For more than two decades, Nigeria and the United States have worked together on major public-health challenges. Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative, polio eradication, laboratory development, disease surveillance, health security and contributions through the Global Fund and Gavi, that partnership has saved lives and strengthened institutions on which millions of Nigerians depend.
Nigeria values this record of cooperation, but the next phase must serve a clear national purpose. No country of our size can indefinitely finance essential health services through external assistance. Our responsibility is to preserve the gains built with partners while expanding domestic financing, strengthening Nigerian institutions and ensuring that critical services remain available as the international financing environment changes.
A national framework for transition
That direction was established before the current bilateral arrangement. In December 2023, President Bola Ahmed Tinubu presciently launched the Nigeria Health Sector Renewal Investment Initiative and the Health Sector Renewal Compact, bringing the Federal Government, the 36 states, the Federal Capital Territory and development partners behind a common reform agenda. Through the Sector-Wide Approach, fragmentation and duplication are being reduced, while public and partner resources are, for the first time, being aligned behind one plan, one budget and one report, with clearer responsibility for results and a deliberate transition towards national ownership.
When the United States revised its global health approach in 2025 under the then-new Administration of President Donald Trump, its emphasis on country ownership, country systems and government-to-government cooperation converged with reforms Nigeria had already begun. The immediate task was to protect continuity of treatment and prevent reversals in HIV, tuberculosis, malaria and other essential services while strengthening the domestic foundations on which those services must ultimately rest.
The health MoU signed by Nigeria and the United States on 19 December 2025 was negotiated within that policy framework and should be understood in that context. Covering April 2026 to December 2030, it provides a managed transition from externally financed implementation towards stronger use of Nigerian institutions, government systems and domestic resources, while preserving essential services as Nigeria assumes a larger share of their financing and management.
Financing the transition
The financing structure under the MoU makes this purpose clear. Planned United States support is nearly $2 billion over five years and declines over the period, while Nigeria plans nearly $3 billion in additional domestic health financing. Nigeria’s contribution is not transferred to the United States; it remains in Nigeria and is applied to priorities determined by Nigeria, including HIV, tuberculosis, malaria, maternal and child health, laboratories, health workers, surveillance, commodities, primary healthcare and health information systems. There is no credible path out of aid dependency that does not require Nigeria to invest more of its own resources in the health of its people.
The Federal Government had already begun to translate this commitment into the budget. The 2025 federal health budget rose by nearly 60 per cent, increasing health’s share of the national budget to 5.2 per cent from just over 3 per cent. In presenting the 2026 Appropriation Bill, President Tinubu proposed ₦2.48 trillion for health and described health investment as 6 per cent of the budget net of liabilities. The 2026 Appropriation Act was subsequently signed into law with an aggregate expenditure of ₦68.32 trillion. Under the MoU, however, Nigeria’s co-investment is measured by actual expenditure: at least 6 per cent of executed annual Federal and State budgets for health, not by budget announcements alone.
The MoU is broader than medicines or vaccines. It covers outbreak surveillance and response, laboratory capacity and biosafety, frontline health workers, health commodities, data systems and strategic investments in service delivery, while supporting procurement reform and increased local manufacturing. Its performance framework includes viral suppression among people living with HIV, tuberculosis outcomes, malaria deaths, maternal and child survival, immunisation, and the speed with which public-health threats are detected, reported and controlled.
Sovereignty, law and public scrutiny
Nigeria negotiated the framework through a whole-of-government process involving the ministries responsible for Health, Foreign Affairs, Finance, Budget and Economic Planning, together with relevant health agencies. The Attorney-General of the Federation reviewed and cleared it, confirming that it did not undermine Nigeria’s national interest. The MoU is legally non-binding, recognises the application of Nigerian law and permits either participant to discontinue cooperation under its terms. Its implementation remains within the country’s legal and institutional authority. Any citizen, journalist, researcher or civil-society organisation wishing to examine the instrument is encouraged to request a copy formally under the Freedom of Information Act, so that public discussion proceeds from the text itself and from the commitments and safeguards it contains.
Regulatory authority and health security
NAFDAC continues to exercise its statutory responsibility for medicines, vaccines and diagnostics. The MoU refers to NAFDAC’s existing regulatory-reliance framework, under which the agency may consider assessments by recognised stringent regulatory authorities while retaining responsibility for Nigeria’s own decision. Regulatory reliance reduces unnecessary duplication and accelerates access to quality-assured products; it does not remove NAFDAC’s authority to evaluate applications, inspect products and facilities, undertake risk-based testing, release vaccine lots and conduct post-market surveillance where required.
The same principle governs cooperation involving health data and pathogens. Nigeria must be able to detect an emerging pathogen, sequence it rapidly and share scientifically useful information when that serves public health. Access requests remain subject to Nigerian law, data-protection requirements, scientific and ethical review and agreement on benefits arising from collaboration. Building domestic genomic-sequencing capacity, secure data systems and a national genomics repository strengthens sovereignty by enabling Nigeria to participate in global science from a position of competence. The bilateral MoU does not displace Nigeria’s position in the continuing multilateral negotiations on pathogen access and benefit sharing under the Pandemic Agreement.
Faith-based service delivery and accountability
The MoU also provides that, to the maximum extent permitted bylaw, approximately ten per cent of planned U.S. support is intended for eligible faith-based health providers. The provision does not designate or confer preference on any religion or denomination. At the signing, the United States Ambassador acknowledged Nigeria’s Christian and Muslim traditions, making clear that eligible providers from both could receive support. This recognises the longstanding contribution of faith-based institutions to healthcare delivery, particularly in communities where access remains limited.
Beyond financing and service continuity, the framework changes how external support is managed and accounted for. Much previous assistance was implemented through non-governmental channels that delivered important results but sometimes limited government’s direct visibility over expenditure and made integration with national systems more difficult. To the maximum extent permitted by United States law, the new arrangement moves financing towards government-to-government and on-budget mechanisms, with audits, performance reviews and tracking of co-investment. This strengthens national oversight, reduces fragmentation and makes both countries accountable for their commitments.
The measure of success
The partnership will ultimately be measured in the lives and institutions it protects. People living with HIV must continue to receive treatment; deaths from malaria and tuberculosis must fall; mothers and children must receive better care; and outbreaks must be detected and contained faster. Nigeria’s laboratories, workforce, supply chains and data systems must also become stronger as Federal and State governments assume a larger and more durable share of the cost.
By 2030, the proper measure of success will not be how much external assistance Nigeria received, but how much more capable and self-reliant our health system became while that assistance declined. Nigeria will continue to work with the United States and other partners in pursuit of shared health, security and development objectives, while strengthening the domestic foundations on which lasting progress depends. The destination is clear: a health system financed increasingly by Nigeria, governed through Nigerian institutions and able to sustain better outcomes for Nigerians.
Muhammad Ali Pate is Nigeria’s Coordinating Minister of Health and Social Welfare.
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