Transcending Borders: Nigeria's State-Led Model for Sustainable Health Product Financing and Equity in Universal Health Coverage
1
ARC_ESM, Abuja, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Achieving Universal Health Coverage requires sustainable, government-led health product supply chains transcending donor dependency. Nigeria's 2021-2025 National Health Product Supply Chain Strategy focused on Pillars 1 and 2: state ownership of integrated supply chains (Federal Ministry of Health, 2020). The Africa Resource Center for Excellence in Supply Chain Management (ARC_ESM) implemented the Strategic Support to Targeted States to Improve Supply Chain Performance (SSTS) Project (2021-2024), funded by the Gates Foundation, establishing State Drug Management Agencies (DMAs) as SPVs for sustainable financing across 10 Nigerian states.
METHODS:
This evaluation synthesizes mid-term assessment findings using workshops, stakeholder interviews, and desk reviews. ARC_ESM supported states in establishing DMAs, strengthening Drug Revolving Fund (DRF) schemes, and advancing through a maturity model tracking progression from Emerging (below 50%) through Maturing Not Ready to Integrate (70-79%) to Maturing Ready to Integrate (80%+) (UNICEF, 2021). Interventions included PPP frameworks, pooled procurement mechanisms, and capacity building.
RESULTS:
Of 26 states adopting the DMA model, five achieved significant maturity: Kaduna (52%→88% MRTI), Nasarawa (39%→87% MRTI), Yobe (63%→83% MNRTI), Kano (76%→71% MNRTI), and Bauchi (47%→70% MNRTI). Mature states demonstrated direct UHC linkage: Kaduna achieved ₦5.4 billion turnover with 100% facility coverage; Kano reached ₦45 billion with 67% coverage; Yobe attained ₦4.5 billion with 72% coverage. Benefits included financial self-reliance through cost-recovery mechanisms (Ogbonna & Nwako, 2016), near-elimination of falsified medicines, and enhanced donor confidence in government-managed systems (Okoro et al., 2020).
CONCLUSIONS:
Nigeria's phased Pillars 1 and 2 implementation demonstrates that systematic state ownership creates sustainable UHC pathways despite persistent supply chain challenges in low- and middle-income countries (Olutuase et al., 2022). This government-led, maturity-based model exemplifies "Health Without Borders" by transcending geographical and sectoral boundaries, providing a replicable framework for African countries transitioning from donor dependency to self-reliant, equitable health systems sustaining essential medicine access across generations.
Achieving Universal Health Coverage requires sustainable, government-led health product supply chains transcending donor dependency. Nigeria's 2021-2025 National Health Product Supply Chain Strategy focused on Pillars 1 and 2: state ownership of integrated supply chains (Federal Ministry of Health, 2020). The Africa Resource Center for Excellence in Supply Chain Management (ARC_ESM) implemented the Strategic Support to Targeted States to Improve Supply Chain Performance (SSTS) Project (2021-2024), funded by the Gates Foundation, establishing State Drug Management Agencies (DMAs) as SPVs for sustainable financing across 10 Nigerian states.
METHODS:
This evaluation synthesizes mid-term assessment findings using workshops, stakeholder interviews, and desk reviews. ARC_ESM supported states in establishing DMAs, strengthening Drug Revolving Fund (DRF) schemes, and advancing through a maturity model tracking progression from Emerging (below 50%) through Maturing Not Ready to Integrate (70-79%) to Maturing Ready to Integrate (80%+) (UNICEF, 2021). Interventions included PPP frameworks, pooled procurement mechanisms, and capacity building.
RESULTS:
Of 26 states adopting the DMA model, five achieved significant maturity: Kaduna (52%→88% MRTI), Nasarawa (39%→87% MRTI), Yobe (63%→83% MNRTI), Kano (76%→71% MNRTI), and Bauchi (47%→70% MNRTI). Mature states demonstrated direct UHC linkage: Kaduna achieved ₦5.4 billion turnover with 100% facility coverage; Kano reached ₦45 billion with 67% coverage; Yobe attained ₦4.5 billion with 72% coverage. Benefits included financial self-reliance through cost-recovery mechanisms (Ogbonna & Nwako, 2016), near-elimination of falsified medicines, and enhanced donor confidence in government-managed systems (Okoro et al., 2020).
CONCLUSIONS:
Nigeria's phased Pillars 1 and 2 implementation demonstrates that systematic state ownership creates sustainable UHC pathways despite persistent supply chain challenges in low- and middle-income countries (Olutuase et al., 2022). This government-led, maturity-based model exemplifies "Health Without Borders" by transcending geographical and sectoral boundaries, providing a replicable framework for African countries transitioning from donor dependency to self-reliant, equitable health systems sustaining essential medicine access across generations.
| eISSN: | 2654-1459 |
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