Nigeria is building a sustainable health financing future, By Muhammad Ali Pate

Nigeria welcomes Gavi’s US$500 million support as part of the shared effort to protect our children over the next five years. Within that period, we will continue to strengthen the domestic financing and institutional capacity needed to sustain immunisation beyond 2030, as Nigeria assumes greater responsibility for financing the programme and meeting the health needs of our citizens.

For much of the past three decades, global health financing rested on the expectation that external assistance would continue to expand alongside the health needs of developing countries. That expectation is now less certain, as fiscal pressures in donor countries, changing political priorities and recent disruptions to established programmes reshape how health partnerships are financed and managed. Nigeria must prepare for that change without surrendering the gains those partnerships have helped to achieve.

The implications are especially clear in immunisation, where nearly 10 million children are born in Nigeria each year. Each cohort must be reached with the vaccines already in the national schedule, while new vaccines are introduced only where the burden of disease, the evidence and the capacity of the health system justify them. With one of the largest birth cohorts in the world, Nigeria is among the most demanding immunisation settings globally.

Against this background, Gavi’s announced support of about US$500 million between 2026 and 2030 at a meeting with President Tinubu is a welcome boost. It will help finance vaccines, strengthen delivery and surveillance, maintain the cold chain and reach children who remain outside routine services. The support is provided within Gavi’s co-financing model, under which participating governments meet a share of vaccine costs and take on more as their capacity grows. Under Gavi 6.0, the Alliance’s 2026–2030 strategy, country leadership and the long-term sustainability of national immunisation programmes remain central to the way support is provided.

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Financing a National Commitment

Nigeria has already co-financed vaccines at a level only few countries in the Gavi portfolio have matched. Over the course of the partnership, more than US$500 million has come from domestic resources. This scale of commitment reflects Nigeria’s demographic weight and a routine schedule of nearly 13 antigens; vaccines are consequently among the highest commodity cost items in the budget of the Federal Ministry of Health and Social Welfare.

This investment reflects the priority President Bola Ahmed Tinubu’s administration has given to immunisation, maternal and child health and primary healthcare. Sustaining that commitment as the programme expands will require counterpart financing to keep pace and responsibility to be shared more evenly across the federation. The Federal Government has historically borne most of the co-financing cost, while states are expected to provide much of the workforce, facilities, transport and community outreach through which vaccines reach children. A lasting financing framework should therefore reflect the shared responsibility between the federal and state levels.

That balance becomes more important with every vaccine introduced, because each addition creates a recurrent obligation as successive cohorts become eligible. Each new vaccine must therefore be judged not only by disease burden, but also by equity, affordability and the ability of the health system to deliver it consistently. Expanding the schedule without sustaining reliable coverage would defeat the purpose of doing so.

Within that framework, domestic financing has risen incrementally under President Tinubu. Health represented about 3.48 per cent of the federal budget when the administration began; it moved to 4.3 per cent, then about 5.28 per cent, and reached 6 per cent of the 2026 budget net of liabilities. Although Nigeria’s needs remain greater, this progression establishes a stronger domestic base over successive budgets instead of resting policy on promises that cannot be sustained.

The Design of the NHSRII

These financing choices cannot be separated from the way the wider health system is organised. The Nigeria Health Sector Renewal Investment Initiative (NHSRII) was designed in response to a system in which priorities, financing and implementation had too often been dispersed across separate programmes. It provides the framework through which government sets national priorities, states and partners align behind them, and resources are connected more clearly to results.

External assistance has contributed immensely to Nigeria’s health gains, much of it delivered through separate plans, procurement channels, contractors and reporting systems. These programmes saved lives and built important capabilities, but they also produced fragmentation, duplication and limited visibility across the sector, leaving national institutions to assume responsibilities without always inheriting the systems, data and financing required to sustain them.

The Sector-Wide Approach (SWAp) was introduced to change that pattern. Under the Health Sector Renewal Compact, the Federal Government, all 36 states, the Federal Capital Territory and development partners have committed to work from one national plan, one budget and one reporting system. Because Nigeria’s health system remains decentralised, national progress still depends on state and local performance; the reform therefore gives the federation a shared direction while making responsibilities, resources and results easier to track.

The HOPE for Quality Primary Healthcare (HOPE-PHC) programme gives practical effect to this approach by linking financing to measurable improvements in primary healthcare at state level.

Building the Domestic Financing Base

These increases are intended to support better services, stronger financial protection and improved population health. Achieving that purpose requires sound planning, predictable financing, disciplined procurement and clear reporting, so that Nigerians can see the connection between increased health investment and medicines in stock, functioning facilities, frontline workers and protection from catastrophic costs.

We expect the Gavi commitment to leave Nigeria with more than the vaccines purchased over five years. By 2030, fewer children should remain outside routine immunisation, differences between states should have narrowed, and federal and state governments should have a clearer and more durable arrangement for sharing recurrent costs. Data, supply chains and programme management should also sit more securely within Nigerian institutions.

From Imports to Domestic Production

As domestic financing grows, it should also change what Nigeria buys and what it is able to produce. Replacing donor money with public money to import the same finished products would leave the country exposed to foreign-exchange volatility, supply disruptions and production decisions made elsewhere.

This is why President Tinubu established the Presidential Initiative to Unlock the Healthcare Value Chain (PVAC). Its mandate covers pharmaceuticals, vaccines, biologics, diagnostics, medical devices, logistics and health technology, with the aim of reducing that dependence by attracting investment into domestic production and building a stronger healthcare economy.

Vaccine manufacturing is technically demanding and requires capital, technology transfer, regulation, quality assurance and dependable demand over many years. Nigeria has the market to support such investment, but viability will depend on pooled procurement, development finance, strong regulation and credible technology partnerships working together. Gavi’s growing support for African vaccine manufacturing can assist countries prepared to build that capacity on sound commercial and regulatory foundations.

Beyond 2030

The Gavi funding, rising domestic budgets and the drive for local manufacturing are therefore parts of one reform programme under the NHSRII. This approach is enabling Nigeria to build a health system in which international cooperation serves national priorities and domestic institutions carry a growing share of responsibility.

That transition is taking place amid constrained public revenues, unequal fiscal capacity across states and rising costs for essential commodities. Meeting these pressures will require careful priority-setting, greater efficiency and a steady expansion of domestic financing without weakening services on which people already depend.

Muhammad Ali Pate (CON) is the Coordinating Minister of Health and Social Welfare, Federal Republic of Nigeria.