Oluwamisimi Akinlolu: Why Nigeria Must Rethink Data to Reach Zero-Dose Children

Nigeria’s immunization challenge is becoming sharper and more urgent. As the COVID-19 pandemic continues to disrupt routine vaccination systems across the world, existing inequalities are deepening, leaving millions of children either partially vaccinated or entirely unreached.

In Nigeria, the concern is especially pressing. Zero-dose children remain concentrated in communities already affected by poverty, displacement, conflict, weak primary healthcare infrastructure and poor visibility within the health data system. As the country works to protect routine immunization gains during the pandemic period, the question is no longer only how many vaccines are available, but whether the health system can identify the children who are still missing from its reach.

In this conversation with Rebecca Ejifoma, health data strategy expert and health information management consultant Oluwamisimi Akinlolu examines Nigeria’s current immunization reality, arguing that the problem is not simply the absence of data, but the failure to connect existing data sources in ways that can guide action.

Drawing from her work across multisource data analytics, digital health data systems, leadership training and resource allocation, she reflects on how Nigeria can better identify missed children, strengthen subnational planning, and ensure that immunization financing reaches the communities most at risk.

How would you describe Nigeria’s immunization challenge amid the COVID-19 pandemic?

Nigeria is facing the pandemic period with deep inequities already embedded in its immunization system. National averages often suggest progress that does not exist at ward or local government level. Routine service data is still inconsistently captured, subnational planning often reflects administrative convenience more than demonstrated need, and too many children remain invisible to the system that is supposed to reach them.

The global context makes the problem clearer. COVID-19 has severely disrupted childhood immunization, with millions of children missing out entirely or partially on routine vaccination and becoming more vulnerable to preventable diseases. Zero-dose children have become an urgent marker of missed access, and Nigeria remains one of the countries carrying a very large share of that burden.

Across Africa, the concentration of under-vaccinated and unvaccinated children remains deeply worrying. Nigeria carries one of the heaviest national burdens on the continent, with more than two million zero-dose children. For a country of Nigeria’s size, the issue is not only about vaccine supply. It is about whether the system can see, locate and reach the children still outside routine services.

Who are Nigeria’s zero-dose children, and what do they tell us about where the system is failing?

Zero-dose children are children who have not received any dose of DTP-containing vaccine by 12 months of age. In Nigeria, they are not evenly distributed. They are concentrated in communities affected by poverty, displacement, conflict, weak primary healthcare infrastructure and chronic exclusion from formal services. They are also concentrated in the places where health information systems are least equipped to see them, which is precisely what makes the problem difficult to solve through conventional approaches.

Globally, zero-dose children are strongly linked to poverty and multiple forms of deprivation. In the Nigerian context, this overlaps almost directly with the populations that the Basic Health Care Provision Fund is established to serve: communities at the social and geographic margins of the formal health system.

That is what makes zero-dose children so important as an indicator. They are not simply an immunization statistic. They are a measure of whether the health system is functioning at the point of first contact. They show where the system is failing the children most at risk, and they reveal how unequal access to basic services remains across the country.

What is the actual problem the data is not solving, and how do you come to see it so clearly?

The problem is not the absence of data. Nigeria already has multiple sources of health information flowing through its systems. Facility data is being captured through DHIS2. Household surveys are generating population-level pictures of coverage. Community health worker records are providing partial local insight. Civil registration systems hold birth data that could, in principle, reveal which children have never entered the immunization pathway.

The problem is that these sources are not yet being used together in a way that can identify missed children, explain why they are being missed, or guide resource allocation toward the areas with the greatest need. Routine data captured in national DHIS2 systems is a key source for identifying low-coverage areas, under-immunized populations and zero-dose children. These data are also critical inputs that campaign planners need to combine with other sources to plan equitable delivery. But that combination is still not happening in a structured or repeatable way.

I see this because I am working inside the system. Facility data can show how many doses are delivered at a given health post. It cannot show how many children in that facility’s catchment area have never arrived at all. Survey data can show population-level patterns, but often with a time lag that limits its operational usefulness. Community-level records offer partial local insight but are rarely connected back to the facility data they are meant to complement. Each source, on its own, produces an incomplete and sometimes misleading picture. Aggregate figures also continue to flatten serious subnational inequities, allowing wide variation in coverage to disappear inside a single national average.

What becomes clear through this work is that the country does not have only a data collection problem. It has a data convergence problem. The information needed to locate zero-dose children already exists across multiple systems. What does not yet exist is a structured mechanism for making those systems speak to one another, surface their contradictions, and produce a picture precise enough to drive resource decisions at the ward and LGA level. That recognition is the starting point for the analytical and institutional response I am working to build.

What is the response you are building, and how does MSDAT fit into it?

The insight driving the response is that zero-dose children become visible not when you look harder at any one data source, but when you force multiple sources to speak to one another and expose the gaps between them. A facility may be reporting strong output numbers while a community survey shows high rates of unvaccinated children in the same catchment area. That contradiction is precisely where missed children are hiding.

That is the founding logic of the Multisource Data Analytics and Triangulation channel, MSDAT. I am involved in engineering this framework, building an architecture that draws together routine facility data, community health worker records, civil registration data, geospatial data and survey data into a structured triangulation system. The design is deliberate. Rather than producing a standalone analytics product, MSDAT is being built so that its outputs can feed directly into DHIS2, the platform already embedded in Nigeria’s national health management information system.

The intent is to place subnational zero-dose intelligence inside the decision-making environment that the Federal Ministry of Health and the NPHCDA are already using, so that evidence arrives where resource decisions are actually being made. DHIS2 is also expanding its data triangulation capabilities, allowing countries to cross-analyse surveillance, immunization and logistics data within a single platform. This gives stakeholders stronger access to data insights on coverage, vaccine stocks, cold chain status and outbreaks of vaccine-preventable diseases.

MSDAT is designed to feed into and extend that capability for the Nigerian context. It is building the upstream triangulation layer that makes DHIS2’s existing analytical infrastructure more powerful by enriching it with data it cannot currently see on its own.

This work is not yet complete. MSDAT, at this stage, is an integration in progress, a solution being built and tested rather than a finished product. But the architecture is taking shape, and critically, it is being connected directly to the decision-making layer where it can produce real consequences for how immunization resources are allocated.

You are also leading DHIS2 training for leadership teams at the FMOH and NPHCDA. Why is that work as important as the technical architecture?

Because the most sophisticated data system in the world changes nothing if the people who control the money and the planning cycles are not sitting in front of its outputs with the confidence to act on what they see. That is the gap I am working to close from the human side, while MSDAT addresses it from the technical side.

Most DHIS2 training in Nigeria at this time is directed at data entry staff, facility-level officers and technical analysts. That is a real and important skill gap. But it is not the most consequential one. The most consequential gap is at the level of programme directors, department heads and senior officials; the people whose decisions determine which facilities get funded, which districts get prioritised for outreach, and how Nigeria’s limited immunization resources are distributed across a country of over 200 million people.

These leaders often receive DHIS2 dashboards and aggregate reports without the analytical literacy to interrogate what they are seeing, challenge the numbers, or use subnational divergence from national averages as a basis for redirecting resources.

The training I am leading is designed specifically for that audience. It is not about how to enter data or configure a tracker programme. It is about how a programme director or senior official can look at aggregated DHIS2 outputs, understand what the coverage maps are actually showing about zero-dose concentration, identify the LGAs and wards where the system is failing most severely, and use that evidence to make and defend equity-driven allocation decisions.

Political interests have historically interfered with primary healthcare resource allocation and distribution in Nigeria, with office holders sometimes directing development projects toward their own localities regardless of demonstrated need. Giving senior ministry and agency leadership the data confidence to push back against that pattern — to say this is what the evidence shows and this is where the resources must go — is not a secondary objective of the training. It is the primary one.

Through its partnership with WHO since 2017, DHIS2 has supported countries across Africa and Asia to integrate Expanded Programme on Immunization data into national health management information systems, empowering EPI programme managers and district staff to identify coverage gaps, reduce stock wastage and monitor cold chain metrics. The training I am delivering at the FMOH and NPHCDA takes that empowerment imperative further up the decision-making hierarchy than it has typically reached.

The goal is to ensure that the leaders who control the largest resource levers are not passive recipients of reports produced by others, but active and literate users of the data infrastructure their own agencies are responsible for.

How does this work connect to how immunization resources are actually allocated?

The connection is direct, and it runs through the Basic Health Care Provision Fund. The NPHCDA Gateway manages a major share of BHCPF disbursements and channels funds directly to primary healthcare facilities. A portion of that facility financing is allocated to essential drugs, vaccines and consumables. The BHCPF also funds essential interventions covering a significant share of Nigeria’s disease burden, with immunization and child health among its core priorities.

The vaccination data insights being surfaced through MSDAT triangulation and interpreted through trained ministry and agency leadership can become important inputs in how those allocations are directed. When subnational evidence shows clearly which wards and local government areas are generating zero-dose clusters, it creates a defensible evidence base for directing vaccine financing toward the highest-need facilities, rather than distributing it by political geography or historical precedent alone.

Nigeria is also increasing attention and funding toward routine immunization as part of the broader effort to close the immunization gap. But an increase in headline allocation only translates into equity outcomes when the data infrastructure and trained leadership exist to direct those resources toward where the evidence says they are most needed. That is precisely the function the MSDAT integration and the ministry training engagements are being built to serve.

Without this work, more money can flow into the system and still follow the same distribution patterns it has always followed. With it, there is a mechanism for the evidence to interrupt that pattern and redirect resources toward the children the system is currently failing to reach.

What does this mean for planning now?

It means that Nigeria’s immunization challenge is not only operational. It is analytical. The country is collecting information but is not consistently translating that information into precise action at the subnational level. The issue is not whether data exists. It is whether the decision-makers who control resources are equipped to use that data to locate the children still outside the system and defend equity-driven allocation decisions in environments where political convenience often carries more weight than demonstrated need.

That is why zero-dose children matter so much right now. They are not just children who have missed vaccines. They are the clearest sign that entire communities remain beyond the reach of routine health services, and that the planning and financing systems responsible for reaching them are operating without the analytical visibility they need. The MSDAT architecture and DHIS2 leadership training are designed to close exactly that visibility gap.

Why does this matter beyond immunization itself?

Because the same communities missing vaccines are almost always the same communities missing maternal care, nutrition services, disease surveillance and other basic primary healthcare services. The convergence is not coincidental. It reflects the same underlying patterns of structural exclusion that Nigeria’s health system has not yet found a way to systematically address.

In principle, the BHCPF financing mechanism exists to reach these communities. In practice, without the analytical infrastructure to show where need is most concentrated and without leaders trained to act on that evidence, the money does not consistently find the children who need it most. The MSDAT framework and DHIS2 leadership training are not immunization-specific interventions in the narrow sense. They are system-level investments in making Nigeria’s health financing architecture smarter, more evidence-driven and more accountable to the populations it is designed to serve.

Nigeria’s challenge now is not only about delivering more vaccines. It is about making the health system analytically visible enough to see who is being left out, and operationally capable enough to act on that picture with precision. That is the problem this work is designed to solve, and it is the reason the engineering of MSDAT and the training of decision-makers to use DHIS2 with genuine skill and confidence are not peripheral activities. They are the work itself.

Finally, where does this leave us?

It leaves us at the point where the gap is clear, and the response is beginning to take shape. The analytical response is being engineered and connected to the decision-making layer that can act on it. The leaders who need to understand it are being trained.

This is not a finished story. MSDAT is still an integration in progress, and the culture of data-driven resource allocation at the FMOH and NPHCDA is being built, not inherited. But the direction is clear. The architecture is taking shape, and the connection between subnational evidence, leadership capacity and BHCPF financing is being drawn tighter with each training engagement and each iteration of the triangulation framework.

The future of immunization in Nigeria will not belong to the system that celebrates the highest averages. It will belong to the system that can see the invisible, reach the excluded, and turn first contact into lasting protection. Until the children still outside the system are reached, that work remains unfinished. But the foundation for finishing it is being laid now.