Nigeria and the US Team Up for Health Improvements

For over twenty years, Nigeria and the United States have partnered on major health issues. Programs like the US President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative, polio eradication, and contributions through the Global Fund and Gavi have saved lives. This partnership has also strengthened institutions that millions of Nigerians depend on.

Nigeria appreciates this history of cooperation, but the next steps must focus on national needs. No country as large as Nigeria can rely on foreign aid forever for health services. We must keep the progress made with partners while increasing local funding, building Nigerian institutions, and ensuring essential services are available as international funding changes.

A National Framework for Transition
This direction was set before the current bilateral agreement. In December 2023, President Bola Ahmed Tinubu launched the Nigeria Health Sector Renewal Investment Initiative and the Health Sector Renewal Compact. This brought together the Federal Government, the 36 states, the Federal Capital Territory, and development partners to focus on common reforms. With the Sector-Wide Approach, we are reducing fragmentation and overlap. Public and partner resources are now aligned behind one plan, one budget, and one report, with clear responsibilities and a focus on national ownership.

When the United States changed its health approach in 2025 under President Donald Trump, the focus on country ownership and government cooperation matched the reforms Nigeria was already making. The priority was to maintain treatment for HIV, tuberculosis, malaria, and other vital services while strengthening the local foundations needed for these services.

The health Memorandum of Understanding (MoU) signed by Nigeria and the United States on December 19, 2025, was part of this framework. It covers the period from April 2026 to December 2030 and outlines a managed shift from external funding to stronger use of Nigerian institutions, government systems, and local resources, while keeping essential services as Nigeria takes on more financing and management.

Financing the Transition
The MoU clearly shows the financing structure. The planned US support is nearly $2 billion over five years, which will decrease over time. Nigeria plans to contribute nearly $3 billion in local health funding. This money stays in Nigeria and is used for Nigerian priorities, including HIV, tuberculosis, malaria, maternal and child health, laboratories, health workers, and primary healthcare. There is no way to reduce aid dependency without Nigeria investing more in the health of its people.

The Federal Government is already acting on this commitment in the budget. The 2025 federal health budget increased by nearly 60 percent, raising health’s share of the national budget to 5.2 percent from just over 3 percent. In the 2026 Appropriation Bill, President Tinubu proposed ₦2.48 trillion for health, representing 6 percent of the budget, excluding liabilities. The 2026 Appropriation Act was signed into law with total spending of ₦68.32 trillion. Under the MoU, Nigeria’s co-investment is measured by actual spending. This means at least 6 percent of executed annual Federal and State budgets for health, not just by budget announcements.

The MoU covers more than just medicines or vaccines. It includes outbreak surveillance, laboratory capacity, health workers, health commodities, and data systems. It also supports improvements in service delivery and local manufacturing. Its performance measures include viral suppression in people living with HIV, tuberculosis treatment outcomes, malaria deaths, maternal and child survival, immunization rates, and the speed of detecting and controlling public health threats.

Sovereignty, Law and Public Scrutiny
Nigeria negotiated this framework through a whole-of-government approach involving ministries for Health, Foreign Affairs, Finance, Budget and Economic Planning, and relevant health agencies. The Attorney-General of the Federation reviewed and approved it, confirming it does not harm Nigeria's national interest. The MoU is legally non-binding, respects Nigerian law, and allows either party to stop cooperation if needed. Implementation remains within Nigeria's legal authority. Any citizen, journalist, researcher, or civil-society group wanting to see the document can request it under the Freedom of Information Act, so public discussions can be based on the text and commitments.

Regulatory Authority and Health Security
NAFDAC continues to oversee medicines, vaccines, and diagnostics. The MoU refers to NAFDAC’s regulatory framework, which may consider assessments by recognized authorities while keeping Nigeria’s responsibility. This approach reduces duplication and speeds up access to quality products without removing NAFDAC's authority to evaluate applications and monitor products.

The same principles apply to health data and pathogens. Nigeria must detect new pathogens, sequence them quickly, and share useful information for public health. Access requests must comply with Nigerian law, data protection, and ethical reviews. Building domestic genomic-sequencing capacity and secure data systems strengthens Nigeria's ability to participate in global science competently. The MoU does not affect Nigeria’s position in ongoing international negotiations on pathogen access and benefit sharing.

Faith-based Service Delivery and Accountability
The MoU states that about ten percent of planned US support is for eligible faith-based health providers, without favoring any religion. At the signing, the US Ambassador acknowledged Nigeria’s Christian and Muslim traditions, emphasizing that both could receive support. This shows the important role faith-based institutions play in healthcare, especially in areas with limited access.

Besides funding and service continuity, the framework changes how external support is managed. Previous aid often went through non-governmental channels, which sometimes limited government oversight. The new arrangement focuses financing on government-to-government methods, with audits and performance reviews. This improves national oversight, reduces fragmentation, and holds both countries accountable for their commitments.

The Measure of Success
The success of this partnership will be seen in the lives it saves and the institutions it strengthens. People living with HIV must get continuous treatment, and deaths from malaria and tuberculosis must decrease. Mothers and children should have better care, and outbreaks must be detected and controlled quickly. Nigeria’s laboratories, workforce, supply chains, and data systems must also improve as the Federal and State governments take on more funding responsibility.

By 2030, the true measure of success will not be how much foreign aid Nigeria received, but how capable and self-reliant our health system has become while that aid decreased. Nigeria will continue to partner with the United States and others for shared health and development goals, while building the local foundations for lasting progress. The goal is clear: a health system funded more by Nigeria, managed through Nigerian institutions, and able to deliver better outcomes for Nigerians.