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Fragile Settings: A Nigerian Perspective

SYP, GHMe 2019

Fragile Settings

Globally, over 1.6 billion people live in fragile settings. These settings are usually volatile with protracted conflicts, crises, violence, disasters and a colossal amount of health inequalities. It is also well understood that 85% of the world's extremely poor and vulnerable populations such as refugees, internally displaced people, live in these fragile settings.

The large global health inequality is a hydra-headed monster that has continually reared its ugly head – in the past, present and with less than half of the target of health-related sustainable development goals unachieved, including maternal and child health, the 2030 SDG agenda may be more far fetched than we would like to believe.

Several policies and initiatives have been documented towards addressing fragile and vulnerable settings in regions most affected. For instance, the Global Strategy for Women's and Children's Health focuses on the time when women and children are most vulnerable (pregnancy and childbirth) and recognizes mothers and children as integral to progressing on all development goals. Furthermore, the need to accelerate innovative programming towards driving sustainable development goals of good health and wellbeing across fragile settings has been well documented in The Accelerator Discussion Frame. Additionally, the “Global Action Plan for Healthy lives and Wellbeing for All is an initiative jointly carried out by 12 global health organizations, for the sole purpose of accelerating progress towards the health-related targets of the 2030 Agenda for Sustainable Development.

The Global Action Plan focuses on seven cross-cutting accelerator areas:

· Sustainable financing

· Primary health care

· Community and civil society engagement

· Health determinants

· Research and development along with innovation and access

· Data and digital health

· Innovative programming in fragile and vulnerable states and for outbreak responses.

In September 2019, the Global Action Plan launched its third phase of mobilizing countries and accelerating progress on health-related SDGs.

Fragility, Conflict, Violence (FCV) in Nigeria

Since 2010, Nigeria has been plagued with rising FCV with the worst hit in the 3 zones (North-East, North-Central, and South-South). Causes range from Boko Haram – a terror group, disputes to access land and resources, criminals, and cultism among other issues. Consequences such as the unabating insecurity and crippled transportation has negatively impacted the health system of the aforementioned zones in Nigeria. The statistics on the health-related sustainable development goals are also underwhelming. For instance, maternal death is 814 per 100,000 live births and the under-five mortality rate is 104 per 1,000 live births (World Health Statistics, 2018). Unfortunately, this may help explain why Nigeria is found at the 164th position of 195 countries rated in achieving health-related sustainable development goals (Global Health Metrics, 2019).

Understanding the weaknesses of health systems and how systems strengthening strategies may address these weaknesses must remain a core component of any approach to secure improvements in population health. Challenges of health delivery in fragile areas of Nigeria include insecurity, migration of people, restricted supplies of drugs and consumables, financial barriers as well as physical barriers in accessing health services. Working on cost-effective strategies to address these challenges is necessary to address fragility and the root causes.

Source: The Guardian

The role of an emerging Global Health Professional

As a Student and Young Professional who has participated in the 2019 Global Health Mentorship (GHMe) Program, it became clear to me that moving towards Universal Health Coverage (UHC) is a passion of mine and could be a reality in Nigeria with focused efforts and strategies.

Under the mentoring of Dr. Weyinmi Erikowa-Orighoye, my GHMe focus area was on maternal and child health. I firmly believe that prioritizing care for marginalised women within the reproductive age bracket (15-45 years) and also children is a vital stepping block towards health improvements. I aspire to strengthen Nigerian health systems by becoming involved in innovative and evidence based maternal and child health intervention projects tailored to the Nigerian environment and strengthening my advocacy skills. Scientific knowledge of Global Health and deeper comprehension of culture and eliminating barriers to essential knowledge and services are paramount for me in my quest to reduce fragility and improve UHC in Nigeria.

The WHO health system framework focuses on 6 building blocks - service delivery, health workforce, health information systems, access to essential medicines, financing and leadership or governance. The ability to integrate these effectively into the Nigerian health system would increase our chances of achieving more equitable and sustainable improvements across health services and ultimately better health outcomes in the population.

From the GHMe program to an aspiring Global Health practitioner, I intend to continue to shape my skill set and focus my efforts on these building blocks so that I can be part of a shift towards enhanced health systems in fragile settings, particularly being able to strengthen and positively impact my home country of Nigeria. By curtailing fragility, conflict and violence, I hope to be a part of creating a new reality where ultimately no one is left behind.

Source: Peace Direct


Thank you to Yunus Dosonmu for your reflective blog post. For any inquiries related to the GHMe Blog, please contact our team at

Disclaimer: This blog was prepared by the author, in his/her/their personal capacity. The opinions, views, and thoughts expressed in the blog belong solely to the author and do not reflect the views of Global Health Mentorships.


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