1.1 Background of the study

Routine immunization delivered through primary health care (PHC) is the backbone of childhood vaccine programmes and a major driver of reductions in vaccine-preventable diseases. Delivering high-quality immunization services requires not just vaccine supply but functioning cold chain and waste management, trained staff, reliable data systems, infection prevention and control, and community outreach capacity (World Health Organization, 2022). International facility-assessment frameworks such as the WHO Harmonized Health Facility Assessment (HHFA) and Service Availability and Readiness Assessment (SARA) provide standard tracer indicators that quantify both service availability and service readiness for immunization; these frameworks show that service-specific readiness (cold-chain equipment, vaccine stock management, trained staff and routine outreach) is a sensitive predictor of whether facilities can deliver reliable, high-quality immunization services (World Health Organization, 2022).

Recent facility-level studies from multiple Nigerian states show persistent gaps in PHC readiness for immunization: shortages or malfunctioning cold-chain equipment, intermittent vaccine stock, variable staff training in cold-chain and immunization safety, and weaknesses in facility-level microplanning and outreach capacity (Oluwole et al., 2022; Gbeminiyi & Ajayi, 2025). Evaluations of multi-partner investments and program strengthening approaches in Nigeria indicate that improvements in financing, cold-chain investment (including solar refrigerators), and regular supportive supervision are associated with measurable increases in service delivery and coverage — but that human-resource instability, weak routine data use and insufficient community engagement continue to limit sustained improvements (Dougherty et al., 2024; Gbeminiyi & Ajayi, 2025). In parallel, scoping evidence on medicines and vaccine supply chains documents chronic logistical bottlenecks in procurement, distribution, inventory management and equipment maintenance that frequently translate into stock-outs at the facility level (Olutuase et al., 2022). Taken together, these findings indicate that facility readiness is multidimensional (infrastructure, workforce, logistics, governance and community linkages) and that measuring these dimensions at the local level is essential to target improvements that will increase both the quality and reliability of immunization services.

1.2 Statement of the problem

Obio-Akpor LGA is an urban/peri-urban district of Rivers State with a high population density and a mix of formal and informal settlements that rely heavily on PHC facilities for routine child health services. Although state-level and national immunization statistics provide broad coverage estimates, they do not reveal facility-level heterogeneity in readiness or service quality within LGAs; few recent, published, locality-specific facility assessments exist for Obio-Akpor (Oluwole et al., 2022; Dougherty et al., 2024). Program managers frequently observe operational problems at PHC level — cold-chain outages, missed outreach sessions, incomplete micro-plans, inconsistent documentation and variable staff confidence in vaccine safety and AEFI (adverse events following immunization) management — but these are usually reported anecdotally rather than measured with standard tracer indicators. Without a systematic readiness and quality assessment at the PHC level, Obio-Akpor health authorities cannot reliably prioritise investments (for example: solar refrigerators vs. staff training vs. supervisory visits), nor can they quantify which gaps most constrain timely, high-quality immunization (Gbeminiyi & Ajayi, 2025; Olutuase et al., 2022).

Moreover, recent program evaluations in Nigeria show that financing mechanisms and partner investments can improve certain readiness domains (cold chain, outreach) but may not address workforce stability, data-for-action processes, or community trust without concurrent governance and social-mobilisation measures (Dougherty et al., 2024). Given the high population density and mobility in Obio-Akpor, small, facility-level service failures (missed sessions, stock-outs, or poor AEFI communication) can create local vulnerability pockets that put large numbers of children at risk of missed or delayed vaccination. A focused, facility-level assessment using standard HHFA/SARA tracer indicators is therefore necessary to describe the current readiness and quality of immunization services, identify modifiable bottlenecks, and recommend targeted, cost-effective actions for Obio-Akpor LGA (World Health Organization, 2022; Gbeminiyi & Ajayi, 2025).

1.3 Aim and objectives of the study

Aim: To assess health-service readiness and the quality of routine immunization services in primary health facilities serving Obio-Akpor Local Government Area, Rivers State, and to identify facility-level determinants that limit reliable vaccine delivery.

Specific objectives:

1. Measure facility-level immunization service readiness using standard tracer indicators (cold-chain equipment and power reliability, vaccine stock records, availability of safety boxes and waste disposal, presence of updated micro-plans, and trained immunization staff).
2. Assess key quality dimensions of routine immunization delivery (regularity of fixed and outreach sessions, completeness and timeliness of immunization registers and tally sheets, availability and use of AEFI reporting and management procedures, and user-facing elements such as session timeliness and caregiver counselling).
3. Describe facility governance and data-use processes (frequency of supervisory visits, availability and use of DHIS2 or facility registers for immunization planning, and presence of budget lines for vaccine logistics).
4. Identify associations between facility readiness indicators and service outputs (monthly doses delivered, session cancellations, stock-out frequency) and propose prioritised, evidence-based interventions (equipment, training, supervision, cold-chain maintenance, microplanning, community engagement).
5. Produce an implementation brief for Obio-Akpor LGA that sequences short-term (“quick wins”) and longer-term investments and recommends monitoring indicators to track progress.

1.4 Research questions

1. What proportion of PHC facilities in Obio-Akpor meet WHO HHFA/SARA tracer standards for immunization readiness (cold chain, vaccine availability, trained staff, and waste management)?
2. What are the common quality gaps in routine immunization delivery (session cancellations, stock-outs, incomplete records, poor AEFI management) at the PHC level in Obio-Akpor?
3. How do facility-level readiness indicators (cold-chain functioning, staff training, vaccine stock-outs) correlate with routine immunization outputs (monthly vaccine doses, session frequency, coverage proxies)?
4. What governance and supply-chain constraints (budgeting, supervision, maintenance arrangements) most strongly limit facility readiness in Obio-Akpor?
5. Which targeted interventions—ranked by expected impact and feasibility—should Obio-Akpor LGA prioritise to rapidly improve immunization service quality and reliability?

1.5 Scope of the study

Design: Cross-sectional facility assessment using a mixed methods approach: standardised HHFA/SARA-based facility checklist (quantitative), routine data extraction (monthly doses, stock-out logs), and a small set of qualitative interviews with facility in-charges, cold-chain technicians and LGA immunization officers to explain operational constraints.

Area of study (single area of study): Primary health facilities serving Obio-Akpor Local Government Area, Rivers State. The sampling frame will include all government PHC facilities offering routine immunization in Obio-Akpor; if the number is large, a stratified random sample (urban wards / peri-urban wards) will be used to ensure representativeness.

Population & inclusion criteria: PHC facilities (government-run) providing routine immunization in Obio-Akpor LGA that have operated for ?6 months. Key informants: facility in-charges, immunization focal persons, and LGA immunisation program staff.

Instruments & measures:

• Facility readiness checklist adapted from WHO HHFA/SARA immunization tracer items (cold chain presence/condition and power source, temperature log availability and record keeping, vaccine stock cards and stock-out history, training records, safety boxes, waste management practice).

• Quality module: review of the last 6 months of session plans and tallies (session frequency, doses delivered, cancellations), AEFI log and caregiver counselling observations, and client exit questions on service experience (short module).

• Governance module: interview checklist for supervisory cadence, budget lines for vaccines/maintenance, maintenance contracts for cold-chain equipment, and community outreach support (CHV lists, defaulter tracking).

• Qualitative guides for 10–15 in-depth interviews exploring causes of stock-outs, maintenance practices for cold chain, staff training gaps and practical solutions.

Sample & sampling: Census of all PHC facilities in Obio-Akpor if ?40 facilities; otherwise stratified random sampling of 30–40 facilities with PPS to represent wards. Key informant purposive sampling for qualitative interviews (facility in-charge, LGA RI officer, cold-chain technician).

Analysis: Descriptive facility readiness scores (proportion meeting each tracer item and composite readiness index), cross-tabulation of readiness vs outcome measures (stock-out days, session cancellations), and regression analysis to test facility predictors of higher monthly service output. Thematic analysis of qualitative interviews to explain supply-chain, maintenance and governance bottlenecks and to identify feasible corrective actions.

Ethics & dissemination: Institutional ethical approval and LGA permissions will be obtained. Findings will be shared as a concise implementation brief and presentation to Obio-Akpor LGA health management, with recommended prioritised actions and simple monitoring indicators for follow-up.

Policy relevance: This locality-specific assessment will equip Obio-Akpor health managers with facility-level evidence to prioritise investments (for example, targeted cold-chain upgrades, scheduled maintenance contracts, focused staff training and strengthened supervisory schedules) that are most likely to increase both the quality and reliability of routine immunization services and to close local gaps that national aggregates conceal (World Health Organization, 2022; Gbeminiyi & Ajayi, 2025; Dougherty et al., 2024).

References

Dougherty, L., Adediran, M., Akinwumi, A., Alabi, M., Etim, E.-O., Ohioghame, J., & Adedimeji, A. (2024). An evaluation of a multi-partner approach to increase routine immunization coverage in six northern Nigerian states. BMC Health Services Research, 24, Article 951.

Gbeminiyi, O. T., & Ajayi, I. O. (2025). Evaluation of immunization service delivery in primary healthcare centers in Akinyele and Lagelu local government areas, Oyo State, Nigeria. SAGE Open Medicine, 13, Article 20503121251352974. https://doi.org/10.1177/20503121251352974

Oluwole, E. O., Adeniran, A., Chieme, C. F., Ojo, O., Akinyinka, M. R., Ilesanmi, M. M., Olujobi, B., & Bakare, O. Q. (2022). Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria. African Journal of Primary Health Care & Family Medicine, 14(1).

Olutuase, V. O., Iwu-Jaja, C. J., Akuoko, C. P., Adewuyi, E. O., & Khanal, V. (2022). Medicines and vaccines supply chains challenges in Nigeria: A scoping review. BMC Public Health, 22, Article 11.

World Health Organization. (2022). HHFA service-readiness: Core questionnaire — October 2022. World Health Organization. Accessed from https://www.who.int/publications/m/item/harmonized-health-facility-assessment-service-readiness-core-questionnaire-october-2022