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Increasing Immunization Outreach Coverage in Kano State, Nigeria

Hi, I am Dr. Ahmad Tijjani Habibu, Director, Disease Control and Epidemiology at the Kano State Primary Health Care Management Board. Together with Tolulope Oginni, Project Manager at Acasus, I am pleased to share three key insights that enabled us to rapidly expand immunization outreach and coverage across Kano State, Nigeria.

At the beginning of 2025, we asked the question: why do thousands of children remain zero-dose despite living within reach of a health facility in Kano State?

One of the key issues was low outreach coverage, meaning immunization services were failing to reach many communities that cannot visit fixed health facilities. In July 2025, only 7% of communities across the 15 zero-dose local government areas (LGAs) in the state were visited; it was clear more needed to be done to reach the rest of the population.

Yet, by December 2025, the picture had changed. Outreach coverage had increased to 26% in that month alone, with 43% of communities reached across the whole year. This expanded footprint led to a steady rise in vaccinations: from 14,433 children in July to 15,417 in September, 18,274 in November, and 22,606 in December.

The most dramatic improvement was recorded in Tudun Wada – a local government authority previously notorious for failing to meet targets due to geography and security-related issues – where coverage surged from 6% in July 2025 to 63% in December 2025. In December, 2,185 children were vaccinated compared to 1,060 in July 2025.

Here are three things that helped turn the situation around.

Increasing clarity through a single source of truth

The government couldn’t reach zero-dose children because we simply couldn’t see them. Outreach was inconsistent, and reporting relied on anecdotes rather than facts. Without location-based data, there was no way to pinpoint exactly where teams had been or who was still missing.

The team created ‘data packs’ to get everyone on the same page. By using GPS mapping, they could pinpoint exactly which communities were being missed by vaccinators. This moved the system from guesswork to real-world tracking, allowing us to watch the map turn from red to green as vaccinators reached each area. The state is now seeing localised improvements with wards like Dalawa in Tudun Wada LGA moving from 0% outreach coverage in November 2025 to sustained 100% outreach coverage in 2026.

Driving results through routine and accountability

Better data is only transformative if it is used consistently. We introduced performance routines to shift the mindset at the local level. When local leadership and partners began using these data-backed routines to guide their approach and drive results, we began noticing rapid improvements. This forced a move away from meetings with no action towards real accountability.

What’s more, this created a healthy sense of competition amongst local leaders. When neighbouring government authorities saw an area like Tudun Wada recording massive gains, they redoubled their efforts. The effect was striking in Gabasawa, an LGA which sat at 6% outreach coverage for four straight months. After seeing the data from surrounding LGAs, the local team pushed their reach to 72%. Likewise, Kumbutso LGA saw its outreach coverage jump from 7% to 64% in just one month.

Collaborative problem-solving

We worked together as a unified team where the local government leads on execution while Acaus provides the tools, acting as scaffolding. By working side-by-side to identify and solve problems in real-time, officials are learning to lead this work themselves. The result is an emerging government-led culture of constant improvement that will continue to deliver results long after initial support.

By integrating our teams on the ground, we ensure that resources aren’t just spent on convenient or easily accessible locations, but the high-priority areas where they were needed most. The learnings from bright spots like Tudun Wada and Gabasawa are rapidly being applied to other areas across the state to drive quick, sustainable coverage gains. The state aims to achieve a target of 70% of outreach settlements within the 15 zero-dose LGAs visited per month by June 2026.

AUTHOR

Dr. Ahmad Tijjani Habibu

ROLE

Director, Disease Control and Epidemiology at Kano State Primary Health Care Management Board

AUTHOR

Tolulope Oginni

ROLE

Project Manager, Acasus

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Increasing Immunization Outreach Coverage in Kano State, Nigeria

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