“Africa, we really need to change our mindset. Access to aid, we can start thinking about the past. We need to focus on two things: attracting and mobilizing our own domestic resources.”
Recent changes in public health landscapes have led to major drastic changes in the past three months, spurring what can only be described as sudden policy changes in the United States (US) and the European Union (EU). The new US leadership and changing domestic priorities in many EU countries have led to a rapid shift from development support to other pressing internal issues and domestic priorities. This transition is unprecedentedly unprecedented, with many countries not being prepared for the resulting collateral damage.
What is clear as this reorganization unfolds is that we still don’t fully understand the extent of the outcome. The implications of these actions are still evolving, but they reflect some of the immediate priorities for Nigerian health, as well as Nigerian influence.
First, there are two events two weeks apart that redefines the future of public health in Nigeria to provide context.
On January 20th, the White House issued an executive order for a 90-day suspension and evaluation of the US Foreign Aid Award. On February 14, Nigerian lawmakers approved another $200 million to fill some of the gaps created by the US government’s foreign suspension following the rapid intervention of the Honorable Minister of Health and Social Welfare.
Speed of response
Nigeria’s response to the US’s evolving policy environment is one of the fastest in the region. This rapid action was immediately bailed out by approximately 1.7 million people in Nigeria regarding the antiretroviral properties of HIV, along with essential drugs, commodities and diagnostic reagents necessary to manage HIV, TB and malaria.
The speed of the announcement, and the details provided by the Health Minister, have earned widespread praise from several African countries. With the short term response, the health sector needs to take serious strategic thinking about what the future holds.
Therefore, these three areas need to be considered.
1. What is the true scale of US funding for public health in Nigeria?
Although data is difficult to find on the Nigerian government website, the US government reported that in 2023 it spent about $600 million on Nigerian health programs and $464 million was paid to Nigeria for the health programs in 2024. The spending primarily supported health initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). However, the data has not been adequately broken down, including ongoing response to the Covid-19 pandemic and significant spending on vaccine-related costs.
An important aspect of healthcare finance in Nigeria is its dependence on out-of-pocket expenditures. New World Health Organization data shows that Nigerians rely heavily on personal funding for their medical needs, with 76% of their medical expenses being raised from out-of-pocket costs and 13% from government revenues from public funds. This trust further strengthened the driving force for increasing domestic resource mobilization by increasing tax revenue through strategic tax reform, thereby increasing potential healthcare funding.
So, the question about everyone’s mind is, can the US government achieve what it was $400-$600 million for $200 million? The optimistic answer is yes, we should be able to do it. From sourcing from a product perspective, we can do so. However, the bigger issues are as the systems and organizations that once managed procurement, supply chain, payments, delivery, allowances, and monitoring and assessments have been shut down. And if no one intervenes, can we deliver products without these systems in place?
2. Can we build an integrated system to provide public health programs more efficiently?
There is inefficiency in vertical approaches developed to realize priority public health interventions such as HIV, TB, malaria, and polio. On paper, it is clear that these vertically funded delivery mechanisms are not the most efficient way to provide health interventions. These fragmented vertical health programs in Nigeria have resulted in inefficiency by creating silos.
In February 2025, the Minister of Health and Social Welfare Coordination launched the AIDS, Tuberculosis and Malaria (ATM) Technical Working Group (TWG). This is a positive step in integrating and coordinating these critical health programs and aligning resources to combat AIDS, TB and malaria.
However, the unpleasant truth is that the primary health care system in Nigeria is also not widely recognized for its efficiency. As Nigeria and many other African countries are considering integrating HIV, TB and malaria into primary health care, the key issues are: How is our system ready to offer this across a complex federal landscape? How can we mitigate the serious risk of losing the intense benefits of vertical delivery systems in our transition to primary healthcare?
In a recent webinar hosted by Nigeria Health Watch and Willow Health Media, Willow Health Media, entitled “Reimagining Health Finance in Africa,” Amrev Health Africa’s Technical Director Primary Healthcare, Charlotte Muheki, outlined several examples of how African countries respond to fundraising.
Countries like Rwanda have already demonstrated the potential for sustainable funding by integrating HIV into a broader primary healthcare, negotiating with donors and recruiting community health workers to provide vital services at the village level.
Can I keep my funding up?
Assume that the realization cost of prioritized public health interventions is actually $200 million a year, and that the system is being built to deliver this efficiently. The next big question is whether we can find another $200 million in our health budget each year. To achieve this, the Nigerian government may need to make tough decisions about where to raise funds. Some countries, like Ethiopia, have already made these decisions, with all workers just unveiling new taxes to close the financial gap left by cutting back on USAID funding.
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Ghana introduced National Health Insurance Collection (NHIL) in 2004. It taxed goods and services at 2.5% to fund basic health services through mutual and private health insurance systems. South Africa has implemented a “sin tax” on tobacco and alcohol, which has made a significant profit on health and contributed to lower smoking rates.
Despite these efforts, Overseas Development Assistance (ODA) has distorted perceptions of health funding. The Ministry of Finance may have believed that the sector was properly funded for the ODA, so it is difficult to achieve the Abuja Declaration’s goal of spending 15% of its GDP on health, meaning that it will not receive health. Only now, with greater transparency and the gaps in health funding becoming more and more clear, Nigeria should be able to better assess the true costs of a true health programme of fundraising. Health is a political choice.
Given these factors, how will Nigeria maintain its response?
We live in an interesting time. With the luxury of time, the Minister’s Priority Programme will be the perfect anecdote for the new world order. Focusing on the Sector-wide Approach to Increase Transparency and Accountability in the Health Sector (SWAP) is a great way to reduce costs, eliminate duplication and promote efficiency. The President’s initiative to unlock the Healthcare Value Chain (PVAC) is an ideal tool to strengthen domestic production of “medicines, medical devices and medical technologies.” But the big unknowns do you have time to make the changes you need to save the day? The ju apprentices are out, but we hope we do.
