Building on what’s worked to transform health and education in Nigeria
By Will Anderson
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Many reform efforts continue the status quo or apply radical solutions to common problems. In our experience the best approach is far simpler - understand what’s already working and use those insights to improve the system.

Health and education outcomes in Nigeria are poor

Nigeria contributes 12% to global child mortality rates (children dying before their fifth birthday), and 10% to maternal mortality rates (deaths related to pregnancy or childbirth). Relatively high levels of serious diseases including HIV, malaria and tuberculosis also burden Nigeria’s 190 million people.


Education outcomes are equally concerning. 10.5 million children are out of school, the highest of any country. Of those, 60% are girls. In some schools, a single teacher is responsible for more than 100 students.  

However a number of recent examples show how Nigeria can improve

The Acasus team explored a range of projects seeking to understand what has already worked in Nigeria. One successful example was the effort to eradicate polio and curb ebola.

In 2012 Nigeria established an emergency operations center (EOC) in Abuja to eradicate polio. The EOC achieved impressive results against polio in Nigeria, including zero cases in both 2015 and 2017. Additionally, following a confirmed case of Ebola in July 2014, the EOC team rapid response meant that Nigeria saw fewer than 20 cases of Ebola.

Polio EOC’s Vaccination Tracking System


The EOC effort embodied all the features of the Delivery Approach:

  • Clearly defined priorities: to stop polio/Ebola.

  • Use of reliable real-time data: collected by healthcare workers using mobile devices

  • Sharing what’s working: by focusing on identifying solutions on the frontline and supporting others to learn how to implement them.

  • A routine of meetings: to monitor cases and coordinate action.

  • Strong political leadership: through the establishment of a Presidential task force and weekly reviews by the Minister of Health.

Other Nigerian efforts which exhibited all or most elements of the Delivery Approach include the Presidential Enabling Business Environment Council (PEBEC), Kaduna Eyes and Ears and the Presidential Delivery Unit.

A Delivery effort, carefully tailored to Nigeria’s context, is capable of addressing systemic challenges in education and health

Elsewhere the Delivery Approach has addressed many of the challenges Nigeria currently faces.

For example in Peru and Pakistan Delivery has been successful at rapidly improving teacher management, classroom inputs and student attendance. In Rwanda and Pakistan Delivery led to significant increases in skilled birth attendance and dramatically improved medicine availability and health facility performance. These improvements were far reaching, including the most remote parts of the countries.


In immunization specifically many countries, including the Democratic Republic of the Congo, Ethiopia, Mozambique, Afghanistan and Pakistan are benefiting from using Delivery to improve immunization coverage. For example In Punjab, Pakistan, coverage increased by 35 percentage points between 2014-2017, saving thousands of lives. Nigeria is equally well-positioned to use Delivery to dramatically increase rates of immunization across the country, saving thousands of lives.

About the authors

Will Anderson supports business development and research at Acasus.

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