By Ibrahim A Jombali
Every good governance wants to impact the people, and in development economics, praise from multilateral agencies is often as political as it is technical. This is even more revealing when institutions, as exacting as UNICEF, World Health Organization, and United Nations Development Programme, converge in their assessment of a subnational government. It warrants closer inspection. Kebbi State, the long peripheral area in Nigeria’s health discourse, is beginning to look like a case study in pragmatic reform.
At the centre of this recalibration is Governor Nasir Idris, a leader who is very enthusiastic about improving the health fortunes of his people and whose administration has placed primary healthcare—not grand infrastructure or political spectacle—at the core of its social contract. The strategy is neither novel nor glamorous. In a federation where healthcare is often undermined by fragmented delivery systems and weak state capacity, execution is everything.
The visiting delegation, led by UNICEF’s country representative, offered more than diplomatic pleasantries. Their observations pointed to a governing logic that prioritises human outcomes over headline projects. One anecdote—a chance encounter with an elderly beneficiary of the state’s health insurance scheme—was deployed as evidence of a system attempting, however imperfectly, to restore dignity at the margins In development speak, this is the language of “last-mile delivery,” an area where many public programmes falter.
Governor Idris’ unique approach also appears to blend welfare with workforce incentives. Improved minimum wage provisions, targeted support for widows, and the absorption of over 500 health workers previously funded by external partners suggest an effort to internalise donor-dependent systems. This is a critical pivot. Too often, African health systems expand on the back of temporary financing, only to contract once the funding cycle ends. By assuming responsibility for these workers, Kebbi signals a move toward fiscal ownership—albeit one that will test the state’s budgetary resilience.
The most consequential battleground, however, remains polio. Nigeria’s certification as free of wild poliovirus in 2020 was a landmark, but not a conclusion. Vaccine-derived strains persist, exploiting gaps in immunisation coverage. Here, Kebbi is being positioned—by its partners and perhaps by itself—as a frontline state in the “last mile” of eradication. The prescription is familiar: tighter surveillance, better data fidelity, and deeper engagement with traditional and religious authority structures. These are not mere add-ons; in northern Nigeria, they are often the difference between uptake and resistance.
The endorsement from the WHO’s country office underscores improvements in precisely these areas. Enhanced disease surveillance systems and more reliable data streams are not politically visible achievements, but they are foundational. Without them, outbreak response becomes reactive rather than anticipatory—a costly lag in public health terms.
Meanwhile, UNDP’s interest signals a broader framing of health within the ecosystem of stability and development. Plans to extend peace and security programming into Kebbi—linking livelihoods, governance, and support for vulnerable populations—reflect an understanding that health outcomes rarely exist in isolation. Border communities, displaced populations, and fragile local economies all shape the epidemiological landscape.
Numbers, of course, tell their own story. Governor Idris parades a beautiful and incredible scorecard. The revitalisation of 22 general hospitals, 179 primary healthcare centres, and 63 dispensaries suggests scale. The enrolment of 45,000 vulnerable residents into a health insurance scheme hints at inclusivity. The recruitment of over 2,000 health workers addresses capacity constraints that have long plagued service delivery. And fresh capital injections—₦1.7 billion for additional primary healthcare upgrades and ₦1.3 billion for equipment—indicate sustained fiscal commitment.
Moreover, integrating donor-supported initiatives into state systems without diluting quality will require administrative discipline.
Still, there are signs of seriousness. The deployment of 45 motorcycles—donated by UNICEF—to reach underserved areas may seem mundane, but in rural health logistics, mobility is often destiny. If health workers can not reach communities, the most elegantly designed policies remain inert.
Kebbi’s experiment is not a revolution in the ideological sense. It is incremental, technocratic, and grounded in the unglamorous mechanics of service delivery. But therein lies its significance. In a policy environment often seduced by scale without substance, Kebbi offers a reminder: effective governance is less about invention than about implementation.
For now, applause from global agencies is justified—but provisional. The durability of Kebbi’s gains will serve as a model for other states to emulate and a foundation of a genuinely resilient health system.
When a government places a premium on healthcare , then it also prepares a wealthy society. Health they say is wealth, and Nasir Idris is taking it seriously.
Ibrahim Abubakar Jombali
Special Adviser on Public Enlightenment and Orientation to the Kebbi State Governor.