As the global health community pushes for a major reform of the international health architecture to reduce fragmentation, improve coordination and strengthen country ownership, questions are emerging about what the proposed changes will mean for countries like Nigeria, which rely significantly on external support to finance and deliver essential health services.
With the reform process expected to produce recommendations by May 2027, concerns over declining external financing, domestic resource mobilisation, weak primary healthcare systems, health workforce shortages and the country’s progress towards universal health coverage have become increasingly important.
What should Nigerians realistically expect it to mean for their health outcomes?
The first point is that the reset is a Member State-driven process. We, as institutions and partners in global health, respect that process and look forward to its outcomes and the decisions of Member States to guide how we focus and adapt our work. The structural questions being considered are important, and the reshaping of the global health architecture should follow that process.
That said, if you ask for my own perspective on what this should ultimately mean for Nigerians, I would be quite pragmatic. In my view, the reset by itself will not change health outcomes in Nigeria, certainly not quickly. What will matter is whether the changes it produces help countries translate resources, partnerships and technical capacities into stronger services and better health outcomes.
For a mother in Sokoto or a child in Borno, the architecture itself is quite distant. What matters is whether it helps strengthen the health services people depend on: primary health care, functioning supply chains, surveillance and laboratory systems, and health workers who are equipped and supported to provide quality care.
And while the global process moves forward, countries do not have to wait to accelerate health outcomes. Every time a government invests more of its own resources through its own national plan, strengthens accountability for results, and partners align their financing and support behind national priorities, we strengthen the country-led foundations that any future global health architecture will ultimately need to support.
Nigeria already has important foundations through the Health Sector Renewal Investment Initiative and the Sector-Wide Approach, or SWAp. These provide an opportunity to strengthen country ownership, partner alignment, accountability and, ultimately, health impact. The Joint Annual Review should be much more than an assessment of progress. Together with quarterly performance reviews, it can be an instrument for identifying bottlenecks, correcting courses and accelerating measurable results.
So, from my perspective, the real test of the reset will not simply be how the global health architecture is ultimately configured. It will be whether it enables countries such as Nigeria to lead more effectively, mobilize sustainable domestic financing, bring partners behind one national direction, strengthen accountability, and translate all of that into better health outcomes for people.
That is ultimately what Nigerians should expect and what we should remain focused on.
So, does the impact on outcomes depend mainly on country capacity?
It is the pillar the others rest on. Sustainable progress depends on national capacity to plan, finance, deliver, measure, and continuously improve health services. International support is most effective when it aligns with national priorities, systems, and accountability mechanisms. I would judge any proposal, whether it combines agencies, pools funds, or sets a timetable for reducing external aid, by one.
Where should Nigerians expect to see results first? Polio is the clearest example of a global initiative operating on a scale here. Where does it stand?
Nigeria ended wild poliovirus, certified in 2020, which many thought impossible. That is a lasting national achievement. But variant poliovirus is still circulating. By GPEI’s 28 October 2026 update, Nigeria had reported 36 type 2 variant cases this year, down from 66 in 2025, alongside 15 type 3 variant cases, up from eight. The August IHR Emergency Committee noted that Nigeria remains the largest contributor to the global variant caseload.
The main lesson now is delivery, and optimisation of limited resources. The remaining transmission is concentrated in a limited number of local government areas in the North-West, where campaign quality, access and routine immunization are weakest. We are working with NPHCDA and states to treat each of those LGAs as a specific delivery problem, with named owners, weekly routines and a short list of indicators, rather than applying uniform national measures. A better-aligned architecture can help by funding that kind of focused delivery predictably, but Nigerian program managers must lead the change on the ground.
And routine immunisation more broadly?
This is where polio is ultimately won or lost. WHO and UNICEF estimates put Nigeria’s zero-dose children at around 2.2 million in 2025. National administrative data often show higher coverage than surveys and modeled estimates, and that gap is itself a finding: it tells us where data quality and denominators need work. The polio infrastructure, its surveillance, microplanning and community networks, must increasingly serve routine immunization and primary health care. That transition is one of the country’s most important capacity questions.
Nigeria is among the largest recipients of Global Fund, Gavi and bilateral funding, the instruments the reset is now re-examining. Is that money working?
External investments have saved millions of lives globally and remain important. But effectiveness must be judged against the burden. WHO’s World Malaria Report 2025 estimates that Nigeria accounted for 24.3 per cent of global malaria cases and 30.3 per cent of global malaria deaths in 2024, roughly 68.5 million cases and 185,000 deaths, the largest share of any country.
A country carrying that share needs malaria money to buy more than commodities; it must also strengthen the surveillance, stratification, and subnational management that determine where nets, chemoprevention, and vaccines will have the most effect.
Tuberculosis Control programme shows what is possible. National notifications rose from about 107,000 in 2018 to about 459,000 in 2025, against WHO’s estimate of roughly 510,000 new cases a year. That gain is largely attributed to better diagnostics, private-sector engagement and active case-finding. The remaining gap, along with low enrolment for drug-resistant TB, is now the priority.
HIV is where the transition question is most urgent. Nigeria’s response has relied heavily on external funding, with PEPFAR historically supporting most of the treatment burden. The new National HIV and AIDS Strategic Plan 2026–2030 and the government’s US$346 million co-financing commitment for HIV, TB and malaria in 2026 are important signals. What matters next is whether those commitments are released on time and whether services move into primary care and health insurance without interruption.
What would make global funding instruments more effective?
Three things. First, align investments with national health priorities, plans and its annual operational frameworks, while strengthening country systems and accountability mechanisms. Second, invest predictably in the cross-cutting capacities on which all programmes depend, on, including health information systems, supply chains and health workforce, and primary health care. Third, develop joint transition plans with government, with clear milestones, so domestic financing rises as external financing falls, not after a gap.
As external financing declines, domestic financing must carry more of the load. How far has Nigeria come?
Domestic financing is critical for sustainability. The policy foundations are strong. The 2022 National Health Insurance Authority Act made coverage mandatory, and NHIA reports enrolment rising to over 22 million by mid-2026, from around 7% coverage for nearly two decades before the Act. That is real progress. It is also about one in ten Nigerians, so most people still pay out of pocket, and enrolment does not by itself guarantee financial protection or quality care. The next phase has to reach the informal sector and the poor, and track what people pay and receive, not only who is registered.
Maternal mortality is often cited as the hardest test. Can the reset make a difference there?
Reducing maternal mortality remains one of Nigeria’s most important health priorities. The UN inter-agency estimates put Nigeria’s maternal mortality ratio at about 993 per 100,000 live births back in 2023. However, National and other estimates differ, often by half. For instance, the 2024 Nigeria Verbal Autopsy and Social Autopsy Study (NVASA), puts the ratio at 572 deaths per 100,000 live births.
We are working with the government and partners to improve the measurement. The solution requires action across the continuum of care, including family planning, antenatal care, skilled delivery, emergency obstetric services, referral systems, and strong primary health care. These are system-wide investments that benefit entire communities. In the 2023–24 Demographic and Health Survey, only about 15 per cent of married women used a modern contraceptive method, and around one in five had an unmet need.
Helping women avoid unintended pregnancies, space births and avoid unsafe abortion can reduce the number of high-risk pregnancies before obstetric care is ever needed. It continues with antenatal care, skilled birth attendance, emergency obstetric care, blood, referral and functioning primary care. These are system investments, not vertical projects, and they are precisely what insurance, the Basic Health Care Provision Fund and the SWAp were designed to finance.
What has to be in place nationally for any reset to translate into better outcomes? Where does primary health care fit?
Primary health care is the foundation of universal health coverage. It is where immunization, maternal care, malaria services, HIV, tuberculosis, and other essential health services reach communities. Nigeria has around 31,800 primary health care facilities, about four in five of all health facilities, but for years many were not functional. The government’s goal of one fully functional PHC in every political ward, about 17,600 facilities, with Basic Health Care Provision Fund money flowing directly to facilities, is the right design.
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NPHCDA reports 8,000 functional PHCs, with about 3,000 upgraded. That is encouraging, but these are administrative figures. The next step is to confirm functionality through joint facility assessments, ensure states draw down and use the funds available to them, and show that utilization and quality of care rise as a result. Integrating vertical programmes into this platform, rather than running them alongside it, is also how external funding transitions can happen without service gaps.
None of that works without health workers. How serious is the gap?
Health workers are the backbone of the health system; it is one of the most binding constraints. Government figures put doctor density at about four per 10,000 people nationally, and the 2025 workforce report shows some northern states at around 0.5 per 10,000. Emigration has accelerated, and the states with the highest burden of maternal deaths, malaria, and zero-dose children are often the ones with the fewest health workers.
Nigeria is responding. It has adopted a National Policy on Health Workforce Migration, expanded training intake, retrained tens of thousands of frontline workers, and, with WHO support, built a National Health Workforce Registry and country workforce profile. What matters now is retention and deployment: getting midwives, nurses and community health workers into the wards and states that need them, keeping them there, and allowing task-sharing so that the existing workforce can do more. Internationally, the WHO Global Code of Practice and managed migration arrangements should mean that destination countries help sustain the training pipelines they draw from.
How should progress towards UHC be judged?
By outcomes for people rather than inputs. WHO’s UHC service coverage index for Nigeria is below the regional average, and out-of-pocket payments still account for roughly 70–75 per cent of health spending Functioning PHCs, an adequate workforce and health insurance are the means. The test is whether service coverage rises and the share of households facing catastrophic health spending falls. That is what Nigeria and its partners should be held to.
But there are important reasons to expect progress. The investments and policy reforms now being pursued by the Government, at both federal and state levels, are increasingly focused on the foundations of UHC: stronger primary health care, a fit-for-purpose health workforce, more reliable access to essential medicines and services, and expanded financial protection through health insurance.
If these reforms are implemented consistently and at scale, we should see that progress reflected in Nigeria’s UHC indicators over time: more people able to access essential health services when they need them, fewer gaps between states and population groups, and fewer families being pushed into financial hardship because they have to pay for health care from their own pockets.
Functioning PHCs, an adequate and well-distributed workforce, reliable medicines and health insurance are the means. The real test is whether service coverage goes up, out-of-pocket spending comes down, and the proportion of households experiencing catastrophic health expenditure declines. Ultimately, that is the UHC improvement Nigerians should expect, and that is what Nigeria and its partners should hold themselves accountable for.
How will Nigeria know whether the reset is improving outcomes?
Strong data and analytics are essential. Countries need reliable information to track progress, identify gaps, allocate resources effectively, and improve outcomes. On maternal mortality, Nigeria today has national figures, UN inter-agency figures and IHME figures that do not agree. Each uses different data and methods, and each is defensible on its own terms. But a minister needs one number to plan against, and the public needs to trust it.
So, we are supporting the government to bring these together. That means a technical working group on mortality estimation that includes WHO, UNFPA, IHME and the agencies working on HIV, TB, malaria and injuries; work with WHO headquarters on national and subnational analytics capacity; and strengthening civil registration and vital statistics, including maternal and perinatal death surveillance, so the country can rely less on periodic surveys.
This is what we call impact focus: using data to track progress, identify bottlenecks, solve problems, and mobilize the actions, resources and partnerships needed to achieve results. The quarterly performance reviews and the Joint Annual Review under the SWAp are where that happens in practice, and better data makes each of those conversations sharper.
Why subnational?
Because a national average hides a great deal in a country as large and diverse as Nigeria. States and local government areas make decisions about polio, malaria chemoprevention, or obstetric care. The goal is for state teams to analyze their own data, reconcile administrative and survey estimates, and act on them. That capacity will remain long after any single grant ends, and we believe WHO adds some of its most durable value there.
Where do digital solutions and artificial intelligence fit into this?
Digital transformation in health is not primarily about technology; it is about stronger, more equitable, people-centred health systems, with technology as the enabler. Data and digital transformation is one of the six pillars of WHO’s cooperation with Nigeria for exactly that reason. Our ambition is not simply more digital health but connected health systems that use digital tools to deliver measurable impact. Too often, countries end up with many disconnected platforms, each funded by a different partner, none talking to the others.
Telemedicine, electronic records, and reporting tools should be built into primary care, referral networks, and the national health information system, not alongside them.
We are ambitious about AI. Artificial intelligence offers significant opportunities to support health workers, strengthen surveillance, improve decision-making and enhance service delivery. However, AI should complement rather than replace professional judgement and must be implemented in line with WHO guidance on ethics, governance, equity, transparency, accountability, privacy and human rights.
Successful deployment of AI depends on strong digital foundations, including high-quality data, interoperability, cybersecurity, appropriate regulation and a well-trained workforce. Its value should ultimately be measured by improvements in health outcomes, service quality and equity.
So three priorities matter for Nigeria. First, treat governance, standards, interoperability and digital architecture as national public goods, owned and led by government. Second, judge every digital investment by measurable improvements in service delivery and health outcomes, not by the number of platforms launched. Third, pursue AI ambitiously but responsibly: guided by ethics, evidence, safety, national regulation and national priorities, with data sovereignty protected and the benefits reaching rural communities, women and people with limited digital access.
This is also part of the architecture question. Partners, philanthropies and technology companies should invest through the national digital health architecture, not around it.
What does the reset mean for WHO’s role in countries?
What does the reset mean for WHO itself? Critics say country offices have become implementers of donor projects.
There have been concerns that WHO country offices have at times assumed substantial operational responsibilities, particularly during disease eradication efforts and public health emergencies. In some contexts, this was necessary to sustain critical public health functions and support national priorities.
How do you show what WHO contributes?
We have to be more precise. WHO rarely “causes” a national result on its own; governments, communities and many partners do the work. What we can show is contribution: a guideline adopted, a surveillance gap closed, a state team that now analyses its own data, a policy decision taken on better evidence. We are moving our country plan towards a small set of national outcome indicators, each with an explicit statement of WHO’s role and the assumptions behind it. Honest attributes build more trust than inflated claims.
What is your bottom line: what should the reform process deliver for Nigeria, and what should Nigeria do?
From the reform process: measure it by what happens in countries. Fewer parallel plans, reports and coordination meetings. More money and reporting through the single plan, budget and accountability framework that the SWAp already provides. Predictable investment in the shared foundations of data, workforce, supply chains and primary care. And honest, jointly agreed transition timelines.
From Nigeria: release domestic financing commitments on time, keep every partner’s money and reporting inside the SWAp, and hold the system publicly to outcome targets rather than activity targets. If both happen, Nigerians can expect the reset to show up where it matters: fewer children missed by vaccines, fewer deaths from malaria and in childbirth, and less money paid out of pocket. In the end, that is how the reset should be measured: in lives improved and saved.
I am cautiously optimistic. Nigeria has shown it can deliver hard things at scale: ending wild polio, vaccinating over 100 million children in an integrated campaign, and expanding TB detection several-fold. The capacity is there; it is uneven, and it needs consistent support. WHO’s role is to strengthen that capacity, be clear about what we contribute, and step back where the country takes over and consistently exercises the function itself. That handover is the measure of how sustainable our time-limited support has been, and whether the results achieved will last. If we get that right in Nigeria, the reshaping decided by the boards will come faster and count for more.
