Supporting Kano state's path to becoming a leader in epidemic preparedness
Civil Society Advocacy for Domestic Investment in Epidemic Preparedness
From 2018 to 2025, Resolve to Save Lives, the Global Health Advocacy Incubator and more than a dozen civil society organizations from nine countries—Ethiopia, Ghana, Kenya, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zambia—partnered to increase domestic investment in epidemic preparedness.
Activities spanned coalition building and toolkit development, advocacy and media training and targeted engagement with political and financial leaders to make the case for investments in epidemic preparedness. The program is a testament to civil society’s potential to change policy, catalyze change, bolster domestic resources and safeguard communities.
Country context
Resolve to Save Lives (RTSL) began supporting the Nigeria Centre for Disease Control and Prevention (NCDC)’s capacity to build a sustainable funding base in 2017. The following year, in partnership with the Global Health Advocacy Incubator (GHAI), RTSL launched an epidemic preparedness budget advocacy campaign in Nigeria. The 2017 WHO-led Joint External Evaluation (JEE) of Nigeria’s capacity to prevent, detect, and respond to epidemics revealed shortcomings. There was limited domestic funding for health security and heavy reliance on donor funding. There was also a need to increase financial support for the NCDC, which had been relying on ad hoc funding from the Ministry of Health and associated Ministries, Departments, and Agencies (MDAs) involved in epidemic preparedness.
Timeline and key achievements
| Jun 2017 | Nigeria conducts first JEE |
|---|---|
| Sep 2020 | Advocacy for epidemic preparedness response (EPR) budget begins in Kano State |
| Jan 2021 | Kano State creates new budget line and allocates US$777k to EPR; 44 localities in Kano allocate US$228k to EPR; Allocates US$647k to establish public health laboratory |
|
Jun 2021 |
Team participates in state-level JEE evaluation |
| Jan 2022 | Kano EPR budget line increases by a third; EPR budget for 44 localities increases by 50% |
| Jan 2024 |
Kano EPR budget line increases by two-thirds since start of campaign; Kano CDC established with US$1.1M budget |
| Jan 2025 |
Kano State Public Health Security Bill assented to |
| Feb 2025 |
Kano State Center for Disease Control and Prevention law assented to |
Nigeria underwent a mid-term JEE in 2019 that showed improvement but highlighted significant epidemic preparedness gaps at the state level. This was problematic as the Nigerian constitution identifies states as crucial players in public health. In response, NCDC, supported by RTSL, developed the Subnational Emergency Preparedness and Response Capacity Building (SERCB) Project. The project had five components: legislative analysis to identify legal regime epidemic preparedness and response gaps; budget analysis and advocacy to increase funding and ensure it was well used; adapting the JEE to measure subnational level capacities; gathering data on outbreak responses to identify bottlenecks and offer solutions; and strengthening emergency operations.
In consultation with NCDC and health experts, the team determined that Kano—the most populous state with the second largest city after Lagos—was at elevated level of risk for outbreaks. Kano was a hotspot for COVID-19 as infections grew in 2020, and the State regularly faces outbreaks of cholera, anthrax, diphtheria, Lassa fever, and other deadly pathogens. On the positive side, its geography, political will to effect change, strong CSO presence, and unspent health security funds also positioned it for improvements. As such, Kano was one of the three States in which the SERCB project was piloted and in September 2020, RTSL and GHAI began epidemic preparedness budget advocacy work build on prior national level efforts.
Launching the campaign
The RTSL Nigeria team and GHAI’s Kano State in-country coordinator partnered with CSOs who were also working at the national level and in Lagos State. These included BudgIT, which focuses on budget analysis and transparency; Nigeria Health Watch (NHW), which has expertise in policy advocacy and media engagement; and the Legislative Initiative for Sustainable Development (LISDEL), which is focused on legislative advocacy.
Based on the experience we have acquired, it is important to understand your stakeholders extremely well, [and] do a very strong landscape and stakeholder analysis before you start to pursue any targets because at the end of the day, it’s about interests and making sure interests can be aligned.
Ibukun Oguntola Program Manager, Nigeria Health Watch
Deploying strategies used at the national level, the teams quickly convened civil society, traditional and religious leaders, policymakers, and government officials to understand Kano’s challenges. A focus group and other research was also undertaken to understand the type and quality of funding spent on epidemic preparedness. This information was incorporated into a landscape analysis, which served as a basis to begin sharing targeted messages on the need for increased epidemic preparedness funding.
A select group of CSOs and government officials formed the Kano State Health Security Advocacy Team (KHESAT). This coalition worked to bolster government engagement and media coverage by sharing key messages via interviews, jingles, and documentaries on radio, in print, and via social media. NHW also held masterclasses for reporters and trained civil society partners to use the media advocacy toolkit they had developed. Meanwhile, the broader team held trainings on tracking funding for journalists and civil society.
In the past, health reporting was often sensational and lacked depth. Throughout the project, we consistently worked to change this by training journalists through masterclasses, fellowships, and other tools that introduced the concepts behind health security. As a result, when journalists had the opportunity to engage with stakeholders, such as legislators and officials from the ministries of health and finance during press briefings and media roundtables, they were equipped to ask informed questions and produce quality stories. This helped advance the agenda of preventing infectious disease outbreaks in the country.
Ibukun Oguntola Program Manager, Nigeria Health Watch
These efforts created momentum for a new epidemic preparedness budget line. The team participated in hearings on the budget. By December 2020, they secured a new budget line for epidemic preparedness and response of ₦300 million (US$777K) and a budget of ₦88 million (US$228K) for Kano’s 44 local government areas. Funding of ₦250 million (US$647K) was also allocated to establish a public health laboratory. Advocates and the government remained engaged, and in 2023 and 2024, allocations increased to ₦400 million and ₦132 million for the epidemic preparedness and response budget line and local government areas respectively. The epidemic preparedness and response budget line increased again in 2024 to ₦500 million, representing a 67% increase.
The teams also supported Kano in accessing additional funding. They helped the state build the capacity needed to meet the requirements to access federal funding which had previously been withheld because Kano did not have the structures in place to receive it. Advocates also looked for sustainable funding to support epidemic preparedness and saw potential in the Kano State Health Trust Fund (KHETFUND). GHAI worked with the fund’s director general to ensure that epidemic preparedness was included in its mandate. After significant advocacy, in January 2023, the governor signed a standing order releasing ₦3 million per month from KHETFUND to be used for epidemic preparedness and response.
Funding accountability
From the beginning, advocates knew that funding increases alone would not be sufficient. They identified a challenge particular to the Nigerian health sector: after the state legislative body allocates money, it still must be released by the government and then effectively utilized by the MDAs—a process often marked by delays and inefficiencies. The MDAs need well-prioritized plans to spend the money and capacity to absorb it. Funding must be tracked in a transparent manner to assess whether the proposed activities are implemented, and to identify glitches and gaps to advocate for improved utilization. Finally, effective budgeting is a dynamic process that requires ongoing vigilance and accountability to ensure allocations are sustained over time.
In some years, less than 60% of Nigeria’s health sector capital budget was released, and less than 60% of the released funds were utilized. In 2022, for example, only 36% of funds allocated to the health capital budget were actually used.1 BudgIT, which had been collecting data to map onto health security priorities, found that these same issues were true for health security funding.
The Kano team addressed these issues. Immediately after the first allocation, they went to work to ensure administrative steps—such as assigning a budget code—were taken. They partnered with the state and local entities who controlled allocated budget releases to ensure the memos needed to release allocated funds were shepherded and approved. The team also held trainings with government staff on how to write a convincing release memo, which resulted in significant releases of funds. To maintain public pressure, advocates held workshops with officials, CSOs, and the media to highlight the small amount of funding released compared to what the budget had allocated. Release of the funds was challenging, often requiring engagement across multiple bureaucratic levels over a period of years.
The team also held workshops on how the money would be spent. They advocated for epidemic preparedness to be prioritized in annual workplans and participated in the June 2021 state-level JEE—a part of the SERCB project—to identify epidemic preparedness and response gaps requiring prioritization. Subsequently, advocates supported dissemination of the JEE and a technical review, costing, and validation of the Kano State Action Plan for Health Security, which was adopted in February 2023. The Plan provided an overarching framework for how to address epidemic preparedness and response gaps in Kano, supporting effective use of funds.
Meetings with officials began in February with the Kenya National Public Health Institute (NPHI). The NPHI was established in 2022 via a Legal Notice—not an act of parliament. As a result, it lacked proper legal and budgeting authority. Despite these limitations, the NPHI, launched with support from the United States CDC, was a key player in epidemic preparedness, and advocates sought to understand how they could support and collaborate with it.
The team decided to leverage NOPE’s network to advocate for epidemic preparedness funding at the central and county levels, the political subdivision below the national government. Meetings were held with leaders in Narok and Kericho Counties, which were both selected in consultation with government officials due to their large population influxes. Kericho County sits on the border with Uganda, and Narok County is home to Masai Mara, a major tourist destination. The meetings sought to share the campaign goals to expand epidemic preparedness funding and understand local conditions.
The beautiful part of this story is that Kano now has a 5-year strategic plan–the Kano State Action Plan for Health Security. Kano, alongside two other states, pioneered the state-level JEE assessment. Now there is a plan for what needs to be done at what time for the state to achieve WHO benchmarks.
Abdullahi Hamza HassanIn-country coordinator for Kano State, Nigeria and coordinator for Kenya, Global Health Advocacy Incubator
To further bolster budget accountability, LISDEL and BudgIT created the Health Security Accountability Framework, which was validated at a June 2022 meeting of civil society and government officials. The framework has been used to track allocations and spending and informs planning by helping to identify bottlenecks. Framework implementation has been challenging because of a lack of access to data, which requires extensive engagement with government stakeholders. While LISDEL and BudgIT, initially managed the Framework at Kano State level, there remained outstanding work to get the state to take ownership of it.
Strengthening legislative and organizational infrastructure
As a part of the SERCB project, Kano State undertook an analysis of legal preparedness gaps in 2020 and began work on the Kano State Public Health Security Bill. RTSL, GHAI and LISDEL collaborated with the Kano State Government, NCDC, FCDO-Lafiya Project, and Africa CDC to hold a five-day workshop to review the draft in November 2021 and provided technical support throughout the process. Enacting the legislation took time and was stalled due to an election. But relentless educational work on the part of the broader advocacy team led to its passage in February 2024. The Public Health Security Bill—the first of its kind at the subnational level in Nigeria—established a robust framework for public health surveillance, emergency management, and the protection of health care workers during crises. Critically, the bill also includes a Public Health Security Fund; once operationalized, it will provide additional, sustainable resources for Kano’s epidemic preparedness. But work to gain assent from the governor remained unfinished.2
Advocates also worked with the government to reactivate epidemic preparedness and response committees in all 44 local government areas. The team supported the committees to create annual operational plans for inclusion in local budgets to bolster local level preparedness activities.
Kano State also saw the establishment of the Kano Centre for Disease Control and Prevention (KNCDC), Africa’s first state-level public health institute, to manage public health threats. The government expressed intention to establish the KN-CDC in July 2023. The teams supported information workshops on the considerations underpinning the creation of the state CDC and offered training once the organization was established. The KNCDC was established with a budget of ₦1B (US$1.1M) in 2024, but as with the Kano State Public Health Emergency Bill, the enacting legislation remained unsigned by the governor.
CSO Academy support to complete work in Kano
The Kano State House of Assembly had made history by passing Nigeria’s first state-level health security bill, which covered critical aspects of how the state would manage and prepare for health emergencies. The Kano State Centre for Disease Control Bill established Africa’s first state level public health institute. However, neither had been assented to by the governor, leaving major gaps in epidemic preparedness and the newly established KNCDC without critical statutory powers. In addition, the Health Security Accountability Framework remained CSO driven without ownership by the government. Competing priorities left this critical work unfinished.
We are talking to the media to highlight the importance of investments in health security, and if we’re going to be prioritizing investment in health security, then we must be accountable. Nobody’s going to invest in a system where you do not have accountability.
Tessy Nongo MainaHealth Communications Specialist, Network for Health Equity and Development
The Network for Health Equity and Development (NHED), which focuses on improving public health, identified these gaps during their landscape analysis. They had conducted this preliminary work as part of their capstone project for the CSO Budget Advocacy Academy, a new model for advocacy developed by RTSL and GHAI to create a broad ecosystem of CSOs equipped to engage in epidemic preparedness budget advocacy. NHED was connected with LISDEL to understand the Kano context and began meeting with a wide array of Kano State officials to emphasize the importance for the governor to sign the health security bill and KNCDC bill. They also continued to advocate for the data needed to populate the Framework and for the Framework to be adopted and incorporated into Kano government workstreams to ensure its sustainability. NHED engaged the media to give visibility to their campaign and keep the issue alive for policymakers.
While health officials viewed the Framework as being owned by LISDEL, NHED was able to work with leaders to validate tit and help them take greater ownership of its findings. The government agreed to adopt the framework and now regularly meets with a CSO coalition who populates it to discuss its findings and how to improve based on the information. In addition, NHED discovered that due to technical issues the bills had been sitting on the governor’s desk and remainedunsigned . Once the technical issues addressed, the governor assented to the Health Security Bill in January 2025 and to the Kano State Centre for Disease Control Bill the following month, establishing Kano State as a leader in Nigeria’s epidemic preparedness.
Lessons learned and legacy
The key objectives were domestic resource mobilization, to strengthen the system, and to harness all forms of resources available. If you look at all the indicators, Kano is now ahead of all 36 states. It was also the first state to have a public health security law that is comprehensive and defines who does what when there are emergencies. For the KNCDC there is legislation, and they have a functional office and dedicated budget line. There are quite a number of structures and systems in place now.
Abdullahi Hamza HassanIn-country coordinator for Kano State, Nigeria and coordinator for Kenya, Global Health Advocacy Incubator
- A systems-thinking approach to health security challenges is critical to lasting impact. The teams recognized that gaps needed to be addressed from problem identification to budget allocation and release, absorption, transparency and accountability. Through its structure and selection of CSO partners , the campaign worked to manage bottlenecks across this entire chain of needs.
- While advocacy campaigns are time limited, government functions are ongoing. As such, creating a sustainable infrastructure from which to continue to build epidemic preparedness is essential. Advocates working in Kano considered sustainability from the start and worked with broad coalitions of established players, providing skill building. They also worked to build structures enshrined into law that would perpetuate their own momentum. Together, these considerations will ensure that even after the formal work has ended, health security work will continue.
- Finding the right advocacy model is an iterative process. The Kano State campaign, which achieved notable wins over five years, benefited from a long runway, consistent support, and GHAI and RTSL’s strong in-country presence. Rather than suggesting that large-scale multi-year investment is the only viable path, emerging models—such as the CSO Academy, which builds on tools largely developed based on what was learned in Nigeria—demonstrate that targeted, strategic investments, combined with sustained relationship-building can offer a more efficient, sustainable approach. Indeed, NHED was quickly onboarded and made significant gains in Kano State due to its involvement with the CSO Academy.
- Policymakers can be invaluable partners. In Kano State, RTSL, GHAI, LISDEL, NHW, and BudgIT became close partners with government after working to understand needs through participation in evaluation exercises, while offering resources to fill identified gaps. Building the KHESAT coalition, which included policymakers, created deep buy-in and insider views to guide advocacy planning. These close relationships developed across the government facilitated effective action that significantly changed Kano’s health security.
Part of what we infused into the strategy across all the activities we implemented was to ensure sustainability even after the grant expired. And that’s why we never worked in isolation. We worked with several CSO and media coalitions. One of the coalitions we worked with last year has been able to include health security in their projects going forward. We will continue to use resources we have elsewhere to continue to push the gains from Kano, Lagos, and at the national level.
Damilola AdemuyiwaDirector of Programs, Legislative Initiative for Sustainable Development
Conclusion
The United States suddenly withdrew its support from many African countries early 2025 . In Nigeria, the government had to suddenly design ways to take over support for nearly 30,000 healthcare workers and find funds to provide antiretrovirals to people living with HIV. As new bilateral health deals are being negotiated, advocates and Nigerian leaders are galvanized to meet the moment and chart their path through increased domestic funding.
It’s a double-edged sword. On the one hand, funding from USAID and indeed other bilateral and multilateral funders has been quite helpful in strengthening Nigeria’s health system That said, for a long time many of us have been advocating for domestic resource mobilization because you cannot depend on other countries using their taxpayer money to support you ad infinitum.
Prof Emmanuel AlhassanNigeria Coordinator, Prevent Epidemics, Global Health Advocacy Incubator
Five years of work has positioned Kano State to continue its epidemic preparedness leadership role. It has built an impressive financial, legal, and operational structure that is supported by a coalition of civil society organizations deeply committed to epidemic preparedness. As the national government works to manage the seismic shift in donor funding, Kano has the tools to continue to consolidate its epidemic preparedness.