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At 7:45 am, Mustapha Shuaibu steps out of his sand-brick house in a crisp, clean white uniform, starts his motorcycle, and heads out along a sandy path toward a nearby health center to collect vaccines. As the manager and routine immunization officer of a tiny clinic in the village of Damba, in the area of Argungu, he is responsible for safely moving the vaccines from a storage facility to his clinic–which lacks the right refrigeration to store the vaccines. These steps help ensure that the children who come to the clinic that day are vaccinated.

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In this remote and insecure area of northwestern Nigeria, going anywhere is challenging due to rough terrain, the harmattan winds that blow dry sandy air in from the Sahara, and the dangers of armed groups that are known to raid towns and steal property. Mustapha will go through security checkpoints 12 times on this day, to and from Damba village.

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The region suffers from extreme poverty, worsened by climate change’s impact on agriculture. Approximately 40% of children in the state have never received any vaccinations (New Incentives coverage surveys show that the rate may actually be closer to 50% in Kebbi). These low vaccination rates contribute to high rates of child mortality: 18 out of 100 children in Kebbi die before their fifth birthday. ‍

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‍Like many in the area of Argungu, Mustapha is a rice farmer. When not at Damba Clinic, he's tending to his farm, his primary source of livelihood. Mustapha understands that most caregivers visiting the clinic are like him––struggling to make ends meet through farming the arid land, often supplementing their income with a small business or other work––and may feel too busy to come to the clinic at all. If he arrives late, caregivers who showed up early might leave, so he moves quickly.‍

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‍The day before, he had already moved the vaccines to a larger nearby clinic with a vaccine refrigerator. This saved him time on the morning of the immunization day, but it still took substantial time and effort. He says he receives ₦500 per month for vaccination transport costs, but he spends about ₦2,000 each immunization day just to buy fuel.

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At Nachini Clinic, he carefully collects the designated number of vaccines he stored the day before, puts them in a blue vaccine cooler, and straps it securely to his motorcycle. He then sets off again down a paved road through several checkpoints before turning down a dirt path to reach Damba Clinic. 

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The Immunization Day Begins

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When Mustapha arrives at the clinic in Damba, New Incentives field officer Sanusi Musa is waiting for him. Inside, the one-room clinic is sparsely furnished with three chairs, some mats that serve as the waiting area, and a dusty diagnostic bed that sits in a corner unused.

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The first thing Sanusi does is check the vaccine vial monitor indicators and expiration dates for the vaccines. He randomly selects vials, holding them by the cap with two fingers, takes photos with his work phone, and quickly returns each to the carrier. His observations and photo verification will be submitted in his daily report. This real-time data on vaccine stock across all clinics where the program operates provides valuable data for our team and supports vaccine supply efforts across northern Nigeria.

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Caregivers arrive and sit down on the mats in the waiting area, chatting and playing with their babies. Tsaibatu Buhari, a mother of five, runs a small food vending business. She left her cooking that morning to bring her 15-month-old son, Uzairu, for his final round of routine immunizations.

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A Mother's Determination

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Tsaibatu's first child, who is now 15, was never vaccinated, she says, because there wasn’t a clinic nearby when he was a baby. She recalls how he frequently fell ill—something she wants to prevent in her younger children.

"Since I started vaccinating my children, they don't fall sick as often," she says.

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Clinic visits require her to take the day off running her business, sometimes losing daily profits of ₦3,000 to ₦5,000 (US $2.00-$3.33), a significant sum in an area where most people live on less than $2 a day. But she says she has no regrets.

“My children’s health is more important than my daily income, so I make that sacrifice. If we don’t return early, we just have to accept that we won’t sell that day and resume the next.”

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By the time Mustapha begins the day's health talk, about 15 women are seated with their infants. He explains the benefits of immunization, common post-vaccination reactions, and how to manage mild fever or irritability. The mothers have the opportunity to ask questions.

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Sanusi joins for the last few minutes of the health talk and reminds the women that the cash incentives provided by New Incentives help with transportation costs, minor medical expenses and offset some lost wages on the day of the vaccination visit.

"The most important thing," he tells them, "is ensuring your child is protected from these dangerous diseases."

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When it’s her turn, Tsaibatu hands Uzairu’s immunization card to Mustapha. At 15 months old, he is due for his second measles shot. Mustapha verifies his records and gives him the shot. Uzairu cries briefly, but Tsaibatu, now familiar with the routine, quickly soothes him.

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She then moves over to the field officer, Sanusi, who verifies eligibility for the cash incentive. When Tsaibatu sat in front of him 15 months ago to be enrolled in the All Babies program, Sanusi first explained the data collection process and sought consent, just as he does for every new enrollment. 

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As part of the enrollment, field officers review key details, including the caregiver’s and infant’s basic information, birth date, and where they live. If they meet the eligibility criteria, the field officer enrolls them in the program and assigns them a unique ID. An ID sticker is placed on both their government-issued Child Health Card and their All Babies program card. Field officers then stamp both stickers, ensuring they cannot be reused. For return visits, they cross-check the ID numbers on both cards to confirm they match and that the records correspond to the child in front of them.

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Sanusi intentionally sits next to Mustapha to verify that the correct vaccines are being administered throughout the course of the day. He double-checks Mustapha’s notations on the Child Health Card and verbally confirms with Tsaibatu that her son received the measles vaccine. Sanusi then provides the cash incentive and uses a secure app to take a verification photo of her holding the cash and All Babies program card. 

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This is just one of the 10 million cash transfers caregivers like Tsaibatu will receive from New Incentives in 2025. Every single one will also be reviewed by an off-site team. These steps ensure accountability and confirm that only eligible caregivers receive cash transfers from the New Incentives program. The photos are stored securely under strict data protection policies and are used solely for verification and audit purposes (as opposed to photos like the ones in this blog that are approved for media).

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After Uzairu receives his second measles vaccine, the final vaccination in the routine childhood immunization schedule, Sanusi gives Tsaibatu an additional ₦5,000 completion bonus, bringing her total incentives to ₦11,000 since enrolling in the program. Uzairu has recently started walking, so Tsaibatu plans to use part of the money to buy him new sandals and a chicken to raise.

“I want him to grow up and see a flock of chickens, so he’ll remember the All Babies program,” she says with a smile.

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As she steps out of the clinic, Tsaibatu’s husband, Mallam Buhari, leans forward to assist her with the child. On their way home, Tsaibatu reflects on how things have changed.

“Before, we had to be persuaded to come for immunization. Some women wouldn’t come unless we were personally visited at home. Now, we come willingly.”

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End of the Day

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By mid-afternoon, when the last women and children leave, Mustapha and Sanusi begin their final tasks—verifying records and accounting for remaining vaccines. Together, they cross-check the Child Immunization Register, tally sheet, and Sanusi's digital Clinic Daily Form to ensure all administered doses are properly documented.

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Mustapha carefully packs any unused vaccines into the insulated carrier, keeping them within the required temperature range. He secures the carrier to his motorcycle and prepares for the bumpy ride back to Nachini Clinic, where the vaccines will be stored overnight.

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Another immunization day is complete, but for Mustapha, the work continues. Tomorrow, he will be back on his farm—until the next clinic day calls him back to his motorcycle, to the clinic, and to the children of Damba.