Epidemic Preparedness in Nigeria: Making the Case for Increased Federal, State and Local Investments
Nigeria doubled funding for its Center for Disease Control over two years, and Kano state added a new budget line for epidemic preparedness, following strategic advocacy led by local civil society organizations supported by the Global Health Advocacy Incubator (GHAI).
The Challenge
Nigeria has taken critical steps to strengthen its epidemic preparedness. In 2011, the government established one national-level agency — the Nigeria Center for Disease Control (NCDC) — to oversee epidemic preparedness and, in 2017, participated in an evaluation of the country’s readiness with support from the World Health Organization, which led to the creation of a national action plan for health security.
NCDC lacked budget authority, however, and domestic investments in epidemic preparedness remained insufficient.
GHAI’s Response
A legislative proposal to grant NCDC additional powers was pending before the National Assembly in late 2018. GHAI and others supported political decision-makers in building momentum for the creation of NCDC’s budget line, paving the way for legislative approval in time for NCDC to receive its first-ever direct appropriation for fiscal 2019.
GHAI partnered with Nigeria Health Watch (NHW), the Legislative Initiative for Sustainable Development (LISDEL) and BudgIT to strengthen public and political support for additional investments in preparedness at the federal, state and local levels. We examined budget processes, conducted political mapping and identified opportunities to elevate epidemic preparedness as a public health priority. Throughout the campaign, GHAI provided strategic and technical assistance to our partners as they built coalitions, conducted media advocacy and engaged government decision-makers.
Coalition Building
Local civil society organizations successfully framed epidemic preparedness as a national priority, recognizing Nigeria’s exposure to a variety of imported and endemic diseases given the country’s massive population and role as a trade and travel hub. LISDEL worked with the Health Sector Reform Coalition (HSRC), Legislative Network for Universal Health Coverage and others to raise awareness and mobilize people to action to support political leadership.
NHW and LISDEL hosted roundtable discussions, field trips to ports of entry and other activities for political decision-makers to increase awareness of the need to prioritize health security in the national budget, and gathered civil society feedback on major reform proposals. More than 500 political leaders, journalists and civil society advocates participated in workshops and activities organized by the campaign.
Media Advocacy
NHW, LISDEL and BudgIT generated media coverage throughout the campaign on the importance of investing in epidemic preparedness. Media events, radio segments, and video messages by respected religious and community leaders helped to build awareness and support. NHW hosted a series of journalism masterclasses and recognized quality reporting through #PreventEpidemicsNaija Journalism Awards.
On social media, #PreventEpidemicsNaija generated almost half a billion impressions within two years; online engagement grew substantially with the spread of COVID-19, making the campaign hashtag one of the most prominent hashtags in social media conversations about the pandemic.
Accountability and Sustainability
Research revealed that federal funds designated for NCDC did not always reach the agency, and health funding for states was often left unspent. To promote transparency, accountability and sustainability of government investments in preparedness, LISDEL worked with BudgIT and other civil society organizations, including HSRC, to develop a Health Security Financing Accountability Framework. The framework may be used to track budget allocations, spending and outcomes at the federal, state and local levels and to identify spending barriers and inform advocacy. Campaign partners are working with political decision-makers to disaggregate spending data where necessary to track releases at the federal level and in Kano state.
Epidemic Preparedness in Kano
LISDEL worked with BudgIT to form a civil society coalition called the Kano State Health Security Advocacy Team (KSHSAT) to make the case for epidemic preparedness investments in Nigeria’s second-most populous state. The campaign engaged key decision-makers in the state’s ministries of Health as well as Planning and Budget, among others.
LISDEL and GHAI cultivated the relationship with epidemic preparedness champions in politics and the media to support the importance of investing in health security. This engagement fostered trust and led to invitations for LISDEL and KSHSAT members to participate in government-led budget review and planning sessions as well as meetings to evaluate the state’s preparedness.
Furthermore, LISDEL, GHAI and KSHSAT engaged with the Kano State Ministry for Local Government and Chieftaincy Affairs through various budget advocacy activities. This was aimed at getting each of the 44 local government areas (LGAs) to allocate funding for epidemic preparedness and response directly from their budgets.
Results
Funding for NCDC grew through our campaign to a record 2.9 billion Naira (US$7.7 million) in fiscal 2021 – more than double from the 1.4 billion Naira appropriated for the agency two years prior. A share of Nigeria’s Basic Health Care Provision Fund will go to NCDC, providing the agency with a sustainable funding source beyond the annual appropriations process.
Kano created a budget line for epidemic preparedness and response, totaling 300 million Naira (US$525,000) in 2021, and the 44 LGAs in the state agreed to allocate 2 million Naira each toward strengthening preparedness.
Lessons Learned
- Sustained advocacy can support new and long-term investments in health security beyond immediate crises.
- Leadership by local civil society is critical to developing effective coalitions and successful advocacy campaigns.
- Campaign plans should be based on detailed knowledge of budget-writing and spending processes.
- Advocacy efforts should support national and subnational decision-makers to get sustainable investment for epidemic preparedness at both levels.
- Political decision-makers are more likely to support funding proposals backed by scientific evidence and public support.
- Media coverage can help to frame epidemic preparedness as a priority.