CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Immunization is a highly effective form of immunotherapy utilized to combat numerous infectious diseases. It achieves this by triggering the immune system to generate targeted antibodies or lymphocytes, thereby combating harmful pathogens. In recent times, immunization has also emerged as a means of safeguarding against malignant tumors. The remarkable aspect of this immunotherapy is its ability to establish a lasting immunological memory, ensuring prolonged protection (Justiz et al., 2022). As a result, immunizations provide a safe, efficient, and economical approach to prevent and eliminate life-threatening infectious diseases.(Ozawa et al., 2017).
The achievements of vaccination in immunization span from eradicating smallpox worldwide to significantly reducing invasive infections caused by Haemophilus influenzae type b in developed nations (Valiquette and Bédard, 2015). As stated by the World Health Organization (2022), immunization presently prevents 3.5-5 million deaths each year by effectively combating diseases such as diphtheria, tetanus, pertussis, influenza, and measles.
Immunization plays a pivotal role in primary healthcare and is universally recognized as a fundamental human right. It serves as the foundation for global health security and has been recognized as a crucial tool in the fight against antimicrobial resistance. In Nigeria, Routine Immunization (RI) stands as a critical component of primary healthcare, acting as the primary point of contact between families, individuals, and communities and the national healthcare system (Alenoghena et al., 2014).
The primary healthcare system aims to bring healthcare services as close as possible to individuals' residential and work areas, serving as the initial stage of the ongoing healthcare process. Its core principle involves extending its services beyond its own facilities and delivering them directly to people's homes within its jurisdiction. In Nigeria, the primary healthcare system comprises three main types of healthcare centers: Comprehensive Health Centers (CHC), Primary Health Centers, and Basic Health Clinics (BHC) (Obionu, 2007).
While nurses predominantly administer vaccines in hospitals, hospital pharmacists can still play a crucial role in the process. With their extensive training in medication management, patient counseling, and ensuring the safe and effective use of pharmaceutical products, hospital pharmacists bring valuable expertise to the healthcare team. Their knowledge in pharmacotherapy and drug information positions them to make significant contributions to immunization administration and support.
However, in Nigeria, the extent of hospital pharmacists' involvement in immunization administration remains largely unexplored. This study aims to investigate the specific role of hospital pharmacists in administering and supporting immunizations within primary healthcare systems in Nigeria. The study will focus on the Basic Health Care Center in Uyo as a case study to provide insights into the involvement of hospital pharmacists in this critical aspect of healthcare.
1.2 Statement of the Problem
Since Edward Jenner's groundbreaking demonstration of the effectiveness of immunization in 1792, vaccination has increasingly become a pivotal strategy in the global fight against infectious diseases. In Nigeria, a country with a population exceeding 170 million, the under-five mortality rate stands among the highest worldwide, with 143 deaths per 1000 live births. Alarmingly, approximately 25% of these deaths could have been prevented through routine immunization (Eboreime et al. 2015).
Nigeria is composed of 37 states, including the Federal Capital Territory, encompassing a total of 774 Local Government Areas (LGAs). The Nigerian constitution establishes a significantly decentralized system of government, both politically and fiscally, where the responsibility for health is shared among the federal, state, and local tiers of government (Abimbola et al., 2014).
The federal government focuses on formulating policies, establishing guidelines, and delivering tertiary healthcare services. On the other hand, the states and local governments are responsible for secondary and primary healthcare (PHC) respectively. Specifically regarding immunization, the federal government takes charge of procuring vaccines, developing immunization guidelines, and offering technical support to sub-national governments through the National Primary Health Care Development Agency. However, it is the states and local governments that provide the necessary infrastructure and logistics for delivering routine immunization services.
The government of Nigeria has a policy in place to ensure that immunization services and effective vaccines are accessible to all individuals at risk, and at no cost. To promote equitable access, the federal government recommends that routine immunization services should be available within a 5km radius of any community (National Primary Health Care Development Agency, 2012).
However, findings from the 2016 Multiple Indicators Cluster Survey/National Immunization Survey Coverage (MICS/NICS) highlight a concerning trend in Nigeria. It reveals that a significant percentage of children aged 12 to 23 months have not received the complete set of routine vaccinations as recommended by the national Expanded Programme on Immunization (EPI) schedule. In fact, 77% of children in this age group have not received all the recommended vaccinations, while 40% have not received any vaccinations at all. These figures fall far below the national target of 90% set by the country (WHO, 2017).
Moreover, northern Nigeria faces particularly low immunization rates, which are among the lowest in the world. According to the 2003 National Immunization Schedule, the percentage of fully immunized infants in targeted states was remarkably low: less than 1% in Jigawa, 1.5% in Yobe, 1.6% in Zamfara, and 8.3% in Katsina. Consequently, numerous children in these areas suffer from vaccine-preventable diseases.
There are multiple factors contributing to these low immunization rates. One significant reason is the ineffectiveness and deterioration of primary healthcare services, primarily due to inadequate investment in personnel. The Federal Government acknowledges that dysfunctional primary healthcare systems and a shortage of healthcare workers are major obstacles in Nigeria's progress towards achieving Universal Health Coverage (Ophori et al., 2014).
While the administration of vaccines is traditionally not considered part of the responsibilities of hospital pharmacists, their knowledge and expertise in vaccine provision enable them to contribute to vaccination efforts in various healthcare settings. However, the specific role of hospital pharmacists in administering and supporting immunizations within primary healthcare systems in Nigeria is yet to be fully explored and recognized. Therefore, this study aims to address this knowledge gap and shed light on the potential contributions of hospital pharmacists in this important area.Thus this aims to fill this gap in knowledge.
1.3 Aim of the Study
This study aims to investigate the role of hospital pharmacists in administering and supporting immunization in primary health care systems in Nigeria, with a focus on the Basic Health Care Center in Uyo.
1.4 Objectives of the Study
The study had the following specific objectives:
- To identify the roles of hospital pharmacists in administering and supporting immunizations in primary health care systems in Nigeria, using the Basic Health Care Center in Uyo as a case study.
- To determine the impact of hospital pharmacist interventions in administering and supporting immunizations in primary health care systems in Nigeria, using the Basic Health Care Center in Uyo as a case study.
- To propose recommendations for improving the role of hospital pharmacists in administering and supporting immunizations in primary health care systems in Nigeria
1.5 Research Questions
- What are the roles and responsibilities of hospital pharmacists in administering and supporting immunizations in primary health care systems in Nigeria, using the Basic Health Care Center in Uyo as a case study?
- What is the impact of hospital pharmacist interventions in administering and supporting immunizations in primary health care systems in Nigeria, using the Basic Health Care Center in Uyo as a case study?
- What recommendations can be made to improve the role of hospital pharmacists in administering and supporting immunizations in primary health care systems in Nigeria?
1.4 Research Hypothesis
H0: Hospital pharmacists do not play significant roles in administering and supporting immunizations in primary health care systems in Nigeria
Ha: Hospital pharmacists play significant roles in administering and supporting immunizations in primary health care systems in Nigeria
1.7 Justification of the Study
The study on the roles and responsibilities of pharmacists in administering and supporting immunizations in primary health care systems in Nigeria is crucial for several reasons. Firstly, Nigeria has one of the highest burdens of vaccine-preventable diseases in the world, and improving immunization coverage is a critical public health goal. Secondly, while hospital pharmacists are recognized as key players in immunization administration, their specific roles are not well understood.
The study will help to identify the specific roles of hospital pharmacists in immunization administration and support and assess the impact of pharmacist interventions on immunization coverage. By using the Basic Health Care Center in Uyo as a case study, the study will provide a detailed and context-specific analysis of the impact of hospital pharmacist interventions in administering and supporting immunizations in primary health care systems in Nigeria. This will enable the identification of best practices and areas for improvement, which can be used to inform policy and practice at the national level.
Finally, the study will provide recommendations for improving the role of hospital pharmacists in administering and supporting immunizations in primary health care systems in Nigeria. These recommendations will help to address the challenges faced by the Nigerian healthcare system in achieving adequate immunization coverage and will contribute to the overall goal of improving public health outcomes in the country. Overall, the study has significant implications for improving immunization coverage and reducing the burden of vaccine-preventable diseases in Nigeria, making it a crucial area of research.
1.8 Scope of the Study
The study will focus on the roles and responsibilities of hospital pharmacists in administering and supporting immunizations in primary health care systems in Nigeria, with a specific focus on the Basic Health Care Center in Uyo. The study will primarily utilize qualitative research methods, including interviews and observations, to gather data and insights from hospital pharmacists involved in immunization services at the selected facility. It is important to note that the study will be limited to the Basic Health Care Center in Uyo and may not be generalizable to other primary health care systems in Nigeria.
