In June 2026, the Federal Government commissioned the expanded Abuja Premier Medical Warehouse to strengthen storage and distribution of essential medicines, vaccines and other health commodities nationwide. The investment increases storage capacity and is intended to improve inventory management, commodity security, and distribution efficiency.

However, strengthening physical infrastructure does not automatically resolve the purchasing challenges that determine whether commodities are available, where and when they are needed. If demand is poorly forecasted, purchasing is fragmented, deliveries are delayed, or stock concentrates in the wrong locations, additional storage capacity may simply hold more commodities without improving their availability to patients. That leaves the more important question behind the infrastructure investment: is Nigeria buying better, or simply buying more?

The answer begins with shifting attention from procurement volume to how procurement decisions are organised, financed and connected to inventory and distribution. One possible response is pooled procurement, bringing related purchasing needs together to increase bargaining power and reduce the inefficiencies of fragmented procurement.

The overlooked purchasing problem

A warehouse can store medicines, but it cannot determine which medicines should be purchased, in what quantities, from whom, or whether the purchase represents the best value. These decisions are made upstream, through the procurement process.

At present, similar commodities may be purchased separately by government agencies, national programmes, states governments, and development partners. Each buyer approaches suppliers with a smaller, fragmented order, which weakens bargaining power, duplicate procurement processes, increase transaction costs, and make aggregate demand less predictable. This is where a coordinated procurement mechanism adds value: it can aggregate requirements across participating buyers and negotiate on basis of a larger and more predictable market, while individual buyers retain visibility over their requirements and obligations.

The rationale for this approach is supported by evidence elsewhere. PAHO reported in 2026 that its Regional Revolving Funds had secured approximately 50 percent savings for vaccines, alongside additional savings on public health supplies, benefiting more than 170 million people over the preceding two years. UNICEF similarly combines vaccine forecasts across the countries it supports to obtain more favourable commercial terms, improve production planning, and reduce the transaction costs. In 2025, the Global Fund’s Pooled Procurement Mechanism managed approximately US$1.02 billion in orders for grant implementers in 81 countries, using consolidated purchasing to negotiate both prices and delivery conditions.

These examples do not show that pooled procurement is a universal solution, or that demand aggregation alone guarantees lower prices, equitable access or better availability. They demonstrate a more specific point: where purchasing is fragmented, coordinated demand aggregation can strengthen leverage, improve value for money, and create more favourable conditions for reliable supply. These gains depend on accurate forecasting, credible and timely financing, transparent governance, effective quality assurance, competitive supplier markets, and the logistical capacity to deliver and distribute what has been purchased.

 What would better buying look like?

• Aggregate procurement demand selectively.
  Nigeria does not need to place every commodity under one procurement arrangement. Products should be pooled where buyers have sufficiently similar requirements, specifications, quality standards, and delivery schedules. High-volume and routinely purchased commodities are often the strongest candidates because combined orders can create scale while reducing duplicated tendering and contract management.
• Let data drive procurement.
  Procurement should begin with reliable information on consumption, demand and facility needs. Better data can help answer three questions: What should we buy? How much? Where should it go?
• Connect purchasing decisions to delivery.
  Securing a competitive price is only one part of the equation. Procurement decisions must be connected to effective inventory management and distribution so that commodities reach health facilities when they are needed. In practice, this means integrating procurement data with logistics management information systems so that what is bought, what is in stock and what is needed at the last mile are visible on the same platform.
• Measure value, not just expenditure.
  Success should be assessed through indicators such as commodity availability, procurement savings, reduced wastage, timely delivery and improved access to essential health services. Government agencies, working with development partners, should track these indicators routinely as part of ongoing supply chain performance management, not only as one-off evaluations.

 The strategic choice

As health financing pressures grow and donor support becomes less predictable, Nigeria will need to secure greater value from every naira spent on procurement. Better coordination is not merely an operational improvement; it is becoming a strategic necessity. The near-term test is whether early pooled procurement efforts can demonstrate measurable gains in price, availability and delivery, evidence that would make the case for wider adoption far harder to ignore.

Diphtheria is back in Nigeria’s headlines. But the more important story is not that another outbreak has occurred. It is what recurring diphtheria transmission tells us about the capacity of our health system to prevent, detect and respond to diseases we already know how to control.

In early September 2026, Plateau State authorities reported more than 140 suspected diphtheria cases and 23 deaths across several Local Government Areas (LGAs), prompting the temporary closure of primary and secondary schools as part of the containment response. This is not an isolated event. Nigeria has been managing a protracted diphtheria outbreak since 2022. In November 2025, the World Health Organization (WHO) reported 8,587 confirmed cases and 884 deaths nationally in 2025 alone, spread across 240 LGAs in 30 states. WHO attributed the scale of the response challenge to low vaccination coverage, delayed laboratory confirmation, gaps in infection prevention and control, and vaccine shortages.

Diphtheria is vaccine preventable, which changes the question we should be asking.

WHO identifies community-wide vaccination, delivered through routine immunisation at the primary healthcare level, as the most effective way to prevent it. That makes every new cluster of cases more than an epidemiological event; It is a signal that somewhere along the prevention pathway, children and communities are being missed. The question is not only how do we stop the current outbreak, but what allowed so many people to remain vulnerable in the first place.

Routine immunisation is the first line of defence

Outbreak response campaigns matter. They close immunity gaps quickly and protect high-risk communities. But they cannot substitute for a routine immunisation system that works consistently. The real test of an immunisation programme is not what happens during an emergency. It is what happens every ordinary day at the primary healthcare level. Is the vaccine available when a caregiver arrives? Is the health worker present? Does the caregiver know when the next dose is due? Does a child who misses an appointment get followed up? Can health teams identify settlements where children have never received a routine vaccine?

These questions matter because protection against diphtheria requires more than one contact with the health system. WHO notes that multiple doses and booster doses are required to build and sustain immunity. Yet Nigeria’s estimated 2024 coverage was 71% for the first dose of diphtheria-tetanus-pertussis vaccine (DTP1) and 67% for the third dose (DTP3). That four-point gap is not a rounding error: at Nigeria’s birth cohort of roughly 7 million children a year, it represents hundreds of thousands of children who start the immunization series but never complete it.

The zero-dose burden is larger still. In April 2026, UNICEF estimated that approximately 2.2 million children in Nigeria were entirely unvaccinated, the highest number in Africa and among one of the highest globally. Earlier data from the 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey (MICS/NICS) found that 18% of children aged 12–23 months had received no routine immunisation, while only 36% had received all recommended vaccines. These figures should make us rethink immunisation as more than a vertical programme. Routine immunisation is a core measure of whether primary healthcare is reaching people consistently and equitably.

Find the children the averages hide

National and state coverage figures can conceal substantial gaps. A state may show moderate average coverage while particular wards, informal settlements, remote communities, mobile populations, or conflict-affected areas remain substantially under-immunised. When these pockets accumulate enough susceptible people, vaccine-preventable diseases spreads. This is precisely the pattern Plateau State’s LGA-level case distribution suggests: outbreaks cluster where coverage gaps cluster, not evenly across a state average.

Health teams need reliable data showing where zero-dose and under-immunised children live, why they are being missed, and what mix of fixed-site services, outreach, community mobilisation and follow-up can reach them. Nigeria is already using approaches like the Periodic Intensification of Routine Immunisation (PIRI) and the Big Catch-Up to locate and vaccinate missed children. who have been missing. The challenge is ensuring these efforts strengthen routine systems rather than temporarily compensate for their absence. The goal should not simply be more doses delivered; it should be a system capable of knowing who has been missing, where they are, and how quickly that gap can be closed.

Surveillance must detect outbreaks before headlines do

Immunisation is one side of prevention. Surveillance is the other. Diphtheria can progress rapidly, and WHO stresses the importance of prompt diagnosis and early treatment. A resilient system depends on frontline workers who can recognise a suspected case, isolate appropriately, notify surveillance teams, collect specimens, initiate referral and support contact management without dangerous delays.

This requires functioning surveillance structures from community to facility, LGA, state and national levels, supported by laboratory capacity, sample transportation, clear reporting channels and data systems capable of turning signals into decisions. WHO has previously highlighted delayed laboratory confirmation and gaps in infection prevention and control as challenges in Nigeria’s diphtheria response. Surveillance should therefore not be seen as an emergency activity switched on after cases increase. It is part of the everyday infrastructure of primary healthcare and health security.

From emergency response to resilient primary healthcare

Nigeria needs rapid outbreak investigation, case management, targeted vaccination, laboratory support, contract tracing and risk communication. But if the response stops there, we will have treated the emergency without addressing what made it possible: reliable vaccine forecasting and distribution, stronger routine immunization, active identification of zero-dose children, supported frontline workers, functional surveillance and laboratories, and consistent infection-prevention practices, all integrated at the primary healthcare level.

Preparedness should not be measured only by how fast we mobilize once an outbreak is declared. It is the missed dose that gets detected and followed up. It is the facility that does not run out of vaccine. It is the community health worker who identifies an unvaccinated household, and the clinician who recognizes a suspected case early. These actions rarely make headlines. But they are what prevent them, and they are the real story behind every diphtheria case Nigeria reports.

Prevention is cheaper than response. More importantly, in the case of diphtheria, prevention is possible.

Safe Motherhood in the Age of Antimicrobial Resistance: From Evidence to Health-System Action

An effective antibiotic can be lifesaving for a woman experiencing a serious infection during pregnancy. But what if the antibiotics don’t work? What does that mean for the woman and the child she is carrying? These questions remind us that maternal health and antimicrobial resistance (AMR) are more closely connected than they are treated.

Safe motherhood depends, among other things, on the ability to prevent infections, recognise them early and treat them effectively. As AMR continues to grow as a global health challenge, it is increasingly necessary to preserve the effectiveness of medicines used to prevent and treat infectious diseases in women during pregnancy, childbirth and the postpartum period.

Maternal infection

Although progress has been made in reducing maternal mortality, the challenge persists in many parts of the world. In 2023 alone, about 260 000 women died during and following pregnancy and childbirth. About 92% of these deaths occurred in low- and lower-middle-income countries.

While there are numerous causes of this challenge, infection deserves attention. The World Health Organisation defines maternal sepsis as a life-threatening condition resulting from infection during pregnancy, childbirth, after an abortion or during the postpartum period. It remains one of the leading direct causes of maternal mortality globally.

The scale of maternal infection provides more perspective. The Global Maternal Sepsis Study (GLOSS) conducted across 52 countries shows that about 70 pregnant or recently pregnant women per 1,000 live births had an infection requiring hospital management. Approximately 11 per 1,000 experienced a severe maternal outcome associated with infection, rising to as many as 15 per 1,000 in low- and middle-income countries. Most of these infections can be treated. But that depends on having antimicrobials that still work.

Antimicrobial resistance

Antimicrobial resistance occurs when microorganisms no longer respond to medicines designed to treat them. As resistance develops, infections can become harder and sometimes impossible to treat. This could increase the risk of severe illness, complications and death.

In maternal care, serious infections can progress quickly and have adverse consequences. For example, a woman who develops sepsis cannot always wait for lengthy laboratory processes before treatment begins. Clinicians may need to start empirical antibiotic treatment immediately while diagnostic investigations are underway. The World Health Organisation has warned that AMR can compromise the management of sepsis because effective empirical antibiotic treatment is often needed early. This means that AMR is not simply a problem of medicine use; it is also a health system challenge.

The answer is not simply “more antibiotics”

Women with serious bacterial infections need timely access to effective antibiotics. Delaying appropriate treatment in sepsis can be dangerous. At the same time, unnecessary or inappropriate antibiotic use contributes to antimicrobial resistance.

The solution, therefore, cannot be indiscriminate restriction of antibiotics. Nor can it be routine expansion of antibiotic use “just in case.” The aim should be the right antibiotic, for the right patient, at the right time, for the right indication and for the right duration, supported by good clinical judgement, diagnostics and local evidence.

WHO guidance recommends preventive antibiotics for specific obstetric needs, while limiting unnecessary use to reduce antibiotic resistance. This means that the careful and appropriate use of antibiotics should be part of routine, high-quality maternal healthcare.

From evidence to health-system action

If we want to protect mothers while preserving the effectiveness of antibiotics, action is required at several levels.

1. Strengthen infection prevention and control in maternity care

Preventing infections reduces maternal harm and lowers the need for antibiotic treatment. Hand hygiene, safe caesarean and delivery practices, sterilisation, environmental cleanliness, appropriate prophylaxis, and adequate water, sanitation and hygiene infrastructure are therefore central to both safe motherhood and AMR control.

2. Build stronger diagnostic and surveillance systems

Health workers need information that helps them move from broad empirical treatment towards targeted therapy when appropriate. Having data is only the beginning. It must be used by clinicians, programme managers and policymakers when decisions need to be made.

3. Support health workers to practise antimicrobial stewardship

Doctors, nurses, midwives, pharmacists and laboratory professionals need training, diagnostics, essential supplies, supportive supervision and clear referral systems. A technically competent health worker may still struggle to provide high-quality care when the system around them is weak.

This is why workforce strengthening must go beyond recruitment. The conditions in which health professionals work directly influence their ability to translate evidence into safe patient care.

4. Generate maternal-specific AMR evidence

Researchers need to generate more maternal-specific AMR evidence that answers important questions: Which organisms are commonly associated with maternal infections in different settings? What are their resistance profiles? How do these patterns vary geographically and between levels of care? Are current empirical treatment guidelines aligned with local susceptibility patterns? What happens to women who develop resistant infections? These are questions that clinical research and routine surveillance can help answer.

5. Translate national AMR commitments into maternal care

Nigeria’s One Health Antimicrobial Resistance National Action Plan 2024–2028 provides a national framework encompassing surveillance and research, infection prevention, antimicrobial stewardship, public awareness and improved evidence-based decision-making. The opportunity now is to ensure that these priorities reach specific areas of care, including maternal, newborn and reproductive health.

Our InSight

At InSight Health Group, we see the movement from evidence to action as central to stronger health systems: clinical research helps generate and strengthen evidence; health consulting helps translate evidence into policy, programmes and implementation; and community engagement helps ensure that health interventions remain connected to the people they are intended to serve. This evidence-to-impact pathway shapes our broader approach to health-system strengthening.

The future of safe motherhood will depend not on whether women can reach health facilities and receive skilled care. It will also depend on whether those facilities can prevent infection, identify it quickly and treat it with effective medicines.

In the age of antimicrobial resistance, protecting mothers also means protecting the effectiveness of the medicines they may one day depend on.

How Can We Improve the Skills of Health Workers in Low-Resource Settings?

Health workers are the backbone of every healthcare system. They play a pivotal role in ensuring quality healthcare delivery by helping to prevent diseases, sensitizing community members on health and safety issues, providing treatment, and promoting healthy lifestyles. In low-resource settings, many health workers deliver these services under difficult and often challenging circumstances. Consequently, there are numerous reports of physical, psychological, and professional burdens experienced by health workers, particularly those working in hard-to-reach areas.

While acknowledging the many health system challenges affecting healthcare delivery in low-resource settings (i.e., such as workforce shortages, inadequate infrastructure, and supply chain constraints), it is important to discuss practical ways of improving the skills of health workers. This is because the competence and capacity of health workers significantly influence the quality of healthcare services delivered to the population.

Furthermore, it is widely recognised that strengthening the skills and knowledge of health workers increases the likelihood of better health outcomes and contributes to stronger healthcare systems. The persistent shortage of health workers in many low-resource settings makes it even more important to adequately equip the available workforce. The critical question, however, is which areas and practical strategies are most effective in improving health workers’ skills and performance.

Some key strategies include supportive supervision, increased government and stakeholder investment in healthcare education, the use of digital technology for learning, mentorship programmes, and continuous professional training.

Supportive Supervision

The quality of healthcare delivery is often influenced by the level of supervision and support available to health workers. Supportive supervision focuses on improving performance through coaching, guidance, and problem-solving rather than fault-finding. It can take two main forms:

• Internal Supportive Supervision

This occurs within the health facility, unit, or ward and focuses on coaching, constructive feedback, and collaborative problem-solving. Internal supervision helps build staff capacity, improve confidence, and enhance the quality of care provided to patients.

• External Supportive Supervision

This is usually provided by district health officers, roving mentors, professional associations, or non-governmental organizations. These supervisors periodically observe frontline workers, provide technical support, assess adherence to care standards, and facilitate the sharing of best practices across facilities.

Investment in Healthcare Education

There is a need for increased government and stakeholder investment in healthcare education and training. Such investments are essential because they generate long-term returns by strengthening the health workforce and improving healthcare delivery. A well-trained and resilient workforce contributes to improved health literacy, better service provision, and progress towards achieving Universal Health Coverage (UHC).

Use of Digital Health Technology for Learning

Digital Health Technologies (DHTs) offer significant opportunities for improving health workers’ skills, particularly in low-resource and rural settings. Their use can enhance treatment adherence, healthcare utilization, and community engagement while helping to address infrastructural barriers and geographical constraints.

Digital technologies can also reduce operational challenges such as logistical difficulties, limited access to training opportunities, medical errors, and delays in accessing specialist support. As a result, health workers can strengthen their skills through innovative approaches such as telemedicine, virtual simulation training, e-learning platforms, and mobile learning applications.

Mentorship Programmes

Mentorship programmes are important for facilitating the transfer of skills, building confidence, and providing intentional guidance for health workers. Effective mentorship strengthens structured co-learning and helps bridge the gap between classroom training and independent professional practice.

In addition, mentorship programmes promote professional growth, encourage mental health awareness, improve job satisfaction, enhance leadership and managerial skills, and foster a culture of continuous learning within healthcare systems.

Continuous Training

Continuous training is a critical component of professional development and lifelong learning. It ensures that health workers remain updated on current evidence-based practices, emerging medical protocols, and new healthcare technologies.

Regular training opportunities enhance the capacity of health workers to respond effectively to routine and emergency health situations. Continuous professional development is particularly important for health workers operating in high-demand and resource-constrained environments, where maintaining up-to-date knowledge can directly influence patient outcomes and quality of care.

Summary

Investing in the skills development of health workers is a strategic investment in the health and well-being of society. The benefits of a skilled health workforce are numerous and include improved disease prevention and management, higher job satisfaction, reduced morbidity and mortality, and stronger healthcare systems that support the attainment of UHC.

Therefore, governments, policymakers, development partners, and healthcare stakeholders must prioritize the training, support, and continuous capacity building of health workers, particularly in low-resource settings. Strengthening the skills of health workers is not only essential for improving healthcare delivery today but also for building resilient healthcare systems capable of meeting future health challenges.

InSight Health Group was pleased to collaborate with the Department of Sociology and Anthropology at the University of Nigeria, Nsukka, to host the Researching Africa Conference 2026, held under the theme “Researching Africa in the Context of the Sustainable Development Goal.” The conference took place from 20–21 May 2026, with a pre-conference workshop held on 19 May 2026, bringing together scholars, researchers, students, practitioners, and development stakeholders to reflect on Africa’s development realities through the lens of research and the Sustainable Development Goals.

The conference provided an important opportunity to listen, learn, and reflect on how African research can speak more directly to African problems. The sessions demonstrated that development challenges across the continent are not isolated. Health, poverty, gender inequality, insecurity, climate change, education, and weak institutions are deeply connected, and meaningful solutions require evidence that is locally grounded, interdisciplinary, and responsive to lived experiences.

Figure 1: Courtesy call to the Vice Chancellor, University of Nigeria, Nsukka

Rethinking Development from an African Lens

One of the strongest messages from the conference came from Dr. ChiChi Aniagolu, the keynote speaker, whose presentation, “Beyond the Blueprint: A Sociological Analysis of the SDG Development Paradigm,” challenged participants to think critically about the Sustainable Development Goals (SDG). Her paper reminded the audience that the SDGs are should not be treated as a simple checklist of global targets, but as a development framework that must be interrogated within Africa’s historical, political, economic, and social realities.

A key takeaway from the presentation was that development is not neutral. While the SDGs provide a useful global language for measuring progress, they also carry assumptions about growth, modernization, markets, and what societies should aspire to become.

Furthermore, she highlighted the contradictions within the SDG framework, especially where economic growth, environmental protection, poverty reduction, and decent work do not always move in the same direction.

For InSight Health Group, this was an important reminder that evidence-based development must also be justice-based. Research should not only ask whether targets are being met; it should also ask who benefits, who is excluded, and whether development models are rooted in local realities.

Figure 2 Presentation by Dr ChiChi Aniagolu, Ford Foundation

Health Systems as Foundations for Sustainable Development

The presentation by the guest speaker, Prof. George Ugwu, Honourable Commissioner for Health, Enugu State, provided a practical example of how state-level health reforms can contribute to the SDGs. His presentation, “Strengthening Healthcare for Sustainable Development,” outlined Enugu State’s ongoing reforms across primary, secondary, tertiary, and emerging quaternary healthcare.

This presentation shows that healthcare infrastructure is not only about buildings. It is about access, workforce, quality of care, referral systems, emergency readiness, data, trust, and continuity of services. The Enugu example showed how investments in health systems can contribute to the SDG.

For us at InSight Health Group, we believe that strong evidence is needed to track whether infrastructure investments translate into better service use, improved quality of care, reduced out-of-pocket expenditure, and better health outcomes for communities.

Figure 3 Presentation by Prof. George Ugwu, Commissioner for Health, Enugu State

Artificial Intelligence and Africa’s Development Future

The lead paper 1 by Prof. Chukwuedozie K. Ajaero, titled “Artificial Intelligence and the Sustainable Development Goals in Africa: Opportunities, Risks, and Governance Challenges,” expanded the conversation into the future of technology and development. His presentation explored how artificial intelligence can support progress across the SDGs, while also warning that Africa must not become only a consumer of technologies designed elsewhere.

The presentation highlighted opportunities for AI in health diagnostics, education, public service delivery, climate adaptation, data systems, and economic innovation. It also emphasized the growing AI ecosystem in Africa, including investments, talent development, business adoption, and emerging national AI strategies.

However, the presentation also raised important governance concerns. These included weak policy frameworks, ethical risks, algorithmic bias, inadequate data infrastructure, regulatory lag, limited technical capacity, funding constraints, and the exclusion of marginalized groups from AI policy discussions.

For InSight Health Group, this presentation was particularly relevant because health systems, clinical research, monitoring and evaluation, and community programmes increasingly depend on data and digital tools. AI has the potential to improve decision-making, but only if it is governed responsibly, locally adapted, ethically deployed, and designed to reduce rather than reproduce inequality.

Figure 4 Presentation by Prof. Chukwuedozie K. Ajaero, University of Nigeria, Nsukka

Mental Health as an SDG Investment

The lead paper presentation by Dr. Nnenna Mba-Oduwusi, delivered by Ifesinachi Eze, brought the discussion directly into InSight Health Group’s work in mental health. The presentation, “How InSight Health Group is Bridging the Gap in Access to Mental Health Care: An SDG Investment,” highlighted the toll-free mental health hotline system implemented through the InSight Initiative for Health and Development in collaboration with the Suicide Research and Prevention Initiative Nigeria (SURPIN).

The presentation showed that mental health is deeply connected to the SDGs. It affects health and well-being, poverty, education, productivity, inequality, peace, and social resilience. It also drew attention to the scale of the mental health challenge, including suicide, limited access to specialist care, and the shortage of mental health professionals in Nigeria. The hotline model presented at the conference demonstrated how a practical, technology-enabled, confidential support system can help close access gaps.

For InSight Health Group, the key lesson was clear: mental health is not a side issue in sustainable development. It is central to human dignity, productivity, education, family stability, community peace, and health system strengthening. The session also showed the importance of turning service delivery data into research evidence that can inform policy, improve quality, and strengthen national mental health response systems.

Figure 5 Ifesinachi Eze presents on behalf of Dr Nnenna Mba-Oduwusi, InSight Health Group

Lessons from the Parallel Sessions

Beyond the keynote and lead presentations, the parallel sessions showed the depth and diversity of research being conducted across SDG-related themes. Papers addressed health system inequalities, social support for older adults, suicidal ideation among university students, patient narratives, substandard drugs, diabetes treatment barriers, reproductive health, telehealth, gendered violence, poverty, insecurity, climate change, education, corruption, workplace structures, and social protection.

A major learning point was that Africa’s development challenges are interconnected. Health cannot be separated from poverty. Gender cannot be separated from work, politics, family systems, and health outcomes. Security cannot be separated from economic life and community trust. Climate change cannot be separated from livelihoods, migration, urban planning, and public health.

The conference, therefore, reinforced the need for interdisciplinary research. Solving Africa’s development challenges requires sociologists, public health experts, economists, clinicians, policymakers, technologists, community actors, and development practitioners to work together.

Key Reflections for InSight Health Group

From InSight Health Group’s perspective, the conference offered five important reflections.

• First, African research must be grounded in African realities. The conference repeatedly showed that imported frameworks must be questioned, adapted, and interpreted through local experience.
• Second, health is a development anchor. Whether the discussion focused on PHCs, mental health, reproductive health, ageing, health workforce, or emergency response systems, it was clear that strong health systems are essential for achieving multiple SDGs.
• Third, mental health must be treated as a core development issue. The InSight/SURPIN hotline example demonstrated that scalable, confidential, and quality-assured mental health support can help bridge major access gaps.
• Fourth, technology must be governed with equity in mind. AI and digital health tools can strengthen systems, but without strong governance, they can widen existing inequalities.
• Finally, partnership is essential. The collaboration between InSight Health Group and the Department of Sociology and Anthropology, University of Nigeria, Nsukka, demonstrated the value of linking academic institutions with implementation-focused organisations.

Figure 6 Group photographs

 Conclusion

The Researching Africa Conference 2026 was a timely and important gathering. It created space to question dominant development models, showcase practical reforms, discuss emerging technologies, and highlight community-centred health and social research.

For InSight Health Group, participating as a collaborator reaffirmed our commitment to evidence generation, health systems strengthening, mental health access, responsible innovation, and Africa-led development solutions.

The most important lesson from the conference is that researching Africa must go beyond describing Africa’s problems. It must help shape fairer systems, stronger institutions, better health outcomes, and more inclusive futures.

As Africa continues to work toward the SDGs, conferences like this remind us that progress will depend not only on targets and indicators, but on context, collaboration, and a clear commitment to improving lives.

In many low- and middle-income countries (LMICs), particularly across sub-Saharan Africa, community health governance structures have become a central feature of primary health care governance. Although they vary in form, authority, and effectiveness, they are all inspired by the World Health Organisation and the Alma-Ata Declaration, which emphasised community involvement in health governance. They usually have the mandate of strengthening accountability, improving service delivery, and bridging the gap between communities and health providers. But a critical question remains; do these groups deliver on accountability?

This question is not just theoretical. It sits at the heart of ongoing debates about health system strengthening, especially in contexts where weak oversight, absenteeism, and informal practices continue to undermine the quality of care.

Understanding the Accountability Promise

Community health governance structures are typically composed of local representatives tasked with overseeing health facility operations, mobilising community participation, and ensuring that health workers remain responsive to local needs. In principle, they embody what is often described as social accountability; a process through which citizens collectively hold service providers and policymakers to account.

Embedding community oversight within PHCs meant that they would:

• Monitor staff attendance and performance

• Report misconduct or corruption
• Facilitate dialogue between providers and users
• Ensure that services reflect local priorities

The Reality on the Ground: Between Potential and Constraint

Evidence from multiple studies suggests that while these structures can contribute to accountability, their effectiveness is highly uneven and context-dependent.

A recurring pattern is that CHCs function less as formal enforcement bodies and more as relational intermediaries. They do not have the power to sanction, so they often rely on negotiation, persuasion, and social pressure.

This has both strengths and limitations.

On one hand, relational accountability can:

• Foster trust between providers and communities
• Encourage voluntary compliance by health workers
• Enable context-sensitive problem-solving

On the other hand, it may:

• Limit the willingness of committees to challenge entrenched power dynamics
• Reduce their capacity to address systemic issues like chronic absenteeism
• Lead to selective enforcement, especially where committee members have personal ties to health workers

Power, Capacity, and Legitimacy

Three interrelated factors consistently shape the effectiveness of community health governance structures in promoting accountability:

1. Power Relations
   Community members may feel constrained in confronting health workers, who are often perceived as more educated or socially elevated. In some cases, health workers themselves dominate committee structures, blurring lines of accountability.
2. Capacity and Knowledge
   Many committee members lack the technical knowledge required to effectively monitor service quality or interpret health data. Without adequate training, their oversight role becomes symbolic rather than substantive.
3. Institutional Linkages
   Perhaps most critically, CHCs are often poorly integrated into formal health system governance. When reports or complaints do not trigger action from higher authorities, community monitoring loses credibility.

When Do CHCs Work?

Despite these constraints, there are contexts where community health governance structures have demonstrated tangible impact. Their effectiveness tends to improve when:

• They are supported by clear legal mandates and defined roles
• There are functional feedback mechanisms linking them to higher-level authorities
• Members receive continuous training and capacity building
• There is external facilitation (e.g., NGOs) to strengthen their voice and autonomy
• Community awareness and engagement are high

In such settings, they can play a crucial role in identifying service delivery gaps, improving responsiveness, and even reducing informal payments.

Conclusion

Community health governance structures hold significant promise, but their impact on accountability is neither automatic nor guaranteed. They operate within complex social and institutional environments where power, relationships, and resource constraints shape their effectiveness. Ultimately, improving accountability in health systems is less about creating structures and more about ensuring that those structures are empowered, connected, and capable of action.