As a signatory to the adoption of the International Health Regulations (IHR) at the 58th World Health Assembly, Nigeria conducted its first Joint External Evaluation (JEE) in 2017 using the JEE tool. This first JEE enabled the development of a five-year National Action Plan for Health Security (NAPHS) in 2018 to help improve the country’s ability to prevent, detect and respond to public health emergencies, and also formed the baseline that will be used to measure the country’s improvements in subsequent JEEs.

The IHR-Strengthening Project (IHR-SP), delivered by UKHSA, has been part of the country’s JEE journey since 2017, providing technical expertise in several IHR thematic areas to the National Coordination Unit for IHR, Nigeria Centre for Disease Control and Prevention (NCDC) and its partners. This is in line with the UKHSA IHR-SP's core mandate to work with partner countries to support improved IHR compliance and global health security.

In 2019, in preparation for its next JEE, Nigeria conducted a country-led mid-term JEE with UKHSA IHR-SP as the mission lead responsible for feeding back immediate recommendations from the evaluation

to the country leads/stakeholders. The mid-term JEE saw an improvement in the overall JEE score from 39% in 2017 to 42%. This mission also identified gaps for further improvements and led to the UKHSA IHR-SP's commitment to include “Chemical Events” thematic area to its portfolio, bringing the total IHR thematic areas in Nigeria supported by the UKHSA IHR-SP to seven (7) i.e., Emergency Preparedness Response and Resilience (EPRR), Laboratory Strengthening, One Health (OH), Surveillance, Human Resource (HR) and Chemical Events.

By August 2023, Nigeria became one of only three countries ready to conduct a second JEE assessment. This second JEE assessment was preceded by a country led multi-sectoral stakeholder self-assessment that determined individual scores and priorities for the 56 indicators of the 19 IHR thematic areas based on answers from the contextual and technical questions of the JEE tool. The priorities identified for each thematic area were tailored to what the country needed to improve scores and allowed the country to objectively assess its Ministries, Departments and Agencies (MDAs) to identify gaps in compliance to the IHRs. The individual scores, as well as the average of the 19 thematic areas, and identified priorities were presented to WHO for the external evaluation.

For the UKHSA IHR-SP, the JEE assessments both serve as a yard stick in measuring the project’s contribution to increasing Nigeria’s IHR capacity and also help highlight gaps for further collaboration. The IHR-SP’s activities via in-country and UK based subject matter experts (SMEs) were highlighted in the discussion of technical areas that we are supporting such as:

· SITAware; an event management system developed and introduced by the IHR Strengthening Project (Surveillance and Reporting technical area),

· The National One Health Risk Surveillance and Information Sharing (NOHRSIS) group (Zoonoses technical area)

· The National Committee on Chemical Surveillance and Emergency System (NCCSES), (Chemical Events technical area)

· Exercise Keep Pushing Simulation Exercises (Health Emergency Management technical area)

· Implementation of national quality standards in line with ISO 15189 (National Laboratory System technical area).

Scores from the JEE self-assessment were validated over a five-day exercise consisting of plenary sessions and site visits where the NCDC, as well as other Nigeria MDA’s and International Partners (IP), defended the scores from the self-assessment. One valuable piece of advice from the WHO Senior Advisor of the Global Secretariat of the JEE of the IHR(2005), Dr Hendrik Jan Ormel, was for the country to place more importance on the identified priorities from the self-assessment and the external evaluations than the overall scores. The overall score, while important, is dependent of several factors including the WHO external evaluators and the version of the JEE operational tool used for the evaluation, however the he priorities identified will be used to create the country’s next NAPHS, highlighting the steps needed to improve the country’s capacity to prevent, detect and respond to public health concerns and by so doing strengthen global health security. At the end of the external evaluation by WHO, scores from the indicators of the self-assessment and the external evaluation were similar and, in both cases, Nigeria showed improvements across all broad IHR thematic areas of Prevention, Detection, Response and IHR Related Hazards and Points of Entry, and was awarded an overall score of 54% for its second JEE Evaluation.

The country was asked to focus on sustaining the progress across all sectors with strong leadership, investment and strategies to increase capacities. Most importantly, dedicated funds to implement health securities must be made at the state level to ensure Nigerians are protected.

The UKHSA IHR-SP continues to support strengthening Nigeria’s capacity to comply with the IHRs and was particularly recognised for its efforts as one of the few international partners supporting the Chemical Events thematic area of the IHRs in the closing speech of the Director General of the NCDC. Following the conclusion of the Second JEE in Nigeria, the UKHSA IHR-SP will be working with the NCDC and its partners to finalize the creation and subsequent implementation of the country’s second NAPHS.