Niger J Paed 2014; 41 (3):163 - 169  
Fatiregun AA  
Alonge TO  
Rukewe A  
An assessment report on an  
immunization clinic located in a  
tertiary institution in Ibadan  
Etukiren E  
Chidinma U  
Adejugbagbe AM  
Accepted: 11th February 2014  
Abstract Objectives: The aims of  
(BCG) vaccine, which peaked in  
2011, other vaccines’ coverage  
peaked in 2009, after which there  
was a decline. The highest dropout  
rate was recorded in 2007, while  
the rates between 2009 and 2010  
were <10%, but the BCG and mea-  
sles drop out rates were >10% for  
the 5-year period. For the adult  
immunizations, yellow fever re-  
corded the highest coverage rate,  
while the lowest rate was recorded  
for tetanus toxoid dose 5 (TT5).  
The vaccines that were most often  
in short supply included Diphthe-  
ria- pertusis-tetanus, Hepatitis B,  
yellow fever, oral polio, and cere-  
brospinal meningitis vaccines.  
Although good-quality supplies,  
equipment and consumables were  
observed, there was no inventory  
of these items. There were evident  
interpersonal communication and  
community mobilization as well as  
capacity building for staff.  
the assessment report were to ap-  
praise immunization system com-  
ponents and review vaccination  
coverage between January 2007  
and December 2011 at the Uni-  
versity College Hospital (UCH)  
immunization clinic.  
Methods: The immunization  
clinic has an annual target popula-  
tion of 997 (for children < one  
year of age) and 1246 (for preg-  
nant women), which were used in  
this assessment. The data collec-  
tion method used included; Key  
informant - interview, administra-  
tion of a semi-structured question-  
naire, records review and observa-  
tions during immunization ses-  
Results: The UCH immunization  
clinic mainly offers fixed sessions  
and only provides outreach ser-  
vices when there is a need, such  
as during outbreaks. However,  
there are no records of vaccine-  
preventable diseases being moni-  
tored. The coverage rate for  
nearly all of the vaccines was  
greater than 100% of the esti-  
mated target population for the  
hospital. Except for the coverage  
rate of Bacille Calmette Guerin  
Fatiregun AA  
Department of Epidemiology and  
Medical Statistics, Faculty of Public  
Health, University of Ibadan.  
Email: akinfati@yahoo.com  
Alonge TO, Rukewe A, Etukiren E,  
Chidinma U, Adejugbagbe AM  
Department of Orthopaedics & Trauma,  
University College Hospital, Ibadan  
Conclusion: The assessment  
showed there was progress in the  
provision and administration of  
immunization based on available  
resources. There is, however, the  
need to improve documentation of  
clinic activities.  
measles, neonatal tetanus, and whooping cough . Nige-  
ria’s child’s immunization coverage has remained low  
over the past decade. The low coverage has been identi-  
fied to be attributed to weak health structures and sys-  
tems, inadequate funding by government, over depend-  
ence on donor funds, withdrawal of funds and lack of  
Immunization remains the primary strategy for the pre-  
vention and control of common childhood diseases, es-  
pecially in the developing world . Prevention of child  
mortality through immunization is one of the most cost-  
effective public health interventions in use in resource-  
ownership at the community level. However, Nigeria,  
poor settings . Childhood immunizations have dramati-  
like many countries in the African region, is making  
efforts to reduce disease burden from vaccine-  
preventable diseases (VPDs) by strengthening the health  
system in general and routine immunization system and  
cally reduced the incidence rates of debilitating and  
sometimes lethal diseases . In developing countries,  
immunization programmes prevent approximately two  
million deaths per year, which would have resulted from  
services in particular . Five operational (service deliv-  
ery, quality vaccine supply, logistics support, surveil-  
lance for VPDs, and advocacy and communication) and  
three supportive (sustainable financing, programme  
management, and human and institutional resources)  
components of the immunization system have been  
increasing on a daily basis. However, no appraisal of the  
immunization coverage and system activities has been  
undertaken since inception.  
National immunization objectives  
identified for improvements . To strengthen the service-  
delivery components of the immunization system, for  
example, the country adopted the reaching every district  
The main national immunization objective was to de-  
velop and promote immunization programmes geared  
towards the reduction of childhood morbidity and mor-  
tality through adequate immunization coverage of all at-  
RED) approach of the World Health Organization and  
renamed it the reaching every ward (REW) approach to  
reflect the administrative structure in Nigeria. In this  
approach, five strategic components (with expected ac-  
tivities) were identified for improvements. These include  
risk populations . The specific objectives of the national  
immunization programme were as follows: Improve and  
sustain routine immunization coverage of all antigens to  
90% by the year 2020, in agreement with the national  
vision; Achieve, through quality supplemental activities,  
interruption of polio transmission by the end of 2009,  
and total eradication by the end of 2013; Eliminate ma-  
ternal and neo-natal tetanus by the end of 2010; Prevent,  
detect, control, and eliminate the occurrence of out  
breaks of CSM, measles, yellow fever, and any other  
VPDs in all parts of the country; and9 reduce childhood  
mortality due to immunizable disease .  
Planning and management of resources, through  
quarterly micro or detailed planning for human,  
material and financial resources, and  
Improving access to immunization services through  
establishment or re-establishment of fixed, outreach  
and mobile immunization sites. Other strategic  
components are  
Supportive supervision through onsite or on-the-job  
Community links with service delivery through  
regular meeting between community and health  
staff, and  
Mission/Vision of the UCH immunisation clinic  
Monitoring and use of data for action through, cov  
Mission/Vision of the UCH immunization clinic is to  
render excellent and prompt immunization services in a  
suitable environment.  
erage/dropout reviews, dose charting, mapping of popu  
lation in each facility and categorizing health facility  
based on access and utilization of services.  
Objectives: The objectives of the UCH immunization  
clinic are as follows: reduce the mortality and morbidity  
rate arising from communicable diseases, especially  
childhood killer diseases, through active immunization  
of members of staff and their families in UCH, including  
registered members of the community; investigate the  
effectiveness of preventive measures (health education,  
counseling, contact tracing, home visits, and surveil-  
lance) offered to control the infectious disease on a quar-  
terly basis; support and participate in the global and na-  
tional targets/programmes in the eradication of the dis-  
eases; and to study default rates among clients and find  
solutions to the identified problems on a quarterly basis.  
The improvement plans for each of the immunization  
system components, expected activities including task  
description, and monitoring indicators at the health fa-  
cilities, ward, local govern7-m10ent, state and National lev-  
els have been described . Improving immunization  
coverage will require regular assessment of the immuni-  
zation delivery system to determine if programme objec-  
tives are being met, to identify problems and causes of  
low coverage and to plan activities to increase cover-  
The National Programme on Immunization (NPI) was  
initiated with a vision of achieving sustainable immuni-  
zation service delivery through community ownership,  
Objectives for conducting the assessment  
community operated and community driven strategies .  
Consistent with the above vision; the University College  
Hospital (UCH) immunization clinic was opened to at-  
tend to the immunization needs of hospital staff.  
The general objective was to appraise the immunization  
system components and review vaccination coverage  
between January 2007 and December 2011 at the Uni-  
versity College Hospital (UCH) Immunization clinic, so  
as to use the findings to make recommendations.  
History of the immunization clinic  
The centralized immunization clinic of UCH was for-  
merly referred to as the staff immunization clinic. The  
clinic was opened to attend to the vaccination needs of  
staff members and their dependants. As a result of the  
small target population, many doses of vaccines were  
usually left over after each vaccination session and the  
liquid vaccines had to be returned to the state vaccine  
store. It was observed later that many UCH patients/  
clients were requesting administration of one vaccine or  
another. The decision was thus made in 1990 that the  
immunization clinic should serve other registered people  
in the clinic. Since then, the clinic attendance has been  
Specific Objectives: The specific objectives were as  
follows: to determine immunization coverage data in the  
clinic; identify the strengths of the services; and deter-  
mine constraints to achieving the program objectives  
using the immunization system approach.  
Catchment area and target population  
The findings of the evaluation were as follows:  
University College Hospital is located in the Ibadan  
North Local Government Area (LGA) of Oyo state. The  
LGA has a population of 374,948 (2011 estimate) based  
on 2006 census estimates and is divided into 12 admin-  
istrative wards. The wards that make up the LGA in-  
clude Oke-Are, Nalende, Yemetu, Agodi, Bashorun,  
Sabo, Sango, Ago-Tagba, Old Bodija, Samonda, and  
Agbowo. UCH is located within the Old Bodija ward,  
which has a population of 41,245. Only three health  
facilities are recognized as immunization clinics in the  
ward (UCH, Institute of Child Health [also within  
UCH], and the Obasa Health Facility). The UCH clinic  
had an annual target population of 997 for children  
Service delivery  
The services provided by the clinic include the follow-  
ing: Infant welfare clinic; Yellow card processing; TB  
screening; Child and adult immunization; and outreach  
programs. The UCH immunization clinic mainly offers  
fixed sessions and only provides outreach services when  
there is a need, such as during outbreaks. The clinic is  
open throughout the week (Mondays to Fridays) be-  
tween 8am and 5pm. The largest number of clients is  
seen on Wednesday and Thursday because all of the  
vaccines are administered to the clients, unlike other  
days. Public health nursing personnel and doctors from  
the Family Medicine Department attend to the medical  
needs of clients on every clinic day. The vaccines ad-  
ministered include the following: Monday (BCG, HBV,  
OPV, and other special/non-routine vaccines); Tuesday  
(yellow fever and TB screening); Wednesday (BCG,  
HBV, OPV, DPT, HIB, and non-routine vaccines);  
Thursday (BCG, HBV, OPV, DPT, HIB, measles, and  
TT); and Friday (special vaccines, child welfare, and TB  
1year of age, and 1246 for pregnant women, as ob-  
tained from the LGA immunization unit. The communi-  
ties served by the UCH clinic include Awosika, Adeyi,  
Abedo, Osuntokun, Ondo, Ajibade, Obasa, Awolowo,  
Ekiti, and Coca-Cola.  
Data collection and instrument  
The information gathered during the assessment was  
both qualitative and quantitative on the five operational  
and the three supportive components of the immuniza-  
tion system. Three methods of data collection were used  
during the assessment, and include the following: Re-  
cord review, extracting data on the vaccines used, and  
vaccination coverage from immunization records from  
January 2007 and December 2011; Interviews, discus-  
sion, and probing of the head of the immunization clinic  
using a semi-structured interviewer administered ques-  
tionnaire adapted from the WHO assessment question-  
naire, with categories based on the operational and sup-  
portive components of the immunization service deliv-  
ery, including, vaccine supply, disease surveillance, lo-  
gistic and advocacy, capacity building, and financial  
management; and Observations during immunization  
For fixed sessions, planning is continuous and daily due  
to the daily administration of vaccines. Work plans are  
non-existent in the clinic, and all of the standard data  
management tools are not available. Specifically, only  
an improvised immunization register and the child  
health card are available, while the tally sheet, immuni-  
zation summary sheet, and immunization coverage  
monitoring chart are not available. Thus, monitoring for  
dropouts, vaccine wastage, categorization, and prioriti-  
zation is nearly impossible. The form for recording ad-  
verse events following immunization (AEFI) are not  
available, thus there is no method for tracking AEFI and  
none has been reported in the past five years.  
The staffs administer the vaccines correctly (the correct  
site, route, and dose). The staff practice injection safety  
and dispose of used syringes/needles immediately into  
the safety box. The staffs record each vaccine on the  
child immunization card correctly, but do not tally cor-  
rectly on the tally sheet. The immunization registers  
used are ordinary notebooks, and thus are not correctly  
filled out and there are no mechanisms to track vaccine  
doses that are due or to track defaults. The staffs are  
aware of the standard operating procedures and neces-  
sary forms to complete if there is a report of an AEFI,  
but the forms are not available.  
Data Analysis  
Data on immunization coverage for the five year period  
was entered into Microsoft excel. In order to compare  
the trends in the coverage rates, the percentage coverage  
for infants and adults vaccines were computed for the  
period the review covered. The cumulative monitoring  
charts for DPT1 & DPT3, BCG & Measles were also  
computed, as well as their dropout rates.  
Ethical consideration  
Immunization coverage for the five year period  
Permission to carry out the assessment was obtained  
from the Chief Medical director of the University Col-  
lege hospital. Permission to use the records of the immu-  
nization clinic was obtained from the head of the unit.  
The coverage rate for nearly all of the vaccines was  
>100% as a result of the low yearly target population of  
the hospital estimated by the LGA from the census  
population of the ward where the hospital is located.  
Except for the coverage rate of BCG, which peaked in  
011, other vaccine coverage peaked in 2009, after  
which there was a decline (Figure1). The DPT1-DPT3  
dropout rate was almost the same as the BCG- measles  
dropout rate; the highest dropout rate was recorded in  
Fig 4: Immu-  
nization cov-  
erage for  
007, while the rates between 2009 and 2010 were  
adults over the  
10%, but the BCG and measles drop out rates were  
10% for the 5-year period (Fig 2 and Table1). For the  
-year period.  
adult immunizations, yellow fever recorded the highest  
coverage rate, while the lowest rate was recorded for  
tetanus toxoid dose 5 (TT5; Fig 3).  
Fig 1: Vaccine  
coverage for  
the 5-year  
Fig 5: Coverage  
for other child-  
hood vaccines  
provided in the  
clinic in the 5-  
year period  
Fig 2: Monitoring  
chart for cumula-  
tive DPT1 and 3  
for the 5-year  
Vaccine supply  
The routine immunization vaccines were collected from  
the LGA by the health facility staff two times per  
month. Auto-disable syringes, which are bundled with  
the vaccines were also collected from the LGA and were  
used to administer vaccines and disposed using safety  
boxes. Vaccines were available during immunization  
sessions. The vaccines that were most often in short sup-  
ply included DPT, HBV, YF, OPV, and CSM. Only  
those vaccines that had not expired and those in vaccine  
vial monitor (VVM) stages 1 and 2 were used for immu-  
nization. After each session, HBV and DPT were re-  
turned to the refrigerator, while YF and measles were  
discarded in line with the multi dose vaccine policy.  
Table 1: DPT1-DPT3 and BCG-measles dropout rates for the  
-year period in the UCH Immunization clinic  
Year 1  
Year 2  
Year 5  
DPT 1  
Drop out/  
5.9 (Cat1)  
*Categorization (Cat4)  
(Cat1) (Cat1) (Cat2)  
Drop out/  
There was no method for vaccine forecasting. Vaccines  
and dry stock ledgers were unavailable, thus vaccines  
were requested based on the previous records and requi-  
sition forms. There were no methods for vaccine utiliza-  
tion, waste monitoring and reduction in the clinic, thus  
the utilization rates could not be determined. Vaccines  
were stored in refrigerators and were handled properly  
during administration.  
*Categorization (Cat2)  
(Cat2) (Cat2) (Cat2)  
Category 1: Good access good utilization  
Category 2: Good access poor utilization  
Category 3: Poor access good utilization  
Category 4: Poor access poor utilization  
Fig 3: Monitor-  
ing chart for  
BCG and mea-  
sles for the 5-  
year period  
Disease surveillance  
The clinic does not maintain records of vaccine prevent-  
able diseases (VPDs) and thus cannot determine if there  
is a reduction or otherwise, in the number of cases.  
Other variables, such as the incidence of VPD, the num-  
ber of cases of non-polio acute flaccid paralysis, measles  
outbreaks, cases investigated, and determining if the  
incidence of disease and coverage rate correlate could  
not be determined. Monthly immunization coverage  
reports were sent to the LGA, but there was no record of  
feedback from the LGA.  
clinic. The target set for UCH is 83 clients per month,  
but because of the nature of the hospital as a tertiary  
health facility, the target is almost always exceeded,  
even on daily basis, thus accounting for >100% cover-  
age recorded by the clinic. Data on the target population  
are determined by the LGA based on projections from  
the national population census figure. The clinic does  
not have a catchment area map for routine immunization  
showing all settlements, the population, and the type of  
session being used to reach the settlements. Work plans  
were not available and there was a lack of information  
sharing between the clinic and other departments of the  
hospital, especially the VPD record unit.  
Previously, routine immunizations, such as DPT, OPV,  
HBV, yellow fever, and vitamin A were received from  
the Jericho state store, but after a decentralization, the  
routine immunizations were supplied from the Ibadan  
North LGA store. In September 2011, a proposal was  
presented to the UCH management for the procurement  
of non-routine vaccines, which had been administered to  
children in Asia, the US, and many other African coun-  
tries, and the same was approved.  
The clinic management ensures a good quality supply,  
equipment, and consumables, but there is no availability  
of stock supplies and consumables inventory. The clinic  
has a sufficient amount and well functioning cold chain  
materials for effective and efficient service delivery,  
including refrigerators, freezers, cold boxes, vaccine  
carriers, icepacks, and foam pads. The temperature of  
the refrigerators and freezers were monitored to ensure  
optimum functioning. When the need for outreach arose,  
adequate transport and materials were made available.  
The UCH immunization clinic mainly offers fixed ses-  
sions and only provides outreach services when there is  
a need, such as during outbreaks. This falls short of the  
1,2,3 strategy for delivering routine immunization sug-  
gested by the Expert Review Committee on Immuniza-  
tion of the National Primary Health Care Development  
Agency . The committee recommended that apart from  
weekly immunization services at fixed sites, outreach  
services are expected to be conducted by a health facility  
in areas >5km to the facility but within its catchment at  
least twice a month to improve access to immunization  
services. The concept of “reaching every ward” (REW)  
is meant to ensure that no community, no matter how  
remote is denied the opportunity to enjoy routine immu-  
nization services. It is therefore, important that commu-  
nities that cannot be effectively accessed by use of exist-  
ing fixed sites, be reached by using outreach or mobile  
immunization services. It was noted that coverage data  
are traditionally considered the best indicators of an im-  
munization programme's performance because they  
reflect the management of access, and utilization of ser-  
Advocacy and communication  
The health staff communicates effectively with parents  
and caregivers, and before administering the immuniza-  
tion, the health staffs provide the six key messages to  
the parents and caregivers. The health staff have good  
interpersonal skills and relate well with the clients. Only  
the UCH community is involved in the planning, while  
the other communities are not involved. This is a result  
of the fact that the clinic was initially established for the  
UCH community alone. There were no active attempts  
to reach the unreachable, defaulters, and non-users. The  
last form of evaluation for the clinic was performed in  
vices . The immunization coverage rate for nearly all the  
vaccines in this report was >100%. This was higher than  
the coverage goal of the Nigeria comprehensive multi  
year plan 2011-2015 of 87.0% of infants for all antigens  
Capacity building  
in the routine schedule by 2015 . This was also higher  
At present, nine staffs currently work in the immuniza-  
tion clinic, of which six are qualified nurses. There have  
been in-service training for the staff on injection safety,  
prevention of HIV transmission, and stress management  
in the last five years. The staffs were also trained on  
calculating and creating the dropout rate chart, but the  
staffs do not put the knowledge into practice. The staffs  
are knowledgeable about administering vaccinations  
correctly and also provide the six key messages to par-  
ents/caregivers before administering the vaccines, but  
some times the staff do not register the vaccination cor-  
rectly in the tally sheet, immunization register, and child  
health card. Job performances are regularly evaluated,  
but feed back is not provided.  
than the WHO-UNICEF estimates for Nigeria for each  
vaccine such as; BCG 69%, D0 PT3 54%, OPV3 61%,  
HB3 41%, and measles 62% . Nigeria is among the  
twelve very high-risk countries in the yellow fever belt .  
While yellow fever vaccine is currently part of the coun-  
try’s routine immunization schedule, the coverage like  
other routine immunization vaccines is low and as such  
there is a potential danger of large outbreaks of yellow  
fever. For the adult immunizations in this report, yellow  
fever recorded the highest coverage rate. This differs  
from the report of immunization coverage made in a  
tertiary teaching hospital in Niger Delta in which yellow  
fever/ measles vaccines had the lowest coverage rate 94  
(17.8%) .  
Although the coverage for individual vaccines for in-  
fants were high at the clinic, the BCG and measles drop-  
out rates were >10% for the 5-year period. Dropouts are  
Targets are set by the LGA and are monitored in the  
people who begin the vaccination schedule but fail to  
complete it. If a child does not receive all doses for a  
specific vaccine required for full protection against a  
specific disease, the resources that have been used are  
generally regarded as wasted. The main reasons for  
dropouts may include: problems relating to dissatisfac-  
tion of the quality of service rendered, such as, long  
waiting time and failure to give mothers and caregivers  
correct information on when and why to come back for  
subsequent vaccines/doses. Others include inability of  
the health facility to provide uninterrupted service deliv-  
ery due to inadequate and timely provision of bundled  
vaccines for the catchment area target population and  
socio-cultural as well as administrative barriers such as:  
religious beliefs, decision making authorization on  
health related issues at the family level and irregular  
provision of routine immunization sessions at health  
facilities or outreach/mobiles services. The REW ap-  
proach is expected to develop the capacity of health  
workers at health facility level to identify and reduce  
dropouts by ensuring quality and un-interrupted services  
tion of the Republic of Myanmar (2012-2013) where  
logistics operations had been manned and maintained by  
dedicated staff at each level of storage and distribution,  
as stock management was computerized at the central  
cold room but done manually at regions and townships  
levels . In 2010, the center for disease control (CDC)  
had developed a vaccine tracking system to facilitate  
vaccine ordering, inventory manageme1n5t, and related  
processes for publicly purchased vaccine  
There has not been any form of external funding for the  
clinic in the past 5 years unlike in Myanmar where most  
of the relevant supplies required for the immunization  
programme were supplied by UNICEF and WHO and  
the cost of the supply transport and storage up to the  
township level was borne by the government (Ministry  
of Health) which was the major reason for the success of  
the immunization programme (Central expanded pro-  
gramme on Immunization, (2012-2013) in this Republic.  
The report of a joint WHO/UNICEF mission on vaccine  
security in Nigeria had also indicated financial con-  
straint due to poor financing of transportation cost of  
vaccines at the State and Local Government areas  
(LGAs), in addition to poor information management  
between states 7and LGAs and poor cold chain capacity  
amongst others .  
at fixed, outreach and mobile sites .  
The vaccines that were most often in short supply in-  
cluded DPT, HBV, YF, OPV, and CSM. Similar report  
had been made by related study in Nigeria, whereby, the  
most common vaccines reportedly missed as a result of  
short supplies were BCG, OPVO, OPV1, HBV1 and  
DPT1 . The most outstanding reason for missing sched-  
uled immunization in this study was lack of vaccine (s).  
However, the lack of vaccines as noted may be due to  
the inability of the health facility staff to forecast prop-  
erly the vaccine needs of the centre, since there was no  
report of vaccine shortage in the country during the pe-  
riod of the study. The lowest coverage rate was recorded  
for tetanus toxoid dose 5 as, this was similarly reported  
in a study in Lahore district of Pakistan among mothers  
who had delivered within the previous 3 months, less  
than a quarter (17%) of the women had received a com-  
plete dose of TT 5 injections which is well below the  
WHO expected level of vaccination of 100% of the  
pregnant women.  
The clinic has come a long way in the provision and  
administration of immunizations and the clinic is doing  
well based on the available resources, but some issues  
have not been resolved.  
Gaps and challenges  
Few clinic activities were shown to be done improperly,  
as follows: There was no dropout monitoring chart, thus  
utilization and categorization could not be determined;  
There was no method of planning or forecasting for both  
vaccines, syringes, and safety boxes; There was no re-  
cord of use of vaccines and syringes; The immunization  
status of children could not be determined from the im-  
munization records; There was no record of VPDs, thus  
no way of determining if it was on the increase or other  
wise; and the monthly/yearly target of the clinic was too  
Data management and reporting has been very poor in  
the past. However, attempts have been made to improve  
data quality and management system by capacity build-  
ing of service providers and provision of data tools to all  
levels. A survey among 27 countries in 2002 to 2003  
had reported some challenges in their immunization  
surveillance and monitoring system, such weakness in-  
cludes; inconsistent use of monitoring charts, inadequate  
monitoring of vaccine stocks, injection supplies and  
adverse events, unsafe computer practices, and poor  
monitoring of completeness and timeliness of report-  
There should be training of staff on planning, forecast-  
ing, and proper recording of immunizations. Standard  
immunization data tools including tally sheets, immuni-  
zation registers, health facility summary sheet, immuni-  
zation monitoring charts should be made available. Ef-  
fort should be made towards computerizing immuniza-  
tion activities in the clinic using standard format. Out-  
reaches services should be conducted in line with the  
1,2,3 strategy of the NPHCDA to further improve over-  
all access to immunization in the hospital catchment  
ing . This was similar to this report where vaccine and  
dry stock ledgers had not been available and there was  
no method for vaccine forecasting, also, records of vac-  
cine-preventable diseases (VPDs) were not maintained.  
The clinic management ensures a good quality supply,  
equipment, and consumables, but there was no availabil-  
ity of stock supplies and consumables inventory unlike  
report made by the expanded programme on immuniza-  
areas. Increase funding and personnel will be required  
for this. Analysis of the immunization performance  
should be done and reviewed on a monthly basis. Vac-  
cines, especially DPT, should be available all the time.  
There should be regular supportive supervision of staff  
in the clinic to ensure the clinic is administering immu-  
nizations properly. The immunization register should be  
used to record vaccines given, to make it possible to  
calculate the proportion of children fully or partially  
immunized. There is a need to synchronize the national  
and clinic objectives for effectiveness and efficiency.  
Goals set for the clinic should be realistic, time bound  
and measurable.  
Authors’ contribution  
All the authors were involved throughout the course of  
the study. Fatiregun A and Alonge T conceived the  
study. Initial draft was done by Fatiregun and approved  
by all authors.  
Conflict of Interest: None  
Funding: None  
The authors are grateful to the staff of the clinics that  
provided the information needed for the report.  
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