Abstract

Centrally channelled operating funds have long delayed vaccination outreach in Niger, leaving primary health centres (PHCs) unable to meet monthly micro-plan targets. To address this bottleneck, the Ministry of Public Health and Askaan introduced a Decentralized Financing Facility (DFF) in Tahoua district in February 2024. Monthly allocations are transferred directly to 66 PHCs through the Nita mobile-money platform, with automated receipt capture and peer verification. Using Illéla district as a non-equivalent control, we applied a quasi-experimental before–after design, triangulating DHIS2 coverage records, electronic ledgers and on-site spot audits through January 2025. Within six months 92 % of PHCs received funds within five days of requisition (baseline > 30 days) and 100 % of expenditures were justified digitally, cutting financial-report latency from a median 56 to 9 days and achieving 97 % completeness. Penta-1 coverage climbed from 74 % to 94 % and Penta-3 from 62 % to 87 %, dwarfing the 5- and 4-point gains in the control district. Drop-out fell from 23 % to 12 %. Economic analysis showed a mean cost of 5.4 USD per fully immunised child—18 % less than control—and an incremental cost-effectiveness ratio of –71 USD per additional 100 children fully vaccinated. Health-worker finance-management scores doubled (1.8 → 3.6/5). The DFF demonstrates that rapid, accountable mobile-money transfers can unlock service bottlenecks, drive equitable coverage and remain cost-saving. Findings have prompted the Government of Niger to expand the DFF to five additional districts and to explore its application to antenatal-care and malaria programs.