2025 Review: Nigeria Rises as the Safety Net Shifts
Lessons from 2025: Nigeria’s Health System Faces a Crucial Crossroads
As the year 2025 comes to an end, it has become clear that Nigeria's health system is at a pivotal moment. The events of the year have exposed the country's reliance on external funding and underscored the urgent need for internal reforms. The sudden pause in external financial support and the subsequent realignment of donor priorities revealed a harsh reality: Nigeria's health security cannot be sustained by decisions made outside its borders. However, 2025 also demonstrated what can be achieved through strong governance and strategic planning.
One of the most significant lessons from the year was the realization that the global safety net is no longer reliable. As international development assistance (ODA) declined and major donors redirected their focus inward, long-held assumptions about consistent funding were challenged. This shift forced Nigeria to confront the necessity of self-reliance in health financing. It became evident that without a robust domestic funding mechanism, the health system would remain vulnerable to external shocks.
Quality Health Systems Turn Crisis into Catalyst
The January 2025 funding freeze and stop-work orders highlighted deep-seated vulnerabilities within the health system. Programs supporting millions of Nigerians on antiretroviral therapy faced disruptions, while vaccine and nutrition supply chains were under strain. Yet, the response to these challenges showcased the potential for resilience when health is prioritized. The Federal Government approved an emergency appropriation of $200 million for HIV, tuberculosis, and malaria, demonstrating the ability to mobilize domestic resources during crises.
Reforms addressing the root causes of poor health outcomes continued throughout the year. The Nutrition 774 Initiative (N774) redefined malnutrition as a multisectoral challenge, spanning health, livelihoods, and productivity across all 774 local government areas. Investments in digital systems gained momentum, with over 7.2 million Nigerians registered on the National Health Information Exchange. However, the true measure of success remains in reducing preventable maternal and child deaths. Initiatives like the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII) focused on high-burden areas, reinforcing the importance of strong primary healthcare systems.
Governance and Financing at a Turning Point
Governance reform gained momentum in 2025. By August, the Federal Government operationalized the Sector-Wide Approach (SWAp) to health, moving from fragmented planning toward a unified framework. The SWAp aimed to replace parallel planning and donor-driven verticals with a national strategy and performance framework. By the end of the year, 35 out of 36 states and the FCT had conducted Joint Annual Health Reviews, aligning their plans with the National Health Sector Strategic Blueprint.
A defining moment came in September with Nigeria's inaugural National Health Financing Policy Dialogue, which led to a presidential directive mandating NHIA enrolment across Ministries, Departments, and Agencies. This move aimed to expand coverage while strengthening accountability and transparency. Reforms echoed a broader continental shift, with the Africa Health Sovereignty Summit and the Accra Reset calling for a move away from aid-dependent models toward nationally owned systems.
Health Security and Epidemic Preparedness
Nigeria's health security efforts in 2025 relied heavily on the Nigeria Centre for Disease Control and Prevention (NCDC), which sustained surveillance and response efforts against multiple public health threats. The year unfolded within a broader context, including the ongoing mpox outbreak and the WHO's declaration of a public health emergency of international concern (PHEIC). Nigeria focused on maintaining surveillance, strengthening cross-border alert systems, and aligning with the Africa CDC's health security agenda.
In parallel, immunization efforts intensified to reduce outbreak risks and close immunity gaps. An integrated vaccination campaign targeting 106 million children was launched in October 2025. While the WHO Pandemic Agreement signaled progress in international cooperation, concerns arose about weakened coordination due to shifts in global engagement.
From Consumption to Contribution
Progress along the health value chain was notable. The African Medical Centre of Excellence (AMCE) transitioned from concept to care delivery, reflecting a strategic shift toward retaining specialized expertise. The Presidential Initiative for Unlocking the Healthcare Value Chain (PVAC) set in motion plans for Africa's first second-generation long-lasting insecticidal net (LLIN) manufacturing plant in Nigeria.
A five-year health cooperation Memorandum of Understanding (MoU) between Nigeria and the United States reinforced this direction, anticipating nearly $2 billion in grant support from the U.S., alongside Nigeria's commitment to mobilize nearly $3 billion in domestic resources. This agreement signals a deliberate shift towards sustainability and reduced reliance on grants.
2026: The Test of Commitment
As political attention turns toward the 2027 general elections, maintaining health as a national priority will require discipline and accountability. Primary Health Care (PHC) remains the clearest test. Experience from Yan Dadi PHC in Kano State highlights the need for more than just infrastructure; accountability must shift from rhetoric to routine practice.
Delays in budget releases and the rollover of capital spending raise questions about resource availability and usage. Budget allocations must be matched by timely release, with quarterly data published showing what was budgeted, released, and delivered. The credibility of the SWAp depends on data integrity, including transparent evidence of how new cadres have improved planning and frontline performance.
The funding freeze of early 2025 serves as a reminder that Nigeria's health system is too important to outsource to donor cycles. This is not a rejection of partnerships but a recognition that primary responsibility for health security must rest with Nigerians. Emergency domestic appropriations, renewed momentum toward local pharmaceutical production, and growing consensus around financing health from within signal this shift.
2025 showed that progress is possible even under constraint. Whether those gains endure will depend on choices made in 2026. Nigeria must move beyond commitments to measurable delivery through timely, cash-backed budget releases, better-performing PHCs, expanded NHIA coverage, and faster outbreak response. Let health be the policy choice Nigeria refuses to postpone, because lives cannot wait for the next budget cycle.
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