Assessment of Immunisation Demand Generation Strategies in Hard-to-Reach Communities in Kebbi State

Hard-to-reach communities in rural north-western Nigeria represent persistent gaps in immunisation programme coverage, and effective demand generation strategies adapted to their geographic, cultural, and logistical characteristics are essential for achieving universal vaccination. This study assessed the effectiveness of immunisation demand generation strategies in hard-to-reach communities in Kebbi State, North West Nigeria. A mixed-methods evaluation was conducted in eight hard-to-reach communities across Augie, Gwandu, and Suru LGAs identified through NPHCDA mapping. Programme documents, community mobiliser activity records, and health facility immunisation register data were reviewed for a 24-month period (2022 to 2023). Focus group discussions were conducted with 32 community members and caregivers. Coverage data from DHIS2 were used to assess programme impact. Results showed that communities receiving social mobiliser visits at least twice monthly showed 28.6 percentage point higher full immunisation coverage compared to communities receiving monthly or less frequent visits. Community health committee engagement was significantly associated with reduced vaccine refusal rates (p < 0.01). Religious leader endorsement was cited as the primary demand driver by 71.9 percent of focus group participants. Supply stockouts negated demand generation gains in 37.5 percent of communities during the period. The study recommends minimum monthly social mobiliser visit standards, religious leader communication training, and integrated supply and demand management for hard-to-reach immunisation in Kebbi State. Keywords: immunisation demand generation, hard-to-reach communities, Kebbi State, vaccination coverage, North West Nigeria