![]() ![]() The Lancet Nigeria Commission aims to reposition future health policy in Nigeria to achieve universal health coverage and better health for all. However, despite a history of weak surveillance and diagnostic infrastructure, the scale up of COVID-19 diagnostics suggests that it is possible to rapidly improve other areas with sufficient local effort and resources. This Commission was written in the context of the COVID-19 pandemic, which has laid bare the inability of the public health system to confront new pathogens with threats to human health. Effective, quality reproductive, maternal, and child health services including family planning, and female education and empowerment are likely to accelerate demographic transition and yield a demographic dividend. Nigeria's demographic dividend has unguaranteed potential, with a high dependency ratio, a fast-growing population, and slow reduction in child mortality. Major obstacles include ineffective use of available resources, a dearth of robust population-level health and mortality data, insufficient financing for health and health care, sub-optimal deployment of available health funding to purchase health services, and large population inequities. If the country confronts its toughest challenges-a complex political structure, weak governance, poor accountability, inefficiency, and corruption-it has the potential to vastly improve population health using a multisector, whole-of-government approach. ![]() In this Commission, we present a positive outlook that is both possible and necessary for Nigeria to deliver equitable and optimal health outcomes. It is Africa's most populous country with 206 million people and immense human talent it has a diaspora spanning the globe, 374 ethnic groups and languages, and a decentralised federal system of governance as enshrined in its 1999 Constitution. Even compared with countries of similar income levels in Africa, Nigeria's population health outcomes are poor, with national statistics masking drastic differences between rich and poor, urban and rural populations, and different regions. About 40% of Nigerians live in poverty, in social conditions that create ill health, and with the ever-present risk of catastrophic expenditures from high out-of-pocket spending for health. Nigeria is both a wealthy country and a very poor one. It is a picture of poverty amidst plenty. Nigeria's gross domestic product is the largest in Africa, but its per capita income of about ₦770 000 (US$2000) is low with a highly inequitable distribution of income, wealth, and therefore, health. ![]() Health is central to the development of any country. Ibrahim Abubakar, Prof, PhD, a, * Sarah L Dalglish, PhD, a Blake Angell, PhD, a, b Olutobi Sanuade, PhD, a, c Seye Abimbola, PhD, d Aishatu Lawal Adamu, FWACP, e, f, g, h Ifedayo M O Adetifa, PhD, g, h, i Tim Colbourn, Prof, PhD, a Afolabi Olaniyi Ogunlesi, DPhil, j Obinna Onwujekwe, Prof, PhD, k Eme T Owoaje, Prof, MPhil, l Iruka N Okeke, Prof, PhD, m Adebowale Adeyemo, FWACP, n Gambo Aliyu, PhD, o Muktar H Aliyu, Prof, DrPH, p Sani Hussaini Aliyu, FRCP, q Emmanuel A Ameh, Prof, MBBS, r Belinda Archibong, Prof, PhD, s Alex Ezeh, Prof, PhD, t Muktar A Gadanya, FMCPH, e, f Chikwe Ihekweazu, FFPH, u Vivianne Ihekweazu, MBA, v Zubairu Iliyasu, Prof, PhD, e, f Aminatu Kwaku Chiroma, FWACP, e, f Diana A Mabayoje, MBBS, w Mohammed Nasir Sambo, Prof, FWACP, x Stephen Obaro, Prof, PhD, y, z Adesola Yinka-Ogunleye, MPH, u Friday Okonofua, Prof, PhD, aa, ab Tolu Oni, MD, ac, ad Olu Onyimadu, MPH, ae Muhammad Ali Pate, Prof, MD, af, ag Babatunde L Salako, Prof, FWACP, ah Faisal Shuaib, DrPH, ai Fatimah Tsiga-Ahmed, FWACP, e, f and Fatima H Zanna, MSPH o
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