Evaluating the implementation of HeRON’s (Health Resilience of Northeast Nigeria) Transition and Sustainability Strategy

The Health Resilience of Northeast Nigeria (HeRON) project was launched in response to the severe challenges facing healthcare in conflict-affected Borno and Yobe states, where prolonged insurgency has destroyed infrastructure and left nearly half of health facilities non-functional. These conditions, worsened by underfunding and weak governance, have led to high maternal mortality, rising malnutrition, and unchecked communicable diseases. HeRON aimed to address these gaps by strengthening health systems, improving service quality, and ensuring access for vulnerable groups, including women and internally displaced persons.

The first year of the HeRON project focused on assessments and activities were amended to incorporate a COVID-19 response. In the second year, the project expanded geographically and intensified capacity building. The final phase prioritized transitioning health system ownership to government partners through the implementation of a Transition and Sustainability Strategy, which was the focus of the process evaluation.

The HeRON process evaluation had two objectives: assessing the success of transitioning program components and identifying lessons learned to inform future partnership-based health system strengthening programs. It examined operational processes and the transition of project components to government partners, including financial support for Community Health Influencers and Promoters (CHIPs), MoH staff incentives, the running of Nutrition Stabilization Centers, and essential drug procurement for Primary Health Care centers.

The process evaluation concluded that capacity building for both government and community stakeholders is key to sustainable health system strengthening. Effective governance, alignment with national policies, and integration of services like Emergency Transport Scheme (ETS) within existing operational agencies, and prioritizing scalable models like market-based Drug Revolving Funds (DRF), also increases the likelihood of sustainability. Community-level engagement offers stability amid shifting political and security dynamics, especially when reinforcing linkages between local structures. Successful collaboration with state actors requires politically smart approaches, adaptability, strong relationships, and strategic staffing. However, funding for sustainability remains a challenge, especially as HeRON’s humanitarian design limited early government ownership and financial commitment.

In addition to providing recommendations, the evaluation concludes with offering a set of design principles for partnership-based health system strengthening interventions in fragile contexts: (1) Program design should be based on alignment, boosting and catalyzing, scaffolding, visibility and attribution, and adaptiveness; (2) the approach to partnership should be politically smart(er) and responsive; and (3) Transition funding should be comprehensive and rely on diversified resources, consider conditionality and matching, and prioritize self-sustaining approaches.