The challenge

Nigeria bears a disproportionately high share of the global zero-dose burden, with over 2 million children, more than 13% of the global total, having never received a single dose of routine vaccines. This burden is most acute in Northern Nigeria, where systemic inequities, security challenges, difficult geography, seasonal migration, and social barriers contribute to persistently low immunization coverage and preventable childhood illness and death. Health worker shortages, vaccine hesitancy, poor cold-chain infrastructure, and unreliable data systems further complicate efforts to deliver life-saving vaccines to the children who need them most.

Our Vision

At the Health Strategy and Delivery Foundation (HSDF), we believe that every child deserves access to vaccines, regardless of where they live or the circumstances they face. Our immunization strategy is equity-driven, people-centered and grounded in a system-wide approach. We aim to support Nigeria’s national immunization goals by co-creating innovative, scalable, and community-owned solutions that improve vaccine uptake, especially among zero-dose and under-immunized children.

This strategy is aligned with Nigeria’s National Strategy for Immunization and PHC Systems Strengthening (NSIPSS), the Immunization Agenda 2030 (IA2030), and Gavi’s strategy 5.0, all of which emphasize reaching zero-dose and under-immunized children through country ownership, strengthening primary health care (PHC), and improving equity, sustainability, and system resilience.

Our Strategic Pillars

Human-Centered Design (HCD) for Contextualized Solutions

HSDF applies participatory HCD methods to uncover the lived experiences of caregivers, frontline health workers, and community stakeholders. This includes:

• Empathy interviews and journey mapping
• Co-creation workshops and prototyping of locally adaptable models
• Tailored service design to respond to behavioral, gender, and socio-cultural barriers

By placing people at the center of design, we ensure that immunization delivery is responsive to local realities and trusted by end users.

Innovation in Last-Mile Delivery

To address geographic and access constraints in reaching zero-dose and under-immunized children, HSDF supports innovative last-mile solutions, including:

• Terrain-adapted delivery modes (e.g., solar-powered tricycles, boats, mobile outreach)
• Microplanning that accounts for seasonal migration, conflict zones, and nomadic routes
• Integration with PHC services to provide holistic child health and immunization outreach

These innovations aim to extend services to previously unreached populations while improving efficiency and reliability.

Community-Driven Demand Generation and Social Mobilization

Demand-side barriers including misinformation, mistrust, and low awareness, continue to undermine immunization efforts. HSDF strengthens community engagement and demand generation through:

• Identification and capacity building of local “vaccine champions”—religious leaders, youth, traditional rulers
• Deployment of culturally resonant communication via mosques, markets, schools, and radio
• Door-to-door outreach by trained community mobilizers using localized messaging

This community-led approach builds confidence, improves uptake and fosters long-term demand for immunization services.

Performance Management, Data Use, and Accountability

At HSDF, we understand that reliable data is critical for responsive and equitable immunization delivery. HSDF promotes:

• Simplified digital tools for vaccine stock monitoring, cold chain tracking, and session planning
• Real-time dashboards and community scorecards
• Regular review meetings and feedback loops that drive performance improvement

At HSDF, data is leveraged to enable real-time course correction and inform strategic decision-making throughout implementation. We aim to institutionalize data use for decision-making at all levels, from facilities to national platforms.

Policy, Governance, and Strategic Partnerships

Effective immunization programs require strong leadership and multisectoral coordination. HSDF supports:

• Evidence-based planning and financing at state and LGA levels
• Strengthened immunization governance structures, including inter-agency coordination platforms
• Policy dialogues to promote sustainable immunization financing and integration with primary healthcare systems

These efforts align with national reforms and position states for long-term ownership and sustainability of immunization programs

Research and Adaptive Learning

HSDF is committed to continuous learning and evidence generation to improve immunization program performance, inform scale-up, and support national policy development. We will embed adaptive learning mechanisms and operational research into all phases of implementation. This includes:

• Documenting and analyzing implementation processes to understand what works, for whom, and in what context
• Conducting periodic learning reviews with community actors, government stakeholders, and partners to co-interpret findings
• Generating and disseminating knowledge products (policy briefs, case studies, learning snapshots) for state and national audiences
• Piloting and refining delivery models using real-time data, feedback loops, and human-centered design insights

This approach ensures the program evolves responsively, supports scale-up decisions, and contributes to national and global immunization learning agendas.

HSDF’s Institutional Capacity and Comparative Advantage

HSDF brings a unique combination of deep local knowledge, health systems expertise, and proven ability to deliver innovative, scalable solutions across Nigeria. Our immunization strategy leverages:

• Strong relationships with state governments, PHC boards, and community networks in high-burden states like Bauchi, Sokoto and Kebbi
• Experience managing complex, multi-state programs in maternal, newborn, and child health, including those supported by USAID, BMGF, World Bank, and Gavi
• A multidisciplinary team of public health specialists, implementation scientists, health economists, and data analysts with national and international experience
• Proven track record in applying HCD, quality improvement (QI), and digital tools to drive service delivery reforms

These assets position HSDF as a trusted and capable partner to governments and funders in the design and delivery of equitable and sustainable immunization programs across Nigeria.