Impact assessment

Nigeria Health Systems Strengthening thematic evaluation: management response and recommendations action plan

Published 24 September 2025

Overall summary

We welcome the comprehensive evaluation conducted by Cadmus on two decades of UK-supported Health Systems Strengthening (HSS) programming in Nigeria. The report provides valuable insights into the effectiveness, relevance, coherence, and sustainability of our interventions, and we appreciate the rigorous methodology, stakeholder engagement, and thematic analysis that underpin its findings.

We are encouraged by the evidence of transformational change achieved through flagship programmes such as PATHS1 & 2, PRRINN-MNCH, MNCH2, and Lafiya, particularly in improving maternal and child health outcomes, strengthening government capacity, and expanding access to essential medicines and services. The evaluation highlights the importance of political alignment, community engagement, and locally tailored delivery—principles that have guided our programming and will continue to inform future strategies.

We acknowledge the challenges identified, including sustainability post-programme, health workforce shortages, and fragmented coordination mechanisms. We note the critical role of community-based structures, such as Ward Development Committees and Facility Health Committees, in sustaining reforms, and the need to further strengthen data systems and financial protection mechanisms.

FCDO Nigeria is committed to applying the lessons and recommendations outlined in the report. In particular, we will:

• continue to support advocacy and policy reform, including the implementation of the National Health Act and the National Health Sector Renewal Initiative
• work with the Government of Nigeria to leverage domestic resources, including through the Basic Health Care Provision Fund and the Sector-Wide Approach
• support Nigerian Government efforts to strengthen coordination with development partners and civil society to ensure inclusive, equitable, and sustainable health systems

We thank all stakeholders who contributed to this evaluation and reaffirm our commitment to supporting Nigeria’s health sector transformation in alignment with national priorities and global best practices.

Recommendations: FCDO	Accepted or rejected	If ‘accepted’, action plan for implementation or if ‘rejected’, reason for rejection
Recommendation 1: FCDO should play to its strengths in supporting legislative advocacy, convening and coordinating among development partners, and civil society and accountability mechanisms.	Accepted	While FCDO’s term as formal co-chair of the Health Development Partner Group has recently ended, FCDO continues to play a key role in supporting advocacy and coordination of development partners and other stakeholders in support of Government of Nigeria’s health systems strengthening efforts.
Recommendation 2: FCDO needs to coordinate and leverage resources from the government of Nigeria, grassroots and the private sector, and other development partners to ensure interventions address all Health Systems Strengthening (HSS) building blocks.	Accepted	FCDO’s health systems strengthening programme in Nigeria continues to provide technical assistance and financial support to enable Government of Nigeria lead and implement its flagship National Health Sector Renewal Investment Initiative (NHSRII). The NHSRII encompasses interventions across all HSS building blocks.
Recommendation 3: Refresh the Change Agents Programme to support the next generation of leaders in Nigerian health reform.	Accepted	In 2025, the Government of Nigeria launched the National Health Fellows Programme—an initiative aimed at cultivating the next generation of reformers in the country’s health sector. Rather than developing a separate Change Agents Programme, the Foreign, Commonwealth & Development Office (FCDO) is co-financing the National Health Fellows Programme through a financial contribution to the World Bank’s Human Capital Opportunities for Prosperity and Equity – Primary Health Care (HOPE-PHC) programme.