Seeking Insights in Vaccine Equity & Health Accountability



Two years ago, we started monitoring COVID-19 funds across African countries with support from our donors(Skoll & Hilton foundation). Since then, we have covered nine countries. In the project’s first phase, we covered seven countries: Nigeria, Ghana, Liberia, Sierra Leone, Malawi, Cameroon and Kenya. In the second phase of the project, which is currently running, our work has expanded to two additional countries; Zimbabwe and Senegal.

Globally, the COVID-19 crisis has severely impacted the prices of commodities, inflation rates and day-to-day businesses, and Africa has not been left out of the challenges. From the start of the pandemic till now, we are still mapping ways to stimulate the economy and ensure equity in vaccine distribution across Africa for wholesome recovery.

Our goal has always been to facilitate and ensure transparency and social accountability on COVID-19 resources, scale-up issues of vaccine equity in focus countries, and mobilise civil society and government stakeholders for health sector system strengthening. CTAP has enabled us to create a coalition of media and civil society organisations across Africa with a dedicated focus on health sector accountability and vaccine equity.

In the first phase of this project, we produced ten quality research across seven countries. Seven reports focused on the Incidence of COVID-19 and resource management in each of the countries. The research work across Nigeria, Liberia, Cameroon, Kenya, Ghana, Malawi, and Sierra Leone, assessed, investigated and understood the overall response of the Governments of these countries toward COVID-19 interventions. The research carefully critiqued the reallocation, disbursement, and expenditure of the donated COVID-19 resources in focus countries. The research also helped to ascertain the obstacles faced by these countries in their response to COVID-19. 

For example, we discovered that the Governments of Liberia, Nigeria and Sierra Leone,  for emergency purposes, instituted Incident Management Systems and a Special Task Force Committee on COVID-19. These special task force committees were saddled with making and coordinating decisions for the government. In Malawi, Cameroon and Nigeria, we discovered how difficult it was to get the expenditure data on COVID-19. In Nigeria, the team could not access the audited statements of the expenditure of COVID-19 finances. Also, our research discovered that all our focus countries didn’t stop declaring lockdowns during the heat of the pandemic, which had spiralling effects on various economies. We also looked into each government’s efforts in getting vaccines in their country to help mitigate the pandemic’s impact on the people and the economy. 


One of the research papers by Oxlade consulting under the project’s first phase focused on the Fiscal Impact of the COVID-19 pandemic, global vaccine financing, most especially in Africa and the role of civil societies towards epidemic preparedness in each focus country. It was discovered that across Nigeria, Kenya, Cameroon, Liberia, Ghana, Malawi and Sierra Leone, the pandemic either increased poverty rates, reduced projected income, increased unemployment or negatively affected the budget projections of each country. Oxlade dived into epidemic preparedness and steps being taken globally towards vaccine access and development. In the new phase of the research work, questions about vaccine equity will be answered. 

Furthermore, we reviewed the status of Primary Health care in Nigeria and scored the government based on the global standards of practice in primary health care. We also uncovered the massive deficit in infrastructure development and how the low morale of healthcare personnel affects the quality of care provided to citizens. 

Eduplana researched the unintended consequences of the pandemic on Nigeria’s education sector. We discovered that the psychological, economic and professional impact of the COVID-19 pandemic was brutal to teachers. Similarly, in Liberia, the government tried to provide $1m as relief for school teachers, which was marred by mismanagement, further aggravating the situation of the teachers. In Malawi, findings showed that despite the allocation of huge funds through the ministry of education and district councils, there were no tangible results to show for it.

While phase one gave us insights into resource management, vaccine production and distribution, and the unintended consequences of COVID-19 on the economy, phase two focused on spotlighting vaccine equity and the state of accountability of the Health Sector in our focus countries. We have focused on Health Sector accountability across all the nine countries and Vaccine Equity specifically in Kenya, Malawi and Ghana

Across the nine countries, we have carried out research which spans the health sector accountability and taken it a step further in Kenya, Malawi and Ghana to review vaccine equity and distribution. The Health Sector Accountability reports dissected the political economy of health care, legislative oversights, systemic challenges, financing and fiscal management of each country, and perceptions of citizens towards health care access and quality.

Our study in Nigeria, Sierra Leone, Ghana, Senegal, Kenya and Liberia has shown that the Abuja declaration of spending 15% of the total budget on health has not been fulfilled across these countries. While this remains a challenge and puts the healthcare structures under pressure, the CTAP project has enabled us to commence advocacies to get the government to increase its investments in the health sector . 

The research also discovered that 70% of the payment for treatments across Nigeria and Sierra Leone comes from private pockets, which points to low healthcare insurance investments in these countries. In addressing this gap, we applaud the signing into law of the new NHIA (National Health Insurance Authority) by President Muhammadu Buhari of Nigeria, which repeals the National Health Insurance Scheme of 1999. This means that it is now mandatory for all Nigerians to have health insurance, a move that will influence a drastic reduction in the population of Nigerians who pay out of pocket to cater for health needs. 

In Nigeria, Zimbabwe and Sierra Leone, we discovered that while oversight parastatals are supposed to be the watchdog between the patients and the healthcare centres, they have not been fully maximised. Servicom in Nigeria, MoHS in Sierra Leone and the anti-corruption act in Zimbabwe all need to be strengthened to perform oversight functions and enable the health sector function optimally. CTAP has allowed us to lead advocacies in this line through our institutional visits to share insights and deliberate on reforms with the government and other relevant stakeholders. 

The problem of low pay has resulted in a massive decline in the health sector’s workforce, and has been a challenge in some of our focus countries. During our research, we discovered that Nigeria and Ghana are third and fifth on the red list of the WHO, an indicator of countries in dire need of health workers, and developed economies shouldn’t poach the existing workers. However, public opinion reveals otherwise. While collating citizen voices, we discovered that the recent rise in the migration of health workers, mainly from Nigeria, Ghana and Sierra Leone, to developed economies is due to the deplorable treatment they receive in their respective countries. In our advocacy engagements, we have called on both the federal government and state governments to, as a matter of urgency, review the working pay and conditions of this demographic as it poses a significant risk to the well-being of the affected countries. 


We have also discovered the need for the private sector to increase investments in the healthcare sectors of countries like Ghana, Liberia, Zimbabwe, Cameroon, Kenya, Sierra Leone and Malawi. These private investments in health will contribute to the quality of healthcare and reduce the pressure on the minimal government health centres in these countries. In Sierra Leone, citizens must travel to the city to access what looks like standard health care, which is often counterproductive as life-threatening cases need to be attended to on the spot. Through CTAP, our coalitions have helped bring some private sector practice entrepreneurs into the room to discuss the needs and investment opportunities, as this will help provide the facilities needed and, in turn, give a return on investment to the private sector investors. 

What did we find researching COVID-19 Vaccinations?

It is important to highlight our discoveries on vaccine equity in Ghana, Malawi, and Kenya and what CTAP is doing to ensure our recommendations in these countries are actualised.

Vaccine deployment has been ongoing globally for approximately one year and six months. With the rate at which COVID-19 ravaged the world and the global economy, ideally, we should be at a 90% vaccination rate. But right now, we are at a 65% vaccination rate which is considered an outstanding development. The significant challenges we have identified include information management by the government, myths making rounds via different media channels, religious beliefs, and the lack of proper vaccine storage systems.

We have mapped out solutions to assist the government’s efforts in tackling vaccine hesitancy and scaling up the vaccination numbers in Ghana, Kenya and Malawi. Our research recommends that these countries take time to understand the media landscape and its complexities; Governments should add COVID-19 vaccination to the list of regular vaccines and ensure availability for every citizen. They should also work with the ministry of health to include community members and healthcare workers in designing and disseminating vaccination campaigns.

To give life to all the recommendations we have discussed, CTAP will implement social media campaigns, advocacy meetings and additional coalition meetings to increase the vaccination rate in our focus countries. We believe our campaigns will reduce the public distrust of the COVID-19 vaccine and encourage religious leaders to promote vaccine acceptance. We also want to mainstream COVID-19 vaccination into national immunization plans. 

While we understand the work is progressive, we also acknowledge the challenges. We intend to continuously use research instruments to drive policy changes, lead advocacies and adequately express the local contexts of the communities where CTAP is domiciled.