After six years of concerted efforts to improve healthcare for women and children in Nigeria, the Integrated Health Program (IHP), funded by USAID and implemented by Palladium, is drawing to a close.

The program, which focused on strengthening Nigeria’s health service delivery systems, leaves behind a significant legacy of improved access to healthcare and strengthened government coordination.

We spoke with two of the program’s leaders to get their thoughts and reflections on IHP’s legacy as they prepare for its closure.

Improving Healthcare Access and Systems

At its core, IHP was about more than just healthcare delivery. It aimed to strengthen the very systems that support healthcare across Nigeria, tackling issues from reproductive health and maternal care to malaria, nutrition, and gender-based violence.

“In a nutshell, IHP was a bilateral project designed by USAID to improve the access to and quality of primary healthcare services in select states across Nigeria,” explains Marta Levitt, IHP Chief of Party. “But crucially, it also involved strengthening the systems that support primary health care. Nigeria has beautiful policies and visions, but often faces challenges in implementing them effectively.”

One such policy, she explains, is Primary Health Care Under One Roof, which was adopted to reduce fragmentation in health service delivery. The team helped the government operationalise this policy to improve services for vulnerable Nigerians.

Navigating Complex Governance to Drive Impact

Over the years, one of the key challenges the program faced was navigating Nigeria’s complex governance structure, making it complicated to stay coordinated. Gebi Usman, Deputy Chief of Party, reflects on how IHP overcame this challenge, especially as local governments may not have had the capacity needed to carry out federal policies.

“This made it difficult to implement policies successfully,” he explains. “Under IHP, we acted as the messenger between different government levels and agencies, facilitating coordination between all relevant stakeholders, including state governors and local primary health care agencies.”

“Our strength was our ability to align different parties around a common goal. This is a success I am especially proud of—helping partners see that it’s a win for everyone to create cohesive plans that work together for the betterment of all.”

A key tool in this success was IHP’s use of political economy analysis to understand power dynamics across local, state, and federal levels, allowing the program to navigate relationships and improve coordination.

Breaking Barriers to Health Insurance Access

One of IHP’s standout achievements was its work on financial risk protection. Levitt highlights how the program helped enrol more than 700,000 people in health insurance over its six-year lifespan, improving access to affordable and quality health services.

“When we started, the Nigerian government had set up an equity fund for vulnerable people, but none of the states we worked in were eligible for it,” explains Levitt. “Working closely with the government, we helped establish appropriate agencies and operational guidelines so our states could become eligible. Insurance improves access, and without it, people don’t get the care they need.”

“Getting 700,000 more people enrolled in health insurance is a massive win.”

Sustainability Beyond IHP

As IHP concludes, a key question remains: will the program’s accomplishments be sustained?

Usman is optimistic, noting that the program’s proof of concept has left a lasting impression on leadership across Nigeria. “The highest levels of leadership have seen the power they can have in improving health outcomes. The trend now is that communities are playing a greater role in defining how their health challenges are handled. We’ve seen empowered communities come together to build primary health care, and this will continue beyond the project.”

Levitt adds that some systems developed under IHP have already become institutionalised. “During COVID-19, we started using WhatsApp to communicate with local governments. The local governments now own these channels and continue to use them. The other day, I saw a message in one of the group chats reminding stakeholders about an upcoming data validation meeting—a practice we introduced.”

“Seeing these systems continue beyond IHP gives me hope that our interventions will endure.”

A Lasting Legacy

Reflecting on IHP’s legacy, both Levitt and Usman emphasise the importance of challenging entrenched myths and driving real, measurable change. One such myth, Levitt recalls, was the belief that “people in Northern states don’t want family planning.”

“We proved that if you have skilled health workers and commodities for family planning, clients will come,” she explains. “The use of and demand for family planning skyrocketed in our Northern states. By the end of IHP, 91% of facilities—mostly government-run—were equipped to provide the full minimum service package, compared to just 50% at the start.”

Usman hopes IHP’s success can inspire other countries to replicate the program’s approach. “We hope other countries can look at what we’ve done to boost utilisation and apply it across other contexts beyond Nigeria. There’s a big opportunity to use what we’ve learned to drive impact elsewhere.”

As IHP comes to an end, the program’s legacy of improved health outcomes, strengthened governance, and sustainable systems promises to continue shaping healthcare in Nigeria for years to come.

For more, contact info@thepalladiumgroup.com.