By Rakiya A.Muhammad
Umm Nasir, 31, entrusts her six-month-old child to a trustworthy neighbour to take her to the Gagi Primary Healthcare Centre in Sokoto State, Northwest Nigeria, for routine immunisations. According to medical experts, vaccines protect against various illnesses at different stages of life, from birth through childhood, adolescence, and old age.
However, Umm cannot personally take her infant for it due to her husband’s refusal, stemming from his vaccine hesitancy, a concern recognised by the World Health Organization as a significant threat to public health.
It is typical in conservative civilisations, such as Umm’s, for a woman to get her husband’s permission before stepping out.
Many males in the Gagi Community have known the need for immunisation and gladly allow their wives to bring their children to the PHC for vaccination. However, some conservative spouses remain oblivious to the significance and, as a result, are uncooperative with the practice despite community-wide attempts to increase routine immunisation.
Therefore, it is commonplace for Gagi women in comparable circumstances, such as Umm’s, to enlist the aid of others to take their children for vaccination.
Medical professionals assert that children are at risk of severe illness and incapacity from numerous avoidable diseases if they do not receive immunisations.
“Vaccination can mean the difference between life and death,” remarks Dr. Bilyaminu Yari Sifawa, The Director of Sokoto State’s Department of Disease Control and Immunization.
“It is the first line of defence against various diseases: measles, diphtheria, tetanus, whooping cough (pertussis), tuberculosis, hepatitis, flu, polio, yellow fever, dengue, cervical cancer. It can protect against pneumonia, which kills more than 700,000 children a year. It can prevent diarrhoea, which kills more than 484,000 a year.”
He adds, “It not only saves an estimated 4.4 million lives annually. It also improves the health and wealth of individuals and communities. It helps children not only survive but also thrive.”

Sifawa characterises vaccination as humanity’s paramount public health accomplishment, highlighting its exceptional efficacy and cost-effectiveness.
However, he observes that some parents do not perceive preventable illnesses as grave or potentially deadly and would rather abstain from introducing further toxins into their children’s bodies.
Other parents, he finds, believe that if their children have good diets and lifestyles, they are less likely to catch preventable childhood ailments due to their financial stability.
“Vaccines are as important to your overall health as diet and exercise;vaccines will help keep you healthy ” the Director points out.
“Vaccinations not only protect your child from deadly diseases, such as polio, tetanus, and diphtheria, but they also keep other children safe by eliminating or greatly decreasing dangerous diseases that used to spread from child to child.”
Umm acknowledges the significance of immunisation and is always ready to ensure that her infant adheres to the prescribed schedule.
“I made sure that my newborn received the essential vaccinations upon delivery and at six weeks, ten weeks, fourteen weeks, and six months,” she states.
“I’ll ensure he completes the remaining ones as scheduled.”
The women of Gagi are incredibly knowledgeable about vaccinations. They welcome the vaccinators who come to their homes as part of the house-to-house vaccination programs, and they make it a point to get their children to the health facility on time for their scheduled immunisation.
These women have shown commendable initiative, especially in a country with many children without immunisations.
According to the State of the World’s Children report, out of 67 million children who missed routine immunisation between 2019 and 2022,48 million did not receive a singular regular dose (zero dose children).
UNICEF reports that zero-dose children account for nearly half of all vaccine-preventable fatalities.
Nigeria has the second-highest number of children who have never received a vaccination, totalling 2.2 million.
Dr Maryam Darwesh Said, Chief UNICEF Field Office Sokoro, reveals they are now focusing on reaching these zero-dose children with a select top 100 zero-dose local government areas in 18 states targeted.
She names Sokoto, Kebbi, and Zamfara as the states with the highest burden of unimmunised children, saying that 186,452 children in three states have not received a single dose of any vaccine in the Routine Immunization Schedule as of December 2022.
Of the total, 122,015 are in Sokoto alone, where more zero-dose children are present in 13 local government areas: Bodinga, Dange Shuni, Gada, Goronyo, Gwadabawa, Kware, Rabah, Sabon Birni, Shagari, Sokoto South, Tambuwal, Wamako, and Wurno.
Stakeholders in Sokoto are escalating their efforts to address zero doses by enhancing service delivery and increasing coverage by implementing routine immunisation surge intervention and state outreach days. They are also improving the supply chain and logistics.

However, all hands must be on deck to ensure no child goes without immunisation.
Despite its location in Sokoto South, one of the thirteen Local Government Areas (LGAs), the community of Gagi distinguishes itself via its exceptional immunisation efforts, which many attributed to the exemplary leadership and coordination demonstrated by the traditional leader of the locality.
“It’s difficult to identify any house with zero doses,” Alhaji Sani Umar Jabbi, the District Head of Gagi, proudly asserts.
“We provide the health facility with supportive supervision and follow-up monitoring and rallying the males, who hold significant authority in making decisions for their families and communities. They can let or restrict their women from accessing opportunities and services outside the home.”
A trip to Gagi PHC reveals several mothers with their children waiting to receive their shots. One of them, Hadiza Ali, believes in immunisation and facility visits following her direct observation of their efficacy in preventing childhood diseases and preserving lives.
Many other mothers polled showed an adequate understanding of immunisation and related health issues.
From where did these rural women acquire such extensive knowledge?
“We enlighten them,” asserts Malama Hawwau Sarki, Gagi women’s leader.
“We built the capacity of women in this community on health concerns such as routine immunisation following the training we had received, including under the breakthrough action programme, Plan Aspire and Plan International.”
Malama Hawwau also discloses that as leaders, they contribute to giving out items such as soap, matches, and detergents to women who attend enlightenment programs to encourage them to come.
“Gagi is a community where women willingly bring their children for vaccination. Every Wednesday at this facility, you will observe several children’s immunisation,” she confidently states.
“Previously, children receiving immunisation get an amount of N500, but now they have raised it to N1000. The availability of funds supports their access to immunisation services, which benefits their well-being.”
Maryam Usman, hailing from another local government area, Denge Shuni, expresses her utilisation of the Gagi health centre because of her admiration for its efficient healthcare delivery system.
Many others also come from other parts of the State, a trend that the district head credits to high-quality services.
“PHC Gagi is no longer just for Gagi; five to six local governments use the services here. If you go to Gagi’s daily outpatients, it’s beyond the operational capacity of every PHC in Sokoto,” he explains.
“Day in and day out, clients come from Kware, Rabah, Wurno, Dange Shuni, and other parts of Sokoto; they patronise it because of the quality services delivered. Further, we are providing 24-hour service.”
Alhaji Jabbi, who assumed the throne around 19 years ago, reflects on the community’s transformation.
“On January 29, 2005, I was turbaned as this community’s district head.” He says, “I came to meet the hospital as a home for donkeys, goats, and horses,” describing how they abandoned the premises with stray animals taking it over.
“I proceeded to rally the community behind our cause, and generous individuals began purchasing necessities like doors, windows, desks, and chairs for our medical staff. We also pushed the local government to assign us highly qualified community health workers.”
He adds: “We successfully restored the lost prestige of the drug revolving fund. We began acquiring clients and providing support, eventually expanding our services to routine immunisation. Initially, we purchased paracetamol to alleviate the pain experienced after vaccination in response to complaints.”
“From a small number of individuals, one, two, fifty, sixty, and today, to a significantly larger group of people, it’s enormous. Watching the vaccination queue will give you a sense of the number of ladies who show up. We won back the trust of the masses by consistently delivering excellent service.”
The traditional leader prioritises leading by example, particularly in instances involving the acceptance of new practices.
“As a leader, it is important to lead by example. If you want children to be immunised, your child should be the first to receive the immunisation. If it is family planning, your wife has to be number one,” he says.
“When the coronavirus vaccination came to Sokoto, I was the first person here to receive the first, second, and booster doses. When they immunised me the first time, it was with a group of 150 people; when they immunised me again, it was with 215 people. When leaders model the behaviour they preach, followers follow.”
A highly enlightened traditional leader, whose authoritative demeanour commands community respect, has successfully influenced the behaviour of several men in their roles as heads of the household and the community.
He coordinates the participation of males, females, girls, and boys in the community, ensuring inclusivity.
“We engage communities in ensuring that we hold the government responsible for delivering high-quality healthcare services, including immunisation, family planning, facility delivery, antenatal care (ANC), nutrition, Oral Rehydration Therapy (ORT), water, sanitation, and hygiene (WASH), among others,” he avers.
“Today, there is a lot of demand for the services, and we are holding the government to its supply promises. We are challenging the government to guarantee sustainable supply chain management to facilitate the advancement of Sokoto state.”