Evaluating the Transition and Sustainability Strategy of the HeRON Health Systems Strengthening Program in Northeast Nigeria

The Health Resilience of Northeast Nigeria (HeRON) project is a large-scale health systems strengthening program implemented from 2020 to 2024 in Borno and Yobe States—two regions heavily affected by over a decade of conflict, displacement, and weakened governance. With nearly half of all health facilities in the region non-functional and persistent shortages of essential staff, medicines, and infrastructure, the HeRON Consortium (IRC, Action Against Hunger, Society for Family Health) worked to strengthen service delivery, improve community engagement, and build health system governance and capacities.

In 2024, Airbel conducted a process evaluation to understand how effectively key components of HeRON were transitioned to state government partners and whether the systems, structures, and skills put in place were likely to be sustained. The evaluation also aimed to capture lessons for future partnership-based health systems strengthening programs operating in fragile and conflict-affected settings.

The evaluation focused on four areas:

• Coordination, communication, and management of the transition process.
• Quality and relevance of technical assistance and capacity building for government and community stakeholders.
• Sustainability and ownership of processes, structures, and outcomes generated by HeRON.
• Operational and resource management within implementing NGOs during transition.

Researchers conducted 66 in-depth interviews across both states with government officials, health facility staff, Ward Development Committees (WDCs), Community Health Influencers and Promoters (CHIPs), Emergency Transport Scheme (ETS) volunteers, and consortium staff. Findings highlight strong collaboration between government and NGOs, effective use of the Joint Task Force as a transition mechanism, and the positive impact of community-level capacity building—especially for WDCs, CHIPs, and ETS.

Government stakeholders praised HeRON’s clarity during transition planning, its emphasis on capacity building, and its use of multiple communication channels. Community members valued increased engagement and felt more equipped to promote healthy behaviors and improve facility accountability. However, persistent challenges included limited government funding and staffing, payment delays, weak trust in some areas, and concerns about long-term ability to maintain incentives and drug supply chains—especially in Borno.

The evaluation concludes that sustainability improves when government ownership is actively supported through early planning, embedded coordination structures, and practical capacity building tailored to local realities. It offers actionable recommendations for future HSS programs, including politically-smart engagement, strengthening community-government accountability mechanisms, and extending transition timelines.