69.84 billion for debt repayment, while Gombe set aside roughly N37.23 billion.

These obligations are fulfilled before many operational funds are released to sectors like PHCs, limiting the money available for routine service delivery.

Health workers say they see these pressures in delayed outreach, postponed field visits, and reduced operational flexibility.

Government spending priorities are also clear elsewhere.

In Kano, the state approved the purchase of 41 SUVs for members of the House of Assembly in 2024 at a cost of about N2.6 billion, along with other vehicle purchases for the executive and security agencies.

In Gombe, similar purchases included 41 SUVs for lawmakers and commissioners in 2023, while over N2 billion was set aside for vehicles for the judiciary in 2025.

Government officials have defended such expenses as necessary for governance and movement across tough terrains.

For health workers travelling across the same terrains, though, the difference is hard to ignore. Many outreach teams continue to rely on motorcycles, commercial transport, or long walks to reach remote communities.

Where the system holds

Despite its weaknesses, the routine immunisation system in northern Nigeria keeps going because thousands of health workers, volunteers, and community mobilisers return to the same communities, often with limited resources, determined to find children who have missed their vaccines.

But keeping this effort going needs more than just commitment, according to public health expert Abdulhameed Adediran. He warned that children who miss their next vaccine doses remain at risk of preventable diseases.

"A child is supposed to have three doses but has only the first dose. That child is not 33 percent protected. That child is not protected because the first dose is supposed to last for a certain period before the next one is given to have a complete effect," he told PREMIUM TIMES over the phone.

Mr Adediran said poor funding for PHC weakens the whole immunisation system. He noted that when outreach activities are poorly funded, children in distant communities are more likely to miss vaccinations, leaving dangerous gaps in disease prevention.

He connected many problems to weaknesses in the system, including inadequate funding, shortages of health workers, weak accountability, and poor infrastructure. In many places, he noted, community health extension workers have to take on responsibilities beyond their intended roles because of years of limited recruitment.

Mr Adediran said immunisation programmes must be designed around the needs of the communities they serve, not through one-size-fits-all solutions.

"People sit in Abuja and make decisions for people in those villages, and those decisions don’t always work for them or might not even apply to them," he explained, adding, "We need to start looking at a tailored, people-focused approach to our health institutions."

Government responds

In response to the findings, the Gombe State Primary Health Care Development Agency admitted that delays in releasing outreach funds sometimes happen. They linked these to administrative processes, financial checks, and the timing of support from partners.

The State Immunisation Officer, Abdulkarim Aliyu, said routine immunisation outreach is funded through a mix of government and donor resources, with disbursements going through several approval and accountability steps before reaching health facilities.

While acknowledging the impact of delayed releases, Mr Aliyu praised frontline workers who keep providing outreach services despite funding issues.

"We also recognise and appreciate the dedication of frontline health workers who often go the extra mile to ensure that vaccination services continue even when resources are delayed," he said.

He said the agency has improved defaulter-tracking systems, expanded community engagement through Ward Development Committees, Community Health Influencers, Promoters and Services (CHIPS) agents, and the Mama-to-Mama initiative. They also hold regular review meetings to find communities with high dropout rates and put in targeted interventions.

Mr Aliyu added that the agency is working on staff training, supportive supervision, and strategic staff deployment to tackle shortages while using routine data checks and quality assessments to monitor immunisation records and find children who miss scheduled vaccinations.

Looking ahead, he said the agency will focus on boosting outreach services, improving community engagement, and finding and vaccinating zero-dose and under-immunised children.

In Kano, the Director-General of the State Primary Health Care Management Board, Salisu Ibrahim, said outreach stipends are paid through a performance-tracking system backed by Acasus, a partner that monitors outreach sessions held by service providers.

Mr Ibrahim explained that payment delays sometimes happen because delivery records must first be checked before payments are processed.

He said the state has taken several steps to reduce vaccine dropout rates, including ensuring that immunisation sessions are held, expanding public awareness campaigns, and addressing practices that cause missed vaccination opportunities.

While acknowledging financial pressures, he said the current administration of Governor Abba Yusuf raised outreach stipends from N1,000 to N4,000 per session to help health workers deal with rising transport and operational costs.

He added that the board also conducts monthly data checks, review meetings, and independent surveys to find service gaps and strengthen routine immunisation in underserved areas.

Whether these efforts will be enough to reduce the number of children missing vaccines is still unclear.

What is clear, though, is that in communities in Kano and Gombe, routine immunisation still depends heavily on the commitment of health workers, volunteers, and caregivers who keep showing up despite funding delays, staff shortages, and the challenges of reaching remote areas.

For many children, completing vaccination relies on that fragile chain.