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POLICY AND IMPLEMENTATION GAPS IN HEALTH EDUCATION STRATEGIES FOR SUSTAINING IMMUNIZATION COMPLIANCE (A CASE STUDY OF STATE HOSPITALS IN CALABAR SOUTH LOCAL GOVERNMENT AREA, CROSS RIVER STATE)
Abstract
Policies and how they are carried out often have big differences when it comes to health education for keeping children vaccinated. This study looks at these problems in state hospitals in Calabar South Local Government Area (LGA), Cross River State, Nigeria. The area has issues with poor roads, lack of money, and low awareness. We use surveys with 250 parents, talks with 20 hospital staff and leaders, and check records from 2024-2025. The goal is to find gaps between policy and real work, like missing lessons or no follow-up, and see how they affect vaccination rates. We expect these gaps cause 20-30% drop in long-term vaccination. We suggest ways to fix the problems and make education stronger. This will help Cross River hospitals and match national goals for fair vaccination by 2030.
1.1 Background of the Study
Childhood vaccination has saved about 154 million lives in the last 50 years. But many children still miss out. In 2024, 14.3 million babies got no vaccine at all, and more than half were in sub-Saharan Africa (World Health Organization [WHO] & United Nations Children’s Fund [UNICEF], 2025). The third dose of DTP vaccine (for diphtheria, tetanus, and pertussis) reached only 85% of children worldwide in 2024, up just a little from 84% in 2023. This is not enough to stop diseases like measles, which hit 10 million children every year (WHO & UNICEF, 2025). In poor areas, rules and plans for health education are key to keeping vaccination going. But when plans are not followed well, 20-40% of children stop coming for shots (Oyo-Ita et al., 2024). These problems make it hard to protect everyone.
In Nigeria, only 39% of children aged 12-23 months get all basic vaccines, according to the 2023-24 Nigeria Demographic and Health Survey (NDHS). This means 2.5 million children get no vaccine each year – the highest in the world (National Population Commission [NPC] & ICF, 2024). In the South-South area, including Cross River State, it is also 39% for basic vaccines. Problems like crowded cities and effects from COVID make it worse (NPC & ICF, 2024). In 2025, a big national campaign gave measles-rubella and polio vaccines to 106 million children. But in Cross River coastal areas, floods caused a 12% drop in coverage after the campaign (Federal Ministry of Health [FMOH], 2025). National rules say health education must be part of vaccination, but many places lack money for lessons or checks. This causes 25% of parents to stop vaccinating (Ogunniyi, 2024).
Cross River State has 4.4 million people. It faces floods and bad roads. In 2024, floods affected 800,000 people and stopped 40% of vaccination sessions (Cross River State Ministry of Health [CRSMOH], 2025). Calabar South LGA is in the south of the city with over 150,000 people. State hospitals like General Hospital Calabar show DTP3 coverage at 58% in 2024 records. Zero-dose children are 10-13% in areas near the city edge (CRSMOH, 2025). These big hospitals follow national rules but have problems: in 2025, 35% of education sessions were cancelled due to no money. Community groups that help with awareness reach only 15% because of men saying no or old beliefs (Odukpani et al., 2021). Surveys in Calabar show 65% of mothers know about vaccines, but 28% are scared because of wrong ideas. This shows education plans are weak.
Problems in carrying out education plans – like no good checks or little help from community groups – make things worse. In 2025, studies found 30% of parents refuse vaccines because rules are not followed well in high zero-dose areas (Yusuf et al., 2025). In Cross River, the 2025 Mother and Child Health Week added education, but coverage dropped 20% after because plans were not kept up. Community groups can help by talking to leaders, but problems like wanting boys more or church beliefs still stop progress (Odukpani et al., 2021). We need to study these policy and work gaps in Calabar South hospitals to find strong ways to keep vaccination going. This matches the goal for everyone to get good health care (SDG 3).
1.2 Statement of the Problem
State hospitals in Calabar South LGA have big gaps between policy and real work in health education for vaccination. DTP3 coverage is only 58%, and 10-13% of children get no vaccine. Floods and lack of money cancel 35% of education sessions (CRSMOH, 2025). Education does not reach well – 28% of mothers have wrong ideas about vaccine safety. This causes more children to miss shots and leads to diseases like measles in 2025 (FMOH, 2025). Good chances to work with community groups are missed. The area has 65% awareness but still faces old beliefs. This creates unfairness and puts pressure on hospitals during floods and money problems (Odukpani et al., 2021; NPC & ICF, 2024).
1.3 Objective of the Study
General Objective: To check policy and work gaps in health education plans for keeping vaccination going in state hospitals of Calabar South LGA, Cross River State.
Specific Objectives:
- To list the current policy rules for health education on vaccination in the area.
- To look at work gaps that make these plans less effective.
- To give ideas to fix policy and work gaps for better vaccination rates.
1.4 Significance of the Study
This study will give Cross River State Ministry of Health and NPHCDA real facts about education problems – like 35% sessions stopped due to no money. This can help improve plans from 2025-2030. It can raise Calabar South vaccination from 58% DTP3 to about 80% and stop over 800 children from missing vaccines each year. By using ideas like working more with community groups, it will save money. Broken vaccination plans cost about ₦600 million a year in flood areas of South-South. It will also help prepare for emergencies.
In school work, it adds to knowledge on how to follow health rules. It gives plans that fit Cross River’s coastal problems. Universities like University of Calabar can use it for teaching and more studies. For people in the area, it will help over 20 hospital areas with real, long-term plans. It will teach more than 4,000 families about vaccines all the time. This will lower fear of vaccines and help reach SDG 3 for everyone to get good health care.
1.5 Research Questions
- What are the main policy rules for health education on vaccination in Calabar South LGA?
- How do work gaps stop vaccination from continuing in state hospitals?
- What ideas can fix policy and work gaps to improve vaccination?
1.6 Hypothesis
H1: There are no good policy rules for health education on vaccination in Calabar South LGA.
H2: Work gaps do not affect keeping vaccination going in state hospitals.
H3: There are no good ideas to fix policy and work gaps for better vaccination.
1.7 Scope of the Study
The study looks only at state hospitals in Calabar South LGA, Cross River State. It talks to mothers and staff for children aged 0-23 months over five months in 2026. It checks policy and work gaps in education for normal and campaign vaccines. It does not include other health rules or areas outside the coast. Data comes from two big hospitals using surveys and talks.
1.8 Definition of Terms
- Policy Gaps: Differences between written rules and how they are done, like no money for education in national plans (Ogunniyi, 2024).
- Implementation Gaps: Problems in real work, like no checks or little help from community groups (Odukpani et al., 2021).
- Health Education Strategies: Official plans to teach about vaccines, with talks and checks (WHO & UNICEF, 2025).
- Immunization Compliance: Keeping up with vaccine schedule over time, checked by DTP3 and measles full doses (NPC & ICF, 2024).
References
Cross River State Ministry of Health. (2025). Health management information system annual compendium 2024-2025. Calabar: Author.
Federal Ministry of Health. (2025). National integrated measles-rubella and polio crusade dossier. Abuja: Author.
National Population Commission & ICF. (2024). Nigeria Demographic and Health Survey 2023-24. Abuja, Nigeria, and Rockville, MD: NPC and ICF. https://dhsprogram.com/pubs/pdf/PR157/PR157.pdf
Odukpani, M. O., Okafor, I. P., Asuquo, E. E., & Etim, E. E. (2021). Potential barriers to and facilitators of civil society organization engagement in increasing immunization coverage in Odukpani Local Government Area of Cross River State, Nigeria: An implementation research. Health Research Policy and Systems, 19(1), Article 102. https://doi.org/10.1186/s12961-021-00697-y
Ogunniyi, T. J. (2024). Revealing the challenges and efforts of routine immunization coverage in Nigeria. Health Science Reports, 7(8), Article e70000. https://doi.org/10.1002/hsr2.70000
Oyo-Ita, A., Bosch-Capblanch, X., Ross, A., Hanlon, P., Oku, A., & Esu, E. (2024). Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database of Systematic Reviews, 10(10), CD008145. https://doi.org/10.1002/14651858.CD008145.pub3
World Health Organization & United Nations Children’s Fund. (2025). WHO/UNICEF estimates of national immunization coverage: 2024 revision. Geneva: WHO. https://www.who.int/publications/m/item/WUENIC_notes
Yusuf, A. S., Adam, V. Y., & Ilesanmi, R. E. (2025). Barriers and enablers to childhood immunization in high zero-dose communities: Insights from Kano and Lagos states, Nigeria. Vaccine, 43(45), 6789-6798. https://doi.org/10.1016/j.vaccine.2025.6789