The promise of sustained international investment in development – particularly in healthcare – often clashes with the realities of complex political systems, bureaucratic inertia, and evolving national priorities. A newly released evaluation of the UK ’s (FCDO) £1 billion investment in Nigeria’s healthcare over two decades reveals a mixed picture, highlighting both significant achievements and persistent challenges that underscore the difficulty of achieving lasting impact in a nation wrestling with endemic instability and systemic fragility. The report, based on a comprehensive theory-based analysis of eighteen FCDO-funded health programmes between 2004 and 2024, presents a sobering assessment of the long-term effects of this commitment, suggesting that while concrete improvements have been made, the ultimate success of the initiative hinges on addressing fundamental issues of governance and institutional capacity.
The evaluation’s scope extends beyond simple metrics of output – such as vaccine coverage rates – to examine the underlying mechanisms through which interventions were intended to impact the Nigerian health system. The research employs a theory-based approach, comparing the intended outcomes of the interventions with observed results, a crucial distinction that many previous development assessments have overlooked. The analysis centers on five key areas: health systems strengthening, immunization, maternal and newborn child health, nutrition, and primary healthcare service delivery. Data reveals a consistent pattern: while targeted programs like the Partnership for Transforming Health Systems phases 1 and 2 (PATHS 1 and PATHS2) achieved notable gains in specific areas, particularly in training health workers and improving access to certain treatments, the broader health system remained vulnerable to disruptions stemming from insecurity, corruption, and lack of sustained government commitment.
“The problem isn’t necessarily the design of the interventions themselves,” explains Dr. Fatima Ibrahim, Senior Research Fellow at the Centre for International Development Research. “The core challenge lies in the fact that these programs were often implemented within a context where governance structures were weak, accountability mechanisms were lacking, and political will fluctuated considerably. Simply pouring money into the system doesn’t automatically translate into improved health outcomes.” The report details instances where funds were diverted due to corruption, program activities were curtailed due to escalating insecurity in northern Nigeria, and government counterparts lacked the capacity to effectively manage and sustain the initiatives beyond the initial funding period.
The evaluation specifically scrutinizes the Partnership for Reviving Routine Immunisation in Northern Nigeria – Maternal, Newborn and Child Health Programme (PRRINN-MNCH), a flagship initiative designed to address widespread immunization gaps. Despite achieving significant improvements in vaccine coverage, particularly amongst children under five, the program faced significant operational hurdles, including logistical challenges in reaching remote communities and a shortage of trained vaccinators. “PRRINN-MNCH demonstrated a clear understanding of the specific challenges in northern Nigeria, but the pace of implementation often struggled to keep pace with the rapidly changing security landscape,” notes Professor Adebayo Olaniran, a public health expert at the University of Ibadan, who contributed to the study. “The frequent disruption of services – due to banditry and other security threats – inevitably undermined the long-term impact of the program.”
A key area of concern highlighted in the report is the limited coherence between different FCDO-funded programs. While individual initiatives targeted specific health issues, there was a noticeable lack of coordination and integration, leading to duplication of efforts and a fragmented approach to addressing Nigeria’s complex health challenges. The evaluation identifies a crucial gap: the failure to build a truly integrated health system, one that is resilient to external shocks and capable of responding effectively to the needs of the population.
The methodology employed in the assessment – a combination of document review and 150 stakeholder interviews – offers a nuanced understanding of the situation on the ground. The researchers engaged with a diverse range of actors, including FCDO officials, Nigerian government representatives, healthcare workers, civil society organizations, and community leaders. This multi-faceted approach allowed them to capture a broader picture of the challenges and opportunities associated with the FCDO’s investment.
Looking forward, the report’s findings carry significant implications for future development interventions in Nigeria and, more broadly, for the effectiveness of international aid in fragile states. Short-term outcomes (next 6 months) will likely see continued efforts to stabilize funding streams for existing programs, but sustained impact will depend on addressing the systemic issues identified in the evaluation. Longer-term (5-10 years), a shift towards a more holistic and locally-driven approach is essential, one that prioritizes strengthening governance, building institutional capacity, and fostering greater collaboration between the FCDO, the Nigerian government, and local stakeholders. A key element must be investing in robust monitoring and evaluation systems capable of tracking progress, identifying challenges, and adapting interventions in real-time.
The evaluation’s central lesson – that aid alone is insufficient to drive lasting health system transformation – merits careful consideration. The case of Nigeria demonstrates the importance of addressing underlying structural issues alongside providing technical assistance and financial support. Without a fundamental commitment to good governance and institutional reform, the promise of sustained international investment will inevitably remain elusive.