Why Nigeria Must Build A Stronger Health System – WHO Country Representative

As the worldwide well being group pushes for a serious reform of the worldwide well being structure to cut back fragmentation, enhance coordination and strengthen nation possession, questions are rising about what the proposed modifications will imply for nations like Nigeria, which rely considerably on exterior help to finance and ship important well being providers.

With the reform course of anticipated to supply suggestions by May 2027, considerations over declining exterior financing, home useful resource mobilisation, weak main healthcare methods, well being workforce shortages and the nation’s progress in direction of common well being protection have grow to be more and more necessary.

In this interview with Leadership Newspaper, the World Health Organisation (WHO) Country Representative and Head of Mission in Nigeria, Dr Pavel Ursu, examines the implications of the proposed international well being reset for Nigeria, the necessity to strengthen home financing and nationwide well being establishments, and why the success of the reform should in the end be measured by enhancements in individuals’s entry to high quality and inexpensive healthcare.

What ought to Nigerians realistically anticipate it to imply for his or her well being outcomes?

The first level is that the reset is a Member State-driven course of. We, as establishments and companions in international well being, respect that course of and stay up for its outcomes and the choices of Member States to information how we focus and adapt our work. The structural questions being thought-about are necessary, and the reshaping of the worldwide well being structure ought to observe that course of.

That mentioned, if you happen to ask for my very own perspective on what this could in the end imply for Nigerians, I might be fairly pragmatic. In my view, the reset by itself won’t change well being outcomes in Nigeria, actually not shortly. What will matter is whether or not the modifications it produces assist nations translate sources, partnerships and technical capacities into stronger providers and higher well being outcomes.

For a mom in Sokoto or a toddler in Borno, the structure itself is sort of distant. What issues is whether or not it helps strengthen the well being providers individuals rely upon: main well being care, functioning provide chains, surveillance and laboratory methods, and well being employees who’re outfitted and supported to supply high quality care.

And whereas the worldwide course of strikes ahead, nations shouldn’t have to attend to speed up well being outcomes. Every time a authorities invests extra of its personal sources by its personal nationwide plan, strengthens accountability for outcomes, and companions align their financing and help behind nationwide priorities, we strengthen the country-led foundations that any future international well being structure will in the end must help.

Nigeria already has necessary foundations by the Health Sector Renewal Investment Initiative and the Sector-Wide Approach, or SWAp. These present a chance to strengthen nation possession, companion alignment, accountability and, in the end, well being impression. The Joint Annual Review must be far more than an evaluation of progress. Together with quarterly efficiency evaluations, it may be an instrument for figuring out bottlenecks, correcting programs and accelerating measurable outcomes.

The Lusaka Agenda and the Accra Reset reinforce this course of journey in direction of larger nation management and stronger alignment of worldwide well being initiatives behind nationwide priorities. Nigeria subsequently has a chance not solely to speed up its personal progress, but additionally to reveal in apply what country-led transformation can obtain.

So, from my perspective, the true check of the reset won’t merely be how the worldwide well being structure is in the end configured. It will likely be whether or not it permits nations similar to Nigeria to steer extra successfully, mobilize sustainable home financing, convey companions behind one nationwide course, strengthen accountability, and translate all of that into higher well being outcomes for individuals.
That is in the end what Nigerians ought to anticipate and what we should always stay centered on.

So, does the impression on outcomes rely primarily on nation capability?

It is the pillar the others relaxation on. Sustainable progress will depend on nationwide capability to plan, finance, ship, measure, and constantly enhance well being providers. International help is only when it aligns with nationwide priorities, methods, and accountability mechanisms. I might choose any proposal, whether or not it combines companies, swimming pools funds, or units a timetable for decreasing exterior support, by one.

Where ought to Nigerians anticipate to see outcomes first? Polio is the clearest instance of a world initiative working on a scale right here. Where does it stand?

Nigeria ended wild poliovirus, licensed in 2020, which many thought unimaginable. That is an enduring nationwide achievement. But variant poliovirus remains to be circulating. By GPEI’s 28 October 2026 replace, Nigeria had reported 36 sort 2 variant instances this 12 months, down from 66 in 2025, alongside 15 sort 3 variant instances, up from eight. The August IHR Emergency Committee famous that Nigeria stays the most important contributor to the worldwide variant caseload.

The essential lesson now could be supply, and optimisation of restricted sources. The remaining transmission is concentrated in a restricted variety of native authorities areas within the North-West, the place marketing campaign high quality, entry and routine immunization are weakest. We are working with NPHCDA and states to deal with every of these LGAs as a selected supply drawback, with named house owners, weekly routines and a brief record of indicators, moderately than making use of uniform nationwide measures. A better-aligned structure may also help by funding that sort of centered supply predictably, however Nigerian program managers should lead the change on the bottom.

And routine immunisation extra broadly?

This is the place polio is in the end gained or misplaced. WHO and UNICEF estimates put Nigeria’s zero-dose youngsters at round 2.2 million in 2025. National administrative information typically present increased protection than surveys and modeled estimates, and that hole is itself a discovering: it tells us the place information high quality and denominators want work. The polio infrastructure, its surveillance, microplanning and group networks, should more and more serve routine immunization and first well being care. That transition is likely one of the nation’s most necessary capability questions.

Nigeria is among the many largest recipients of Global Fund, Gavi and bilateral funding, the devices the reset is now re-examining. Is that cash working?

External investments have saved thousands and thousands of lives globally and stay necessary. But effectiveness have to be judged towards the burden. WHO’s World Malaria Report 2025 estimates that Nigeria accounted for twenty-four.3 per cent of worldwide malaria instances and 30.3 per cent of worldwide malaria deaths in 2024, roughly 68.5 million instances and 185,000 deaths, the most important share of any nation.

A nation carrying that share wants malaria cash to purchase greater than commodities; it should additionally strengthen the surveillance, stratification, and subnational administration that decide the place nets, chemoprevention, and vaccines could have essentially the most impact.

Tuberculosis Control programme reveals what is feasible. National notifications rose from about 107,000 in 2018 to about 459,000 in 2025, towards WHO’s estimate of roughly 510,000 new instances a 12 months. That acquire is essentially attributed to raised diagnostics, private-sector engagement and energetic case-finding. The remaining hole, together with low enrolment for drug-resistant TB, is now the precedence.

HIV is the place the transition query is most pressing. Nigeria’s response has relied closely on exterior funding, with PEPFAR traditionally supporting a lot of the remedy burden. The new National HIV and AIDS Strategic Plan 2026–2030 and the federal government’s US$346 million co-financing dedication for HIV, TB and malaria in 2026 are necessary indicators. What issues subsequent is whether or not these commitments are launched on time and whether or not providers transfer into main care and medical insurance with out interruption.

What would make international funding devices simpler?

Three issues. First, align investments with nationwide well being priorities, plans and its annual operational frameworks, whereas strengthening nation methods and accountability mechanisms. Second, make investments predictably within the cross-cutting capacities on which all programmes rely, on, together with well being info methods, provide chains and well being workforce, and first well being care. Third, develop joint transition plans with authorities, with clear milestones, so home financing rises as exterior financing falls, not after a spot.

As exterior financing declines, home financing should carry extra of the load. How far has Nigeria come?

Domestic financing is essential for sustainability. The coverage foundations are robust. The 2022 National Health Insurance Authority Act made protection necessary, and NHIA studies enrolment rising to over 22 million by mid-2026, from round 7% protection for practically twenty years earlier than the Act. That is actual progress. It can also be about one in ten Nigerians, so most individuals nonetheless pay out of pocket, and enrolment doesn’t by itself assure monetary safety or high quality care. The subsequent part has to succeed in the casual sector and the poor, and observe what individuals pay and obtain, not solely who’s registered.

Maternal mortality is usually cited as the toughest check. Can the reset make a distinction there?

Reducing maternal mortality stays one in every of Nigeria’s most necessary well being priorities. The UN inter-agency estimates put Nigeria’s maternal mortality ratio at about 993 per 100,000 reside births again in 2023. However, National and different estimates differ, typically by half. For occasion, the 2024 Nigeria Verbal Autopsy and Social Autopsy Study (NVASA), places the ratio at 572 deaths per 100,000 reside births.

We are working with the federal government and companions to enhance the measurement. The resolution requires motion throughout the continuum of care, together with household planning, antenatal care, expert supply, emergency obstetric providers, referral methods, and powerful main well being care. These are system-wide investments that profit total communities. In the 2023–24 Demographic and Health Survey, solely about 15 per cent of married ladies used a contemporary contraceptive technique, and round one in 5 had an unmet want.

Helping ladies keep away from unintended pregnancies, area births and keep away from unsafe abortion can cut back the variety of high-risk pregnancies earlier than obstetric care is ever wanted. It continues with antenatal care, expert delivery attendance, emergency obstetric care, blood, referral and functioning main care. These are system investments, not vertical tasks, and they’re exactly what insurance coverage, the Basic Health Care Provision Fund and the SWAp have been designed to finance.

What must be in place nationally for any reset to translate into higher outcomes? Where does main well being care match?

Primary well being care is the muse of common well being protection. It is the place immunization, maternal care, malaria providers, HIV, tuberculosis, and different important well being providers attain communities. Nigeria has round 31,800 main well being care amenities, about 4 in 5 of all well being amenities, however for years many weren’t purposeful. The authorities’s purpose of 1 totally purposeful PHC in each political ward, about 17,600 amenities, with Basic Health Care Provision Fund cash flowing on to amenities, is the suitable design.

NPHCDA studies 8,000 purposeful PHCs, with about 3,000 upgraded. That is encouraging, however these are administrative figures. The subsequent step is to verify performance by joint facility assessments, guarantee states draw down and use the funds out there to them, and present that utilization and high quality of care rise in consequence. Integrating vertical programmes into this platform, moderately than operating them alongside it, can also be how exterior funding transitions can occur with out service gaps.

None of that works with out well being employees. How severe is the hole?

Health employees are the spine of the well being system; it is likely one of the most binding constraints. Government figures put physician density at about 4 per 10,000 individuals nationally, and the 2025 workforce report reveals some northern states at round 0.5 per 10,000. Emigration has accelerated, and the states with the very best burden of maternal deaths, malaria, and zero-dose youngsters are sometimes those with the fewest well being employees.

Nigeria is responding. It has adopted a National Policy on Health Workforce Migration, expanded coaching consumption, retrained tens of 1000’s of frontline employees, and, with WHO help, constructed a National Health Workforce Registry and nation workforce profile. What issues now could be retention and deployment: getting midwives, nurses and group well being employees into the wards and states that want them, maintaining them there, and permitting task-sharing in order that the prevailing workforce can do extra. Internationally, the WHO Global Code of Practice and managed migration preparations ought to imply that vacation spot nations assist maintain the coaching pipelines they draw from.

How ought to progress in direction of UHC be judged?

By outcomes for individuals moderately than inputs. WHO’s UHC service protection index for Nigeria is under the regional common, and out-of-pocket funds nonetheless account for roughly 70–75 per cent of well being spending Functioning PHCs, an satisfactory workforce and medical insurance are the means. The check is whether or not service protection rises and the share of households going through catastrophic well being spending falls. That is what Nigeria and its companions must be held to.

But there are necessary causes to anticipate progress. The investments and coverage reforms now being pursued by the Government, at each federal and state ranges, are more and more centered on the foundations of UHC: stronger main well being care, a fit-for-purpose well being workforce, extra dependable entry to important medicines and providers, and expanded monetary safety by medical insurance.

If these reforms are applied constantly and at scale, we should always see that progress mirrored in Nigeria’s UHC indicators over time: extra individuals capable of entry important well being providers after they want them, fewer gaps between states and inhabitants teams, and fewer households being pushed into monetary hardship as a result of they need to pay for well being care from their very own pockets.

Functioning PHCs, an satisfactory and well-distributed workforce, dependable medicines and medical insurance are the means. The actual check is whether or not service protection goes up, out-of-pocket spending comes down, and the proportion of households experiencing catastrophic well being expenditure declines. Ultimately, that’s the UHC enchancment Nigerians ought to anticipate, and that’s what Nigeria and its companions ought to maintain themselves accountable for.

How will Nigeria know whether or not the reset is enhancing outcomes?

Strong information and analytics are important. Countries want dependable info to trace progress, determine gaps, allocate sources successfully, and enhance outcomes. On maternal mortality, Nigeria in the present day has nationwide figures, UN inter-agency figures and IHME figures that don’t agree. Each makes use of totally different information and strategies, and every is defensible by itself phrases. But a minister wants one quantity to plan towards, and the general public must belief it.

So, we’re supporting the federal government to convey these collectively. That means a technical working group on mortality estimation that features WHO, UNFPA, IHME and the companies engaged on HIV, TB, malaria and accidents; work with WHO headquarters on nationwide and subnational analytics capability; and strengthening civil registration and very important statistics, together with maternal and perinatal loss of life surveillance, so the nation can rely much less on periodic surveys.

This is what we name impression focus: utilizing information to trace progress, determine bottlenecks, clear up issues, and mobilize the actions, sources and partnerships wanted to realize outcomes. The quarterly efficiency evaluations and the Joint Annual Review below the SWAp are the place that occurs in apply, and higher information makes every of these conversations sharper.

Why subnational?

Because a nationwide common hides an incredible deal in a rustic as giant and various as Nigeria. States and native authorities areas make selections about polio, malaria chemoprevention, or obstetric care. The purpose is for state groups to investigate their very own information, reconcile administrative and survey estimates, and act on them. That capability will stay lengthy after any single grant ends, and we consider WHO provides a few of its most sturdy worth there.

Where do digital options and synthetic intelligence match into this?

Digital transformation in well being is just not primarily about expertise; it’s about stronger, extra equitable, people-centred well being methods, with expertise because the enabler. Data and digital transformation is likely one of the six pillars of WHO’s cooperation with Nigeria for precisely that cause. Our ambition is just not merely extra digital well being however related well being methods that use digital instruments to ship measurable impression. Too typically, nations find yourself with many disconnected platforms, every funded by a distinct companion, none speaking to the others.

Telemedicine, digital data, and reporting instruments must be constructed into main care, referral networks, and the nationwide well being info system, not alongside them.

We are bold about AI. Artificial intelligence affords vital alternatives to help well being employees, strengthen surveillance, enhance decision-making and improve service supply. However, AI ought to complement moderately than exchange skilled judgement and have to be applied according to WHO steering on ethics, governance, fairness, transparency, accountability, privateness and human rights.

Successful deployment of AI will depend on robust digital foundations, together with high-quality information, interoperability, cybersecurity, applicable regulation and a well-trained workforce. Its worth ought to in the end be measured by enhancements in well being outcomes, service high quality and fairness.

So three priorities matter for Nigeria. First, deal with governance, requirements, interoperability and digital structure as nationwide public items, owned and led by authorities. Second, choose each digital funding by measurable enhancements in service supply and well being outcomes, not by the variety of platforms launched. Third, pursue AI ambitiously however responsibly: guided by ethics, proof, security, nationwide regulation and nationwide priorities, with information sovereignty protected and the advantages reaching rural communities, ladies and other people with restricted digital entry.

This can also be a part of the structure query. Partners, philanthropies and expertise firms ought to make investments by the nationwide digital well being structure, not round it.

What does the reset imply for WHO’s position in nations?

What does the reset imply for WHO itself? Critics say nation workplaces have grow to be implementers of donor tasks.

There have been considerations that WHO nation workplaces have at instances assumed substantial operational duties, notably throughout illness eradication efforts and public well being emergencies. In some contexts, this was essential to maintain essential public well being features and help nationwide priorities.

However, such preparations are usually not meant to substitute for sustainable nationwide capability and management over the long run. Our position is shifting in three instructions. First, our position is more and more centered on supporting nations to steer and maintain public well being features, strengthening establishments and methods in order that they’ll independently plan, implement, monitor and constantly enhance well being programmes . Second, from tasks to the system: norms, tips and technical recommendation that enhance each programme, not simply those we fund. Third, from exercise reporting to accountability for outcomes we are able to plausibly affect. WHO is totally dedicated to supporting this nationally led, demand-driven and defragmented method.

How do you present what WHO contributes?

We need to be extra exact. WHO hardly ever “causes” a nationwide consequence by itself; governments, communities and plenty of companions do the work. What we are able to present is contribution: a suggestion adopted, a surveillance hole closed, a state workforce that now analyses its personal information, a coverage choice taken on higher proof. We are transferring our nation plan in direction of a small set of nationwide consequence indicators, every with an specific assertion of WHO’s position and the assumptions behind it. Honest attributes construct extra belief than inflated claims.

What is your backside line: what ought to the reform course of ship for Nigeria, and what ought to Nigeria do?

From the reform course of: measure it by what occurs in nations. Fewer parallel plans, studies and coordination conferences. More cash and reporting by the one plan, finances and accountability framework that the SWAp already offers. Predictable funding within the shared foundations of information, workforce, provide chains and first care. And sincere, collectively agreed transition timelines.

From Nigeria: launch home financing commitments on time, maintain each companion’s cash and reporting contained in the SWAp, and maintain the system publicly to consequence targets moderately than exercise targets. If each occur, Nigerians can anticipate the reset to indicate up the place it issues: fewer youngsters missed by vaccines, fewer deaths from malaria and in childbirth, and fewer cash paid out of pocket. In the tip, that’s how the reset must be measured: in lives improved and saved.

I’m cautiously optimistic. Nigeria has proven it may possibly ship exhausting issues at scale: ending wild polio, vaccinating over 100 million youngsters in an built-in marketing campaign, and increasing TB detection several-fold. The capability is there; it’s uneven, and it wants constant help. WHO’s position is to strengthen that capability, be clear about what we contribute, and step again the place the nation takes over and constantly workouts the operate itself. That handover is the measure of how sustainable our time-limited help has been, and whether or not the outcomes achieved will final. If we get that proper in Nigeria, the reshaping determined by the boards will come sooner and depend for extra.