The World Bank has urged state governments to take ownership of investments made under the Immunisation Plus and Malaria Progress by Accelerating Coverage and Transforming Services project to prevent the reversal of gains recorded in child survival, malaria prevention and primary healthcare delivery.
The World Bank Country Representative, Matthew Verghis, gave the advice on Thursday at the IMPACT End-of-Project Dissemination and Transition Forum, held as part of the 2026 Joint Annual Review of the health sector.
Verghis said the project had demonstrated the benefits of sustained investment in primary healthcare but warned that its achievements could only endure if governments maintained the facilities, supported health workers and provided adequate financing.
“The challenge now is not simply to preserve these gains. It is to take what worked and move it to greater scale,” he said.
He disclosed that the project contributed to reducing under-five mortality from 132 to 110 deaths per 1,000 live births, surpassing its target of 112 deaths.
He added that malaria prevalence among children under five declined from 22 per cent to 15 per cent, while the proportion of fully vaccinated children aged 12 to 23 months increased from 31 per cent to 39.7 per cent.
According to him, the quality-of-care scores in supported health facilities also increased from 39.3 per cent to 50.2 per cent.
“The results are concrete. IMPACT contributed to reducing under-five mortality from 132 to 110 deaths per 1,000 live births, surpassing the Programme Development Objective target of 112,” Verghis said.
He said more than 2,600 primary healthcare facilities nationwide were upgraded to Level Two standards, with improvements including solar power, boreholes, staff quarters, perimeter fencing, additional service rooms and wards, as well as essential medical equipment.
The project, he added, procured and distributed more than 10 million long-lasting insecticidal nets, prioritising pregnant women and children under five.
Verghis disclosed that more than $20m was transferred directly to primary healthcare facilities to address operational needs and support the implementation of the Basic Health Care Provision Fund.
He also said approximately $170m was spent on routine vaccine procurement over four years, providing bridge financing for Nigeria’s domestic co-financing obligations and helping unlock Gavi-supported vaccine financing.
On human resources, the World Bank representative said more than 15,000 health workers were engaged to address staffing shortages and had subsequently been absorbed by state governments.
He added that more than 6,000 primary healthcare facilities were equipped with laptops, while medical records officers were trained to upload routine service-delivery data through the District Health Information Software 2 platform.
“As a result, all supported facilities now report routine service-delivery data digitally from their facilities,” he said.
Verghis said the project also supported Nigeria’s drive towards vaccine security and self-reliance by strengthening the work of the Presidential Vaccine Advisory Committee and contributing to the institutional foundations for domestic vaccine manufacturing.
On the transition, he said the Nigeria Health Sector Renewal Investment Initiative, its Sector-Wide Approach and the HOPE-PHC programme would provide a framework for sustaining and expanding the achievements.
“HOPE-PHC does not simply start where IMPACT ends. It builds on foundations that IMPACT has helped establish,” he said.
He added that HOPE-GOV would complement the programme by strengthening financial and human resource management in primary healthcare and basic education.
Verghis said the success of the transition would depend on ownership by federal institutions, states and local governments.
“Investments must be maintained, health workers supported, facilities financed, data used for decisions, and accountability for results strengthened,” he said.
Also speaking, the Executive Director of the National Primary Health Care Development Agency, Dr Muyi Aina, said IMPACT had contributed significantly to the agency’s ongoing primary healthcare reforms, particularly in immunisation, malaria control and infrastructure development.
Aina disclosed that 16.6 million children had been fully immunised, according to the agency’s Primary Health Information System records.
He said the proportion of fully immunised children aged 12 to 23 months increased from 31 per cent to 39 per cent, based on the Nigeria Demographic and Health Survey.
On malaria control, Aina said prevalence declined from 22 per cent to 15 per cent between 2021 and 2025, while the proportion of pregnant women who received the recommended three doses of intermittent preventive treatment for malaria increased from 31 per cent to 33 per cent.
He also reported a four per cent increase in the proportion of children using insecticide-treated mosquito nets.
“Some of the gains we have recorded in immunisation would have been more challenging to achieve without the financing opportunities provided by the IMPACT Project,” he said.
Aina said the project funded more than 200 million doses of routine vaccines over three years and provided more than 3,000 solar-powered vaccine refrigerators to strengthen the cold-chain system.
He added that 2,500 primary healthcare centres across 30 states and the Federal Capital Territory were upgraded to Level Two functionality.
“The cold-chain infrastructure also benefited from the project, with the provision of over 3,000 solar-powered vaccine refrigerators,” he said.
The NPHCDA boss further disclosed that the project supported an ultra-modern vaccine storage hub in Lagos, which would serve more than 90 million Nigerians across the South-West and South-South regions.
However, he warned that the closure of the project must not affect the delivery of essential services at the upgraded facilities.
“First, the programme may close, but our health centres will not close. The need for health services among our people does not end,” Aina said.
He urged state governments, local governments and communities to take ownership of the facilities, equipment and other interventions provided under the programme.
“Therefore, the infrastructure, equipment, commodities and every other intervention provided through this project must now become assets of the states, local governments and communities. We must take ownership of them and ensure that they are protected and properly maintained,” he said.
Aina said the agency would work with the Federal Ministry of Health and Social Welfare to incorporate the project’s achievements into ongoing and future interventions, including the Basic Health Care Provision Fund and HOPE-PHC.
Earlier, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Pate, said Nigeria’s health sector reforms had evolved over more than two decades, moving from investments in buildings and equipment to a system increasingly focused on measurable health outcomes.
Tracing the reforms to 2004, Pate recalled that efforts initiated under former Minister of Health, Prof. Eyitayo Lambo, laid the groundwork for the National Health Act, which was signed into law in 2014 and established the Basic Health Care Provision Fund.
He said the World Bank’s earlier health interventions largely focused on financing infrastructure, equipment and procurement before the introduction of results-based financing through programmes such as the Nigeria State Health Investment Project and the Saving One Million Lives Programme.
“You can build the buildings, provide the equipment, but if the outcomes don’t change, what have you done?” Pate asked.
The minister described IMPACT as part of a multi-phase programme that helped bridge the gap between investment financing and the implementation of the Basic Health Care Provision Fund.
He said the next phase, anchored on the Nigeria Health Sector Renewal Investment Initiative and the Sector-Wide Approach, would build on the progress made through stronger coordination and accountability.
“The challenge for us is how to sustain it, because reform is a continuous process. Every system needs to continually adapt and change,” he said.
Pate disclosed that additional financing from the French Development Agency and other development partners would support interventions in human resources for health, health insurance and primary healthcare revitalisation.
He expressed optimism that Nigeria could outperform comparable countries in health outcomes within the next five to 10 years but said this would require discipline and collective commitment.
“Execution requires discipline. Discipline to do what needs to be done,” he said.
He urged government institutions, development partners and political leaders to work together rather than pursue separate interests.
“If we do that, then Nigeria’s health system will continue to go from strength to strength. But if everybody goes their own way, because of this or that, I think we’ll struggle and progress will stop,” Pate added.
The IMPACT project was designed to improve access to essential healthcare services through expanded routine immunisation, malaria prevention and treatment, and stronger primary healthcare delivery.
Its interventions came against the backdrop of Nigeria’s persistent burden of preventable maternal and child deaths, low immunisation coverage, malaria prevalence and weaknesses in primary healthcare infrastructure and staffing.
The project also supported the implementation of the Basic Health Care Provision Fund established by the National Health Act 2014, which provides a framework for financing essential services at the primary healthcare level.
Its completion coincides with the implementation of the Nigeria Health Sector Renewal Investment Initiative, launched in December 2023, which seeks to improve health outcomes through coordinated investments, stronger governance and accountability under a Sector-Wide Approach.
The HOPE-PHC programme is expected to build on the IMPACT investments by strengthening primary healthcare delivery, while HOPE-GOV focuses on improving governance and resource management in primary healthcare and basic education.
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