LOCAL GOVERNMENT AND THE DELIVERY OF IMMUNIZATION SERVICE: A STUDY OF SELECTED LOCAL GOVERNMENTS IN KADUNA STATE, NIGERIA. BY Idris Jamo AHMED PhD/ADMIN/8091/2009-2010 A PhD DESERTATION PRESENTED TO THE DEPARTMENT OF PUBLIC ADMINISTRATION, FACULTY OF ADMINISTRATION, AHMADU BELLO UNIVERSITY ZARIA AS PART OF THE REQUUIREMENTS FOR THE AWARD OF PH.D IN PUBLIC ADMINISTRATION OCTOBER, 2015 i DECLARATION I declare that this work is the Ph.D. dissertation thesis entitled “Local Government and Service Delivery: A Study of Selected Local Government Councils in Kaduna State‟‟ has been performed by me in the Department of Public Administration under the Supervision of Dr. S.B. Abdulkarim, Dr. M. K. Isa and Prof. A. Anyebe. The information derived from the literature has been dully acknowledged in text and a list of References provided. No part of this work was previously presented for another Degree or Diploma at any University. __________________ ________________ Idris Jamo AHMED Signature Date ii CERTIFICATION This work entitled “Local Government and the Delivery of Immunization Service: A Study of Selected Local Governments in Kaduna State, Nigeria”. By Ahmed, Idris Jamo meets the regulations governing the requirements for the awards of the Doctor of Philosophy (Ph.D. Public Administration) of Ahmadu Bello University Zaria, and is approved for its contribution to knowledge and literary presentation. Dr. S. B. Abdulkarim Date ………………………… Chairman Supervisory Committee Dr. Mohammad Kabir Isa Date ……………………… Member Supervisory Committee Prof. A. Anyebe Date ………………………….. Member Supervisory Committee Dr. Hamza A. Yusuf Date ………………………….. Head, Department of Public Administration Prof. K. Bala Date ………………………….. Dean, School of Postgraduate Studies iii DEDICATION This study is dedicated to my late father Alhaji Ahmad Jamo and my mother, Hajiya Fatima Ahmad Jamo. May Allah (SWT) grant them Jannatul Firdaus, Amen. iv AKNOWLEDGEMENT All glory is due to Allah who through his help I accomplished this work successfully. I thank Him very much. During the course of this study, I benefited from many persons and organizations to which I owe a lot of gratitude. I am particularly indebted a lot of gratitude to my former Head of Department and chairman supervisory committee, Dr. S. B. Abdulkarim for his encouragement and scrutiny of my study. I am also grateful to members of supervisory committee Dr. M.K. Isa and Prof. Anyebe. I am also grateful to my internal examiners Prof. Shehu Dalhatu, Prof. Adejo Odoh and Dr. Hamza Yusuf for their constructive criticisms and adding value to the work. I thank you very much. I am also thankful to my external examiner Prof. Mukhtar Alti for his contributions to the success of this study. Thank you very much. I am grateful to Dr S.M Ngu, Dr. Bashir Jumare, Prof. Owen Sichone Compperbelt University Zimbabwe, Prof. Antonio Tomas of Makarere Institute of Social Research, Kampala, and Prof. Abdulkadir Adamu for their guidance and adding value to this work. I benefited from assistance of many people during my field survey. They include Awwal Waziri and Hassan Junaidu Kaduna state Ministry for Local Governments, Usman Garba Kaduna State Primary Health Care Division, Alh. Yusuf Abdulkarim Yakasai, Sabon Gari Local Government, Alh Yakubu Yakasai and Haj. Saadatu Legal officer Giwa Local Government. Bashir Tukur Kauru Local Government, Aliyu Dogara of Kajuru Local Government. Sulaiman Shehu Gidan Makaranta, Bello Mohammed Jamo, Daura Local Government, Sani Bawa Dutsin Ma Local Government, Lawal Babashani, Bashir Moh‟d and Ibrahim Mamman Danja Local Government. I also wish to acknowledge the roles played by DR Butawa Nuhu Director Planinig and statistics Kaduna state Ministry of Health and his staff Mr. Timothy Jonathan. v I also want to appreciate the support of members of my family particularly my wife Aisha Lawal Atiku, my kids and my brothers Barr. Mohammed Ahmed Jamo and Shehu Ahmed Jamo. Finally, this work is the product of many people whose names and assistance may not be included here, but their assistance had been noticed and appreciated. Thank you very much. Alhamdulillah. vi LIST OF ABBREVIATIONS ASD Alternative Services Delivery ASDM Alternative Service Delivery Model BCC Behavioural Change Communication BCG Tuberculosis BCG Bacillus Calmette Guerin (vaccine) CBN Central Bank of Nigeria CBO Community Based Organization CHEW Community Health Extension Worker CHO Community Health Officer DPT Diphtheria, Pertusis, Tetanus (vaccine) DSDM Decentralization Service Delivery Model DHIS District Health Information System DSDM Direct Service Delivery Model DTWP Pertussis/Whooping Cough EHO Environmental Health Officer FMOH Federal Ministry of Health GDP Gross Domestic Product HDI Human Development Index IMCI Integrated Management of Childhood Illness. IMNCH Integrated Maternal, Neonatal and Child Health JICA Japan Intervention Program LG Local Government vii LGA Local Government Authority (Area) LGSD Local Government Service Delivery MDG Millennium Development Goal NCD Non Communicable Disease NDHS National Demography and Health Survey NGO Non-Governmental Organization NICS National Immunization Council Survey NPC National Population Commission NPHCDA National Primary Health Care Development Agency NPI National Program on Immunization OPV Oral Polio Vaccine OPV Oral Polio Virus (vaccine) PATHS Partnership for Transforming Health Systems PHC Primary Health Care PPP Public Private Partnership PSDM Privatization Service Delivery Model RI Routine Immunization SD Service Delivery SMOH State Ministry of Health TB Tuberculosis TT Tetanus Toxoid UNDP United Nations Development Program UNICEF United Nations International Child Emergency Fund viii VDC Village Development Committee VHW Village (Voluntary) Health Worker WDC Ward Development Committee WHO World Health Organization AFRO African Regional Office WHS Ward Health System WMHCP Ward Minimum Health Care Package DHIS District Health Information System ix LIST OF APPENDICES Page LIST OF APPENDICES Page List of Appendices Page Appendix I Local Government cold chain inventory 185 Appendix II Kauru Local Government Cold Chai Inventory 186 Appendix III Sabon Gari LG Cold Chain Inventory 187 Appendix IV: Questionnaires for Health personnel 188 Appendix V Interview Schedule for Parents on Immunization service delivery 191 Appendix VI: WHO financial support to Kubau LG for IPDs program for Jan, 2015 191 Appendix VII Facilities required and functional available for Kubau LG 192 Appendix VIII: Kubau LGA Cold chain inventory for Kubau LG 2015 191 Appendix IX Cold chain inventory for Jema‟a LG 195 Appendix X Cold chain inventory for Kubau LG, 2015 198 Appendix XI: Giwa LG Cold Chain Inventory As At December 2014 199 Appendix XIII: Giwa LG Cold Chain Inventory As At March 2015 203 Appendix XII: Cold chain inventory per health facility, 2015 213 Appendix XVIII: Routine Immunization Supervision Checklist 216 x LIST OF TABLES LIST OF TABLES PAGES Table 3.1 LGs Population and Senatorial Districts - - - - - 61 Table3.2 Composition of Population and Sampled per Institution - - - 61 Table 3.3 Composition of Sampled Population interviewed and Focus group 61 Discussion (FGDs) per LG and organization--- --- --- --- --- --- 62 Table 3. 4 Schedule Plan for Questionnaires Administration, Interviews and Focus Group Table 3. 4 Interview Schedule and Plan for Questionnaires Administration - -59 Table 4.1 Wild Poliovirus (WPV) cases 2012-13.- - - - - -92 Table 4.4: Health Manpower for Ward Health System in Nigeria - - -98 Table 4.5: Health education and Community Mobilization - - - -103 Table 4.6 Basic Immunization requirements - - - - - -104 Table 4.7 Basic Requirements of Cold Chain and Logistic Materials at LGA, Ward and Health - - - - - - - -105 Table 4.8 Work Schedule for Immunization - - - - - -106 Table 5.1 Classification of Respondents According to Gender - - - -118 Table 5.2 Distribution of the respondents based on Age distribution - - -100 Table 5.3 Classification of Respondents According to Level of Education - -119 Table 5.4 Classification of Respondents Based on Marital Status - - -120 Table 5.5 Trend in Donor Financing for immunization in Nigeria (US$) - -122 Table 5.6 Funding of immunization by the development partners to Kaduna state (2009-2014) - - - - - - - - - -123 Table 5.7 Funding support by WHO for the December, 2009-2014 Sub-National xi Immunization Plus Days (SNIPDS) Campaign in Kaduna State - - - - - - - 124 Table 5.8 Local Government budgets for Immunization in Kaduna State from 2009 to 2014 - - -- - --- - - -- - -- ------------------------ 125 Table 5.9 Funding and Immunization service delivery - -- - -- - - - - -- - - - - 126 Table 5.10 Immunization Coverage for six LGs in Kaduna State from 2009 to 2014 - - - - - - - - - - -- - - -- - - - - -- - -- - -------- -- - - - 128 Table 5.11 Responses on the Success of Immunization - - - - - - - - - - - - - - -- 132 Table 5.12 Availability of health personnel per LG - -- - - - - - - - - - - - 133 Table 5.13 Training organizations for Health personnel in Kaduna state for the LGs and program per year. ----- -- - -- - -- - --- -- - -- -- - - 134 Table 5.14 Responses on Availability and Competence of Health Personnel --------135 Table 5.15 Staff Responses in Respect to Local Government Efforts at Immunization ---- - - -- - --------------------------------- - - -- - -- - -- - - -- - 136 Table 5. 16 Responses on Positive Outcome of Immunization Service Delivery.--- 140 Table5. 17 Trends of infant and under five child mortality rates per 1000