The Colour of Trust: Institutional Fragmentation and Public Confidence in Vaccination Systems in Nigeria Background: Public trust is a prerequisite for resilient health systems. In Nigeria, vaccine uptake is often hindered not by scientific skepticism, but by "administrative distrust" caused by institutional fragmentation. This paper explores how the lack of coordination between state-level service delivery and federal-level certification creates a "Verification Gap" that erodes the social contract. Methods: The study employs a qualitative research design based on reflective case analysis and autoethnography. It centers on a "Critical Incident" at the Lagos State University Teaching Hospital (LASUTH) during a National Primary Health Care Development Agency (NPHCDA) campaign. Data was triangulated through field observations, physical artifact analysis of vaccination records, and transactional evidence of administrative fees. Results: The analysis reveals a systemic disconnect between the locally issued "Green Card" (SIA record) and the federal "Yellow Card" (International record). This fragmentation leads to: Medical redundancy: Citizens are forced to undergo re-vaccination for administrative recognition. Financial penalties: Citizens face validation fees for previously administered services. Document-Centric Trust: The study identifies that trust is currently tied to the physical properties of a document rather than the medical act itself. Conclusion: To restore institutional legitimacy, Nigeria must transition from a document-centric to an identity-centric model. By leveraging the National Identification Number (NIN) as a universal identifier, the health system can achieve cross-tier interoperability. Adopting a "Capture Once, Use Often" policy is not merely a technical upgrade but a strategic necessity for public health security and citizen-centric governance.
Nancy Rita Jegede (Wed,) studied this question.