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For decades, Nigeria’s relationship with major health donors has been a complex one. While the country has received billions in aid to fight HIV, tuberculosis, malaria, and other health challenges, concerns about governance, accountability, and inefficiency have often shadowed the progress.
In recent years, however, something has changed. Independent evaluations by the Global Fund and other development partners point to a sharp improvement in how Nigeria plans, spends, and tracks donor resources.
The shift has been most visible in the work of the Country Coordinating Mechanism (CCM), the multi-stakeholder platform that oversees Global Fund grants. Between 2021 and 2023, the CCM underwent what insiders describe as its most significant governance reform in over a decade.
From paperwork to performance
Previously, the CCM’s oversight often relied on retrospective reporting, data came in late, problems were spotted long after they occurred, and decision-making lagged. That changed under a suite of reforms introduced during the 2021–2023 grant cycle.
An Enterprise Resource Planning (ERP) dashboard now provides near real-time updates on programme performance. Civil society participation has been expanded, giving non-government actors a more active role in grant monitoring. Funding requests are now explicitly aligned with the National Strategic Health Development Plan to avoid duplication and ensure sustainability.
A central figure in this overhaul was Chidozie Ezechukwu, who served as Executive Secretary of the CCM during this period. With a background in public health systems strengthening, Ezechukwu championed the introduction of performance-based oversight, working to integrate government, private sector, and civil society actors into one coordinated governance framework.
“Accountability is not about catching people doing the wrong thing,” Ezechukwu said in an interview last year. “It’s about creating systems that make it easier to do the right thing, every time, without fail.”
Restoring donor confidence
The impact was immediate. By the end of the 2021–2023 cycle, Nigeria had achieved or exceeded key targets for all three of the Global Fund’s focus diseases. Audit reports reflected a notable drop in financial management queries, while grant implementation timelines improved.
These results were a factor in Nigeria securing the largest-ever single-country allocation from the Global Fund, US $993 million for 2024–2026 just months after completing the previous record-setting US $890 million cycle.
A senior official in the Federal Ministry of Health, who asked not to be named, credited the governance reforms for “restoring donor confidence” and making it easier to argue for larger allocations. “The system now runs on evidence, not on assumptions,” the official said.
Governance lessons beyond health
Policy analysts believe the CCM reforms offer a blueprint for other sectors. The combination of digital tracking, multi-stakeholder oversight, and strategic alignment with national plans could be applied to agriculture, education, and even infrastructure funding.
Ezechukwu himself sees the lesson in broader terms. “If you want sustainable development, you need governance systems that outlast individual projects or political cycles,” he notes. “That’s the only way to build resilience.”
The road ahead
While progress has been made, challenges remain. Nigeria still relies heavily on donor funding for key health interventions, and domestic financing for health remains below the Abuja Declaration target of 15% of the national budget.
But for now, the quiet overhaul of the CCM stands as a case study in how targeted governance reforms can change the trajectory of national health programmes, and potentially, the country’s development path.
For the donors who write the cheques, the results speak volumes. And for the Nigerians whose health depends on these programmes, the reforms could mean the difference between temporary aid and lasting impact.
