Submission ID 129800
| Issue/Objective | Persistent non-compliance, zero-dose prevalence, and inequitable service reach remain major constraints in polio outbreak response (OBR) in rural Northern Nigeria. Between 2022 and 2025, vertically driven immunization strategies have shown limited effectiveness in addressing structural barriers, particularly in geographically remote and socio-politically marginalized populations. This study examines whether institutionalizing community engagement as a core component of health system delivery is associated with reductions in non-compliance and improved equity in immunization outcomes, while enhancing system resilience. |
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| Methodology/Approach | A longitudinal mixed-methods analysis was conducted using cVDPV2 OBR campaign data from Northern Nigeria (2022-2025). The study evaluates an enhanced Social Mobilization Network (SMNet) model integrating Volunteer Community Mobilizers (VCMs) and traditional/religious leaders into micro-planning, household validation, and settlement-level risk mapping. Intervention areas implementing this model were compared with areas using conventional externally driven approaches. Quantitative indicators included non-compliance rates, zero-dose identification, and antigen coverage, complemented by qualitative implementation insights. |
| Results | Implementation of the community-integrated model was associated with a sustained reduction in non-compliance between 2022 and 2025, with relative decreases of 15-22% compared to standard approaches. Community-led identification of zero-dose children in nomadic, border, and conflict-affected settings improved antigen coverage and reduced missed settlements. Additionally, these community structures demonstrated continuity beyond campaign cycles, supporting routine immunization and primary healthcare outreach. |
| Discussion/Conclusion | Findings suggest that community engagement functions as distributed health system infrastructure rather than a peripheral activity. The observed decline in non-compliance indicates that trust-based, locally embedded strategies effectively address both demand- and access-related barriers. Embedding community actors within formal health system processes enhances adaptive capacity and supports equitable service delivery. This approach provides a scalable pathway for strengthening resilience and closing immunization equity gaps in fragile settings. Policy Implications: Institutionalizing community actors as formal components of health system governance, through decentralized micro-planning authority, integration of community-generated data into surveillance systems, and sustained investment in community-led delivery platforms, offers a practical and scalable strategy for improving immunization equity and strengthening primary healthcare systems in underserved and fragile contexts. |
| Presenters and Affiliations | Aliyu Yakubu Chigari Foundation Aliyu Yakubu Chigari Foundation Umar Nisser Chigari Foundation Zaiyad Garba Habib Chigari Foundation Musa Abba Mohammed Chigari Foundation Aminu Surajo Chigari Foundation Muhammad Hamza Maishanu Chigari Foundation |
