National Action Plan for Health Security Federal Republic of Nigeria

Objectives

Nigeria’s National Action Plan for Health Security (NAPHS) 2018–2022 is a five-year, country-owned and costed framework to strengthen the core capacities required under the International Health Regulations (2005), close gaps identified through the 2017 Joint External Evaluation and the Performance of Veterinary Services assessment, and reduce illness, deaths and economic disruption from public health emergencies.[1][2]It integrates existing national strategies on disease control, immunisation, antimicrobial resistance, infection prevention and control, primary healthcare and emergency preparedness into a prioritised multisectoral roadmap.[1][3]

• Prevent, detect and respond to public health threats across all 19 health-security technical areas through a whole-of-government, One Health approach connecting human, animal and environmental health.[1][3]
• Strengthen legislation, governance and sustainable financing for International Health Regulations implementation, including completion of the Nigeria Centre for Disease Control Bill and clearer institutional responsibilities.[4][5]
• Improve surveillance, laboratory networks, real-time reporting, workforce capacity, immunisation, infection prevention and control, risk communication, emergency operations and response readiness.[6][7]
• Control priority hazards including antimicrobial resistance, zoonotic and foodborne diseases, biosafety and biosecurity risks, chemical events, radiological and nuclear emergencies, and threats at points of entry.[6][7]
• Expand integrated surveillance coverage by 2021 to all states and 80% of local government areas, public and private health facilities, and private veterinary clinics, while linking human and animal systems to the District Health Information System 2.[8]
• Build a sustainable public health workforce with a target of one trained field epidemiologist or equivalent per 200,000 population, supported by advanced, frontline and intermediate Field Epidemiology and Laboratory Training Programmes.[9]
• Improve measles control through routine and supplementary immunisation coverage targets, including reducing incidence to five cases per million by 2023 and below one case per million by 2028.[10]

The plan provides a detailed one- to two-year implementation roadmap subject to annual revision, alongside a costed menu of activities for 2018–2022.[2][11]Its total planned cost is estimated at 134 billion Naira, of which immunisation accounts for 81 billion Naira and the remaining 18 technical areas for approximately 53 billion Naira.[3]

Implementation

NAPHS implementation is organised through coordinated technical-area workplans, annual implementation plans and a shared tracking platform, led principally by the Nigeria Centre for Disease Control as the International Health Regulations National Focal Point and secretariat.[2][12]Delivery relies on multisectoral One Health coordination among federal, state and local authorities, health and veterinary services, laboratories, emergency-management and security bodies, civil society, private-sector actors and development partners.[3][12]

• Coordinate implementation through working groups for all 19 technical areas, each with designated leads, focal points, activity dates and output or process indicators.[3][11][12]
• Align activities with national planning and budgeting cycles, including the Mid Term Expenditure Framework, and direct government and partner financing towards unfunded health-security gaps.[12]
• Establish One Health coordination platforms and information-exchange mechanisms at national, state and local government area levels to improve collaboration across human, animal, food and environmental health sectors.[13][14]
• Strengthen operational systems through electronic reporting and laboratory information systems, integrated surveillance, reference laboratories, emergency operations centres, stockpiles, trained rapid-response personnel and designated points of entry.[6][7]
• Develop and test all-hazards preparedness, emergency response, medical-countermeasure and risk-communication plans through simulations, tabletop exercises and after-action reviews.[15][16][17]
• Engage the Federal Ministries responsible for health, agriculture, environment, finance, justice, security, transport and information, alongside the National Emergency Management Agency, National Primary Health Care Development Agency, National Assembly, state governments and international technical partners.[3][11][12]
• Mobilise resources from the Nigerian government and partners, while prioritising activities feasible in 2018–2019 with existing or limited additional resources.[3]

Progress is to be monitored through the NAPHS shared electronic platform, technical-area reviews held quarterly or monthly, multisectoral International Health Regulations working-group meetings twice yearly, and formal mid-year and annual plan reviews.[12][4]The framework also uses Joint External Evaluation assessments, International Health Regulations Monitoring and Evaluation Framework processes, annual State Party Annual Reporting, simulation exercises and after-action reviews to assess capacity and redirect activities or resources.[4]Although technical working groups are required to develop activity indicators, the source does not specify a consolidated national indicator set or complete reporting timetable.[12][4]

Monitoring & Evaluation

The National Action Plan for Health Security uses a shared monitoring platform, technical-area workplans and periodic reviews to track delivery across 19 technical areas, with the Nigeria Centre for Disease Control coordinating implementation alongside the International Health Regulations National Focal Point, relevant ministries and technical working groups.[12][4]Monitoring combines routine surveillance, assessment of International Health Regulations capacities, simulation exercises and after-action reviews to identify gaps and revise implementation plans.[4][8]

• Track each prioritised activity through assigned focal points, start and end dates, and output and process indicators developed by technical working groups.[11][12]
• Conduct technical-area reviews quarterly or monthly, formal mid-year reviews in February, annual reviews in August, and wider multisectoral International Health Regulations reviews twice yearly.[12][4]
• Measure outcomes through the International Health Regulations Monitoring and Evaluation Framework, annual State Party Annual Reporting, periodic Joint External Evaluation reviews and, where relevant, Regional Disease Surveillance Systems Enhancement reporting.[4]
• Strengthen integrated human, animal and environmental surveillance through indicator- and event-based reporting, laboratory information exchange, data-quality assessment, supportive supervision, syndromic surveillance and interoperable electronic reporting linked to the District Health Information System 2.[8][18]
• Target surveillance coverage by 2021 in all states, 80% of local government areas, 80% of public and private health facilities, and 80% of private veterinary clinics.[8]
• Monitor reporting completeness, consistency and timeliness, including private-sector reporting, and establish baseline assessments where information is unavailable.[19][20]
• Use Joint External Evaluation indicators across legislation, coordination, antimicrobial resistance, zoonoses, food safety, biosafety, immunisation, laboratories, surveillance, workforce, preparedness, emergency response, risk communication, points of entry, chemical events and radiation emergencies.[21][4]
• Test operational readiness through tabletop and real-time simulations, routine drills, emergency operations centre activations and after-action reviews.[22][23]

Important quantified targets include reporting-system reach of 80% of public and private human and animal-sector facilities by 2021, three simulation exercises annually for rare diseases, national detection and response capability for radiation emergencies by 2021, and a target of one trained field epidemiologist or equivalent per 200,000 population.[6][19][7][9]The framework also sets dated food-safety, laboratory, preparedness and legislative milestones.[24][25][26]However, several technical areas do not specify detailed indicator targets, reporting schedules, evaluation methodologies or formal accountability arrangements beyond Joint External Evaluation indicators, review mechanisms and named coordinating institutions.[16][27][28]

Costing & Financing

The plan is a costed five-year health-security framework for 2018–2022, intended to guide annual planning, domestic budgeting, partner support and resource mobilisation.[3][11]Its total estimated cost is 134 billion Naira, equivalent to 439 million United States dollars.[3]The minimum investment level is estimated at approximately 130 Naira per person per year.[29][1]

• Allocate 81 billion Naira to immunisation under the Nigeria Strategy on Immunization and Primary Health Care Systems Strengthening, representing 60% of total plan costs and supported through its own funding source.[3]
• Allocate approximately 53 billion Naira, equivalent to 174 million United States dollars or 56 Naira per person per year, to the remaining 18 technical areas, with laboratory capacity, emergency preparedness, surveillance and workforce development as major cost drivers.[3]
• Mobilise financing from the Nigerian Government and development partners, align partner commitments with unfunded gaps, and integrate activities with the Mid Term Expenditure Framework and national budgeting cycles.[3][12]
• Revise costed workplans annually and redirect resources in response to implementation bottlenecks and emerging priorities.[4]
• Address persistent financing constraints, including inadequate funding pools, weak state and local government participation, non-allocation to existing budget lines, absence of dedicated One Health, antimicrobial resistance and chemical-management budget lines, and reliance on transitioning polio and Gavi resources.[5][30][31][32]

The economic case emphasises that preparedness can generate an estimated return of 2 to 7 United States dollars for each United States dollar invested.[2][7]Nigeria spent 0.6% of gross domestic product on health in 2016, equivalent to 11 United States dollars per person.[7]A full-scale influenza pandemic was estimated to cause annual losses of 9.6 billion United States dollars, approximately 2% of Nigeria’s annual gross domestic product.[7]The extracts identify extensive resource needs for infrastructure, commodities, training, staffing, laboratory systems, emergency operations, risk communication and points-of-entry preparedness, but most technical areas do not provide activity-level funding sources, confirmed allocations or quantified financing gaps.[33][22][17][34]