The problem: Low immunization rates
Childhood vaccines prevent an estimated 4-5 million deaths every year [1]. They are recognized as one of the most cost-effective child health interventions in low-income countries. Yet, in 2022, an estimated 14.3 million infants around the world didn’t receive a single dose of diphtheria-, tetanus-, or pertussis-containing (DTP) vaccines[2]. The problem of low immunization rates is especially clear and pressing in Nigeria. Nigeria is home to just 2.7% of the world’s population [3], yet it accounts for 18% of the world’s mortality of children under five [4]. Nigeria has some of the highest under-five mortality rates [5] and lowest vaccination coverage in the world. Around one-quarter of infants in northern Nigeria get fully immunized, leaving a large population of infants vulnerable to disease outbreaks[6].
The problem of low vaccination coverage in Nigeria is further exacerbated by extreme poverty. This is especially true in northern Nigeria, where many mothers live on less than US$2 a day and cannot visit the clinic for various reasons. They face challenges such as affording the transportation cost to the clinic, associated loss in earnings from small-scale trading or farming, receiving permission from their partners, fear of vaccination side effects, cultural barriers to vaccination, or often a combination of these factors [7].
The solution: Cash incentives for routine childhood vaccination
New Incentives increases vaccination rates by raising awareness about the benefits of childhood vaccinations, providing cash incentives at government clinics after children receive vaccinations, and helping improve the vaccine supply chain to ensure enough vaccines are available at the clinics.
Cash incentives of N1,000 (~US$1.30) are disbursed at six different routine immunization visits, totaling N6,000 (~US$8) over the first 15 months of an infant’s life.
A randomized controlled trial found that their program led to:
- 108% Increase in full vaccination coverage
(relative to 25% full vaccination coverage rate in the control group) - 62% Increase in timely vaccination of measles 12
(relative to 53% of timely Measles 1 vaccination in the control group) - 180% Less likely for clinics to report stockouts
(relative to 10% of clinics reporting no stockouts in the control group) [8]
