National Action Plan for Health Security Federal Republic of Nigeria

Objectives

Nigeria’s National Action Plan for Health Security for 2018–2022 is a country-owned, whole-of-government and multisectoral framework to strengthen the capacities required to prevent, detect and respond to epidemics, pandemics and other public health threats, while addressing gaps identified through the 2017 Joint External Evaluation and other assessments.[1][2][3]It applies a One Health approach connecting human, animal and environmental health, alongside public health, security and emergency-management functions.[2][4]

• Strengthen legal, policy, financing and coordination arrangements for implementation of the International Health Regulations (2005), including the legislative foundation and coordinating role of the Nigeria Centre for Disease Control.[5][6]
• Prevent antimicrobial resistance, zoonotic disease, foodborne illness and biological risks through surveillance, laboratory strengthening, infection prevention and control, antimicrobial stewardship, food-safety systems, biosafety and biosecurity.[7][8][9][10]
• Improve immunisation coverage, vaccine supply, cold-chain management, vaccine-preventable disease surveillance and data quality, particularly in underserved, hard-to-reach and security-compromised areas.[11][12]
• Build integrated human, animal and environmental surveillance and laboratory networks, including interoperable reporting, specimen referral, quality assurance and testing for priority diseases.[13][14]
• Develop and retain a skilled public health and animal-health workforce, including field epidemiology training and a target of one trained field epidemiologist or equivalent per 200,000 population.[15]
• Enhance all-hazards preparedness, emergency operations, risk communication, public health and security collaboration, medical countermeasures, points-of-entry capacity, and chemical, radiological and nuclear emergency readiness.[16][17][18][19][20][21]
• Support veterinary-service capacity for disease prevention, laboratory diagnosis, quarantine, surveillance, emergency response, certification, traceability and animal-health regulation.[22][23]

Implementation

Implementation is structured around 19 technical areas, with prioritised activities for 2018–2019 and a costed menu of actions for 2018–2022.[2][3]The plan integrates existing national strategies and programmes, aligns activities with national budgeting and annual planning, and uses regular review to adapt implementation as capacities are gained and activities completed.[1][24]

• Coordinate delivery through the Nigeria Centre for Disease Control as the International Health Regulations National Focal Point and Secretariat for technical working groups, working with federal, state and local institutions and relevant public and private stakeholders.[25][24]
• Apply One Health coordination through national, state and local platforms linking health, agriculture, environment, food safety, laboratories, security, emergency management and other sectors.[26][27][28]
• Assign lead agencies, focal points, implementation dates and output and process indicators to priority activities, with technical working groups developing detailed workplans for each area.[3][24]
• Establish a project-management and shared tracking platform to monitor delivery, support mutual accountability and enable technical-area reviews quarterly or monthly alongside twice-yearly plan reviews.[24]
• Use the International Health Regulations Monitoring and Evaluation Framework, periodic Joint External Evaluations, annual State Party Annual Reporting, simulation exercises and after-action reviews to assess capacity and revise priorities.[5]
• Strengthen surveillance through electronic information exchange, integrated human and animal reporting, laboratory information systems, data-quality assessment and expansion of reporting to public and private facilities.[29][14]
• Mobilise domestic and partner resources through costed activities, annual implementation plans, advocacy and alignment with the Mid-Term Expenditure Framework, while seeking commitments to address unfunded gaps.[1][3][24]
• Fund the full 2018–2022 plan at an estimated 134 billion Naira, including 81 billion Naira for immunisation and approximately 53 billion Naira for the remaining 18 technical areas; the latter is estimated at about 56 Naira per capita annually.[4]

Monitoring & Evaluation

The monitoring framework combines International Health Regulations (IHR) assessment, Joint External Evaluation (JEE) indicators, technical working-group monitoring and multisectoral surveillance to track Nigeria’s 2018-2022 National Action Plan for Health Security. The Nigeria Centre for Disease Control Secretariat is intended to operate a shared tracking platform, while technical-area groups develop output and process indicators and reviews support mutual accountability.[24][5]

• Use the IHR Monitoring and Evaluation Framework, periodic external JEE assessments and annual State Party Annual Reporting to assess health-security capacities and outcomes.[5]
• Review implementation twice yearly, with a mid-year review in February and an annual August review to revise costed workplans and prepare the following year’s plan.[5]
• Assign focal points, start and end dates, and monitoring and evaluation indicators to prioritised 2018-2019 activities.[3]
• Track surveillance quality through reporting consistency, completeness, private-sector participation and timeliness, including integration of data for 41 priority diseases under Integrated Disease Surveillance and Response.[30]
• Expand reporting to 80% of public and private human and animal health facilities by 2021, covering all states and 80% of local government areas, and link human and animal surveillance systems to District Health Information Software 2 by December 2020.[30]
• Monitor laboratory performance through priority-disease testing, specimen referral and transport, quality assurance, accreditation arrangements and a shared laboratory information system.[31][32]
• Assess preparedness through risk mapping, resource mapping, simulation exercises, after-action reviews, emergency operations centre activation and implementation of multi-hazard response plans.[5][16][17]
• Track specific technical priorities including antimicrobial resistance reporting, zoonotic and foodborne disease surveillance, immunisation coverage and data quality, biosafety audits, points-of-entry capacities, chemical-event surveillance, radiation exercises and risk communication feedback.[8][33][11][34][35][36]

Important performance targets include conducting six of ten World Health Organization core laboratory tests, establishing an appropriately trained field epidemiologist or equivalent per 200,000 population, increasing Animal Disease Surveillance Agents from 591 to 1,000, and meeting 70% of identified annual needs through pre-positioned commodities, equipment and medicines.[31][15][37][38]Several extracts identify indicator frameworks and review mechanisms but do not specify consolidated reporting templates, baselines, targets or accountability arrangements for every technical area.[7][18][39]

Costing & Financing

The plan presents health security as a costed, multisectoral investment financed through Nigerian government resources, existing agency budgets and development-partner support, but identifies substantial unfunded needs across implementation areas. The full 2018-2022 portfolio is budgeted at 134 billion Naira, equivalent to 439 million United States dollars, with immunisation accounting for 81 billion Naira and the remaining 18 technical areas estimated at 53 billion Naira.[4]

• Allocate approximately 60% of the total plan cost to immunisation under the Nigeria Strategy on Immunization and Primary Health Care Systems Strengthening, which has a separate funding source.[4]
• Estimate the remaining technical areas at approximately 56 Naira per capita annually, or 0.18 United States dollars per capita annually, over 2018-2022.[4]
• Estimate minimum health-security investments at approximately 130 Naira per capita annually, including strengthening of the national immunisation programme.[25]
• Mobilise domestic funding by aligning the plan with annual budgeting, the Mid-Term Expenditure Framework and sectoral plans, while seeking bilateral and multilateral commitments for gaps not covered by REDISSE or existing commitments.[24]
• Prioritise 2018-2019 activities that can proceed with existing or limited additional resources, while developing costed activity menus for later annual implementation plans and partner programmes.[1][4]
• Address recurring resource gaps, including insufficient State and local government financing, absent dedicated budgets for antimicrobial resistance, One Health, chemical-event management and biosafety, and inadequate funding for points of entry, workforce development, laboratories, emergency operations and risk communication.[40][41][42][34][39]
• Recognise preparedness as an economic investment, with an estimated return of 2 to 7 United States dollars per United States dollar committed.[1]

The source cites approximately 13 million United States dollars spent on Nigeria’s 2014 Ebola response and prevention of a larger outbreak, compared with an estimated nearly 12 billion United States dollars economic loss from a 2% reduction in 2014 gross domestic product.[26]It also identifies transition risks because Gavi support is expected to decline while co-financing requirements rise over five to seven years.[43]Specific radiation-emergency activities are costed, but most technical areas do not provide activity-level allocations, financing commitments, total funding gaps or economic assumptions.[44][45]