Provider and community perspectives of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study

Abstract

Abstract Background In Nigeria, COVID-19 vaccines were delivered through outreach activities and integrated with routine immunisation. However, evaluations of integrated approaches for novel vaccines are scarce. We aimed to understand the perceived benefits and challenges of integrating the COVID-19 vaccine within routine- immunisation in Nigeria and identify ways to strengthen this approach. Methods We conducted 30 semi-structured interviews with community members and healthcare workers in primary healthcare (PHC) facilities in Jigawa (n = 16) and Oyo (n = 14) states, Nigeria in August 2022. Participants were selected purposively from PHC facilities. Healthcare worker and community interviews were analysed separately using thematic analysis. Results We identified four themes that describe the community response, perceived impact, and health system adaptions to the challenges associated with the integrated vaccine delivery approach. Community members expressed concern that children might be given COVID-19 vaccines instead of routine immunisations, while others appreciated the integrated approach due to their trust in the efficacy of COVID-19 vaccines, government, and healthcare providers. Healthcare providers perceived the integrated approach as improving vaccination coverage and awareness but noted additional problems of increased workload, vaccine scarcity, and prolonged clinic visits. Insufficient resources were subsisting barriers to effective integration in both states, but the provider’s gender was also a challenge in Jigawa state. Additionally, the use of incentives to generate demand had ambiguous effects in Jigawa state. Conclusion Taking an integrated approach to deliver COVID-19 vaccines was acceptable by health workers but resisted from the community. Addressing persistent challenges in existing vaccination programmes is pertinent to enhance effectiveness and acceptability of the integrated approach.