47
Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
Interrogating the Health - Foreign Policy
Nexus: The Nigerian Experience
Interrogando a Saúde - Nexo da Política Externa: a
experiêncianigeriana
Interrogando el nexo entre la salud y la política exterior: la
experiencia de Nigeria
Benjamin Anaemene1
DOI: 10.5752/P.2317-773X.2023v11n1p47-64.
Recebido em: 16 de julho de 2022
Aprovado em: 07 de novembro de 2023
R
O nexosaúde - política externa é exploradonesteartigo por meio de um estudo
de caso da Nigéria que interroga a motivação para a diplomacia da saúde e
demonstra as instituições e mecanismos para suaconduta. O objetivodestearti-
go é demonstrarcomo a Nigéria, desde a conquista da independênciaem 1960,
atribuiuimportância à utilização da saúdecomoinstrumento de promoção da
política externa. O artigoutiliza o métodoprimário e secundário de coleta de
dados. Os dados primáriosforamobtidos a partir de entrevistasorais e reporta-
gens de jornaisdiários. Alémdisso, baseia-se emmateriais dos Arquivos da OMS
emGenebra e dos ArquivosNacionais, Ibadan. Os dados secundáriosforamobti-
dos de livros, artigos de periódicos, publicaçõesgovernamentais e da internet. Os
dados geradosforamanalisados por meio de análisedescritiva e de conteúdo. O
artigoconclui que a experiêncianigerianarevela as ligações entre saúde e política
externa. Oscompromissos de saúdena forma de ajuda, assistência e coopera-
çãosãousados comouma forma de soft power que cumpreobjetivos de política
interna e externa, incluindosegurança, crescimentoeconômico e outros interes-
ses. a condução da diplomacia da saúde da Nigéria. De qualquer forma, essesfa-
toresconstituem um pesadoalbatroz para osdiplomatas da saúdeenfrentarem as
diculdadesapresentadas pela disseminação global de doençasinfecciosas.
Palavras-chave: Saúde; Políticaestrangeira; Nigéria; Diplomacia; Diplomacia da saúde
A
The health - foreign policy nexusis explored in this articlethrough a case study
of Nigeria that interrogates the motivation for health diplomacy and demons-
trates the institutions and mechanisms for its conduct. This article demonstrates
how Nigeria since the attainment of independence in 1960 has attached impor-
tance to utilising health as an instrument for promoting foreign policy. It utilizes
the primary and secondary method of data collection. The primary data were
obtained from oral interviews and daily newspaper reports. It further draws
upon materials from the WHO Archives in Geneva and National Archives,
1. Dr Benjamin Anaemene, Department
of History and International Studies,
Redeemer’s University Nigeria. E-mail:
anaemeneb@run.edu.ng
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estudos internacionais • Belo Horizonte, ISSN 2317-773X, v. 11, n. 1, (fev. 2023), p. 47-64
Ibadan. Secondary data were sourced from books, journal articles, government
publications and the internet. The data generated were analysed using descrip-
tive and content analysis. The Nigerian experience reveals the linkages between
health and foreign policy. Health engagements in the form of aid, assistance and
cooperation is used as a form of soft power that fullls domestic and foreign
policy goals including security, economic growth and other interests.However,
institutional pluralism, divided responsibilities and non-professionalisation of
health diplomats have marred the conduct of Nigeria’s health diplomacy. These
factors constitute weighty albatross to health diplomats in meeting up with
diculties presented by the global spread of infectious disease.
Keywords: Health; Foreign policy; Nigeria; Diplomacy; Health diplomacy
R
El nexo entre la salud y la política exterior se exploraenesteartículo a través de
un estudio de caso de Nigeria que cuestiona la motivación de la diplomaciaensa-
lud y demuestra las instituciones y los mecanismos para suconducta. El objetivo
de esteartículo es demostrarcómo Nigeria, desde la consecución de la indepen-
denciaen 1960, ha concedidoimportancia a la utilización de la saludcomoinstru-
mento para promover la política exterior. El artículoutiliza el métodoprimario
y secundario de recopilación de datos. Los datosprimarios se obtuvieron de
entrevistasorales e informes de periódicosdiarios. Además, se basaenmateriales
de los Archivos de la OMS enGinebra y los ArchivosNacionales de Ibadan. Los
datossecundarios se obtuvieron de libros, artículos de revistas, publicaciones-
gubernamentales e Internet. Los datosgeneradosfueronanalizadosmediante-
análisisdescriptivo y de contenido. El artículoconcluye que la experiencia de
Nigeria revela los vínculos entre la salud y la política exterior. Los compromisos
de saluden forma de ayuda, asistencia y cooperación se utilizancomo una forma
de poderblando que cumpleobjetivos de política interior y exterior, incluidos la
seguridad, el crecimientoeconómico y otrosintereses. Sin embargo, el pluralis-
moinstitucional, las responsabilidadesdivididas y la falta de profesionalización de
los diplomáticos de la saludhanestropeado la conducta de la diplomacia sanitaria
de Nigeria. Encualquiermedida, estosfactoresconstituyen un obstáculoimpor-
tante para los diplomáticos de la salud a la hora de hacerfrente a las dicultades
que presenta la propagaciónmundial de enfermedadesinfecciosas.
Palabras llave: Salud; La política exterior; Nigeria; Diplomacia; diplomacia de la salud
INTRODUCTION: EMERGENCE OF HEALTH IN FOREIGN POLICY
Health concerns have become a signicant issue in international po-
litics. Regardless of the unprecedented upsurge in the health and foreign
policy discoursemuch of the emerging literature has focussed on the theo-
retical underpinnings of the eld or particular aspects of the health foreign
policy linkage. There is little in-depth analysis in the existing literature to
advance knowledge on how individual countries engage with health as a
foreign policy issue. This phenomenon is investigated in this articlethrough
a contextual analysis of Nigeria that interrogates the motivations for health
diplomacy and elucidates the institutions and mechanisms for its conduct.
It is incontrovertible thathealth received little consideration in foreign
policy and international relations mainly due to its focus on applied concer-
ns of power politics, diplomacy and foreign policy, which has resulted in
the preoccupation with peace and security. Consequently, health has been
categorised as ‘low politics.’(Weber, 1997;Fidler, 2016; Khazatzade-Mahani;
49
Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
Ruckert; Labonte, 2018), in the hierarchy of foreign policy functions.
Classifying foreign policy objectives as high and low politics has been a lon-
g-standing distinction in the eld of international relations (Morgenthau,
1962). Health was seen as a social welfare function performed by states.
Thus, international health activities were perceived to involve ‘technical,
scientic, non-political endeavours which were outside the purview of the
state’s national security, economic interests and concerns about countries
and regions of strategic importance’(Fidler,2005). Apparently, international
health has been viewed as purely humanitarianism.
However, Fidler has argued that health has not always been at the
margins of low politics, as health arose as a foreign policy issue in the con-
text of countries promoting their economic interest (Fidler, 2005). The
links between health and foreign policy were born out of the expansion of
trade, particularly between Europe and the outside world. With increased
trade came the risks of diseases spreading in Europe. Thus, the tension
between the promotion of trade and health development could not be re-
solved by introducing quarantine measures at the national level. Instead,
international cooperation was sought, resulting in negotiating a series of
conventions on trade and health referred to as the International Sanitary
Conventions(McInnes; Lee, 2012).The practice of linking international
health with humanitarianism and human dignity developed only after
powerful states’ commercial interest in international health cooperation
dwindled, in the years after the Second World War (Goodman, 1971).
Health prominence in the foreign policy functions of security, eco-
nomic interest, political and economic development and human dignity
can be attributed to the governance transformation taking place within
and among countries. This is traceable to the end of the Cold War and glo-
balisation, which highlighted the importance of health as a critical element
of development, good governance and security. The importance of health
is underscored by the redenition of national security to include issues of
health to make the concept of health security more relevant to the challen-
ges states face in the post-Cold War era. For instance, in 2000, the United
Nations Security Council adopted a resolution identifying HIV/AIDS
as a threat to international peace and security (United Nations Security
Council, 2000).Health was the subject of three of the eight-millennium de-
velopment goals.The 2030 Agenda for sustainable development recognised
from the start the importance of health. Health is covered under SDG 3,
“Ensure healthy lives and promote wellbeing for all ages” (United Nations
General Assembly, 2015). It is also critical to delivering other sustainable
development goals, mostly because good health is fundamental to human
potentials’ realisation. Besides, health has achieved uniquerecognition as a
critical determinant of socio-economic progress. The protection and pro-
motion of health has also become an independent marker of good gover-
nment at national and international levels. All these have given health an
entry into studies of foreign policy and international relations.
Indeed, one key initiative that explored the nexusbetween health
and foreign policy was the global health and foreign policy initiative laun-
ched in September 2006 when the Foreign Aairs Ministers from France,
Norway, Indonesia, Senegal, South Africa and Thailand announced the
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estudos internacionais • Belo Horizonte, ISSN 2317-773X, v. 11, n. 1, (fev. 2023), p. 47-64
commencement of a process of cooperation on health and foreign policy.
They argued that “health is one of the most important, yet still broadly
neglected long term foreign policy issues of our time” (Oslo Declaration,
2007). The Ministers agreed to make an impact on health “a point of depar-
ture and a dening lens that each country would use to examine key ele-
ments of foreign policy and development strategies”.The Oslo Declaration
was acknowledged by the UN General Assembly, where Resolution 64/108
‘recognised the close relationship between global health and foreign poli-
cy’(United Nations General Assembly, 2010).By 2006 global health issues
had begun to occupy a signicant position on the G-8 agenda. For ins-
tance, during the St Petersburg G-8 Summit in 2006 the leaders pledge to
ensure greater cooperation in the areas of global health emergencies and
response, as well as improve disease surveillance and monitoring and ste-
pping up public awareness of eorts to combat disease (Frist, 2007).
The US government also armed the link. In 2009, President
Barrack Obama launched his Global Health Initiative arguing that the
US cannot isolate itself from the rest of the world and still expect the best
nor ignore the public health challenges beyond the US borders(White
House,2009). Examples of how health concerns have entered the realm
of foreign policy are abundant. The outbreak of severe acute respira-
tory syndrome (SARS) in 2003, the HIV/AIDS pandemic, the 2014 Ebola
outbreak in West Africa, the spread of Zika virus, bioterrorism and the
recent Covid-19 pandemic are all seen as direct threats to national se-
curity and foreign policy interests because of their ability to threaten in-
ternational stability (Feldbauum, 2009; Elbe, 2010; Michaud; Kates, 2013;
Rushton, 2019; Harman, 2020).
The goal of this article is to demonstrate how Nigeria sincethe attain-
ment of independence in 1960 has attached importance to utilising health as
an instrument for promoting foreign policy. The Nigerian experience reveals
the linkages between health and foreign policy. Health engagements in the
form of aid, assistance and cooperation is also used as aform of soft power
that fulls domestic and foreign policy goals including security, economic
growth and other interestsIt is no gainsaying that the hierarchy of foreign po-
licy functions of national security, the global economy, political and social de-
velopment and the protection and promotion of human dignity through hu-
manitarianism and human right policies are echoed in Nigeria’s international
health relations. Its avowed foreign policy interests include socio-economic
and political tieswith its immediate West African neighbours, particularlyon
domestic health security issues focusing on ECOWAS and the African Union,
Nigeria’s cooperation in the eld of health with key bilateral actors (Britain,
the United States and Japan) and a commitment to global citizenship through
membership in multilateral organisations outside Africa, including the UN,
the WHO, European Union, and the Commonwealth. The threats of infec-
tious diseases to human health and economic activities have caused an inten-
sication and organisational formulation of Nigeria’s health diplomacy at the
bilateral and multilateral level. Such diplomacy has gone beyond pandemics’
threats and has established a basis for developing a more extensive set of coo-
perative relationships.The article utilizes the primary and secondary method
of data collection. The primary data were obtained from oral interviews and
51
Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
daily newspaper reports. It further draws upon materials from the WHO
Archives in Geneva and National Archives, Ibadan. Secondary data were
sourced from books, journal articles, government publications and the inter-
net. The data generated were analysed using descriptive and content analysis.
THEORETICAL UNDERPINNING
This article is anchored on two theories, namely realism and
constructivism. Analysing health diplomacy eorts through the prism
of international relations operationalised through realist and construc-
tivist frameworks helps to comprehend better the motivation that drives
states, particularly Nigeria, to utilise health to pursue its foreign policy
goals. According to the realist,states actions are driven by the pursuit of
power (Jervis, 1998; Griths, 2007). The realists believe that the con-
duct of international relations is the outcome of the choices of states
operating as independent actors rationally pursuing their interest in a
system of sovereign states. Joshua Goldstein (2005) summarised the rea-
lists framework in three propositions; 1. States are the most important
actors; 2. They act as rational individuals in pursuing national interest,
and 3. They act in the context of an international system lacking central
government. Under this framework state’s use of health in foreign policy
is seen to promote its national interest. In this wise, disease prevention
and control serve to protect national security and economic power.
In contrast, constructivism sees the world and what we can know
about the world as socially constructed. It holds that shared ideals and
values – independent of national interest, hold inuence in international
relations (Theys, 2017). Constructivists posit that the behaviour of sta-
tes in international relations is shaped by complex cultures. In fact rule
governed interactions shape states’ interest and identities. For construc-
tivists, norms help states pursue their selsh interest in mutually bene-
cial ways and overcome collective goods problems. Norms dene how
states conceive their interests and identities (Katzenstein, 1996;Onuf,
1989). Thus, states’ conception of its interest, its presentation on the in-
ternational stage and its behaviour can change due to interstate inte-
ractions. States, like, people come to see themselves as others see them.
Diplomatic interactions can aect how states formulate their political
inuences and articulate interests. Hence, health diplomatic processes
become more than mechanical conduits for articulating and defending
predetermined interests. They havebecome avenues through which sta-
tes and non-state actors construct and express their ideas, interests and
identities.
Significantly, Nigeria’s use of health as a foreign policy tool is
not merely a natural and inevitable development arising from what
is happening in the real world. Instead, the motivations are made or
socially constructed in such a way as to reflect the ideas, interests and
relative power of individuals and communities. These communities
are not merely states, governments or political actors but can include
other groups such as practitioners and academic disciplines within the
health and international relations fields (McInnes; Lee, 2012).
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NIGERIA AND INTERNATIONAL HEALTH ORGANISATIONS
Nigeria’s membership of international health organisationsreects a
religious implementation of one of its foreign policy principles. The fourth
principle of Nigeria’s foreign policy – multilateralism, explains Nigeria’s en-
thusiastic and instinctive search for membership in key international orga-
nisations globally and at regional levels (Olusanya; Akindele, 1986). Nigeria
believes that international organisations provide numerous opportunities
for multilateral negotiations and collaboration among states and could be
used by the country to its advantage.In line with its avowed foreign policy
principle, Nigeria joined a host of international health organisations such
as the World Health Organisation. This suggests that a signicant charac-
teristic of Nigeria’s diplomacy at independence was multilateral diploma-
cy. This was particularly true in the eld of health. In recent years, the
cross-border transmission of infectious diseases has facilitated cooperation
among countries. Therefore, international health organisations have beco-
meideal fora for states to deliberate on global and national health challen-
ges. In this regard, Nigeria joined the International Health Organisations to
participate in international health decision-making processes actively.
Nigeria and the World Health Organisation
The World Health Organisation (WHO) is the UN-designated spe-
cialised agency in health and plays a leading role in coordinating inter-
national health activities. The World Health Organisation has played a
central role in Nigeria’s health development since its inception in 1948. In
doing this, the WHO also acted beyond its original mandate.Nigeria be-
came an associate member of the WHO in 1956. However, much was not
achieved both before and during associate membership because Nigeria
was sovereign void.Since the attainment of independence in 1960, Nigeria
has been actively involved in the WHO’s activities.
In 1979, the World Health Organisation formally designated the National
Orthopedic Hospital Igbobi Lagos and the Aro Mental Hospital Abeokuta as
WHO collaborating centres. The two hospitals’ designation was in recognition
of their potentials to perform the three main functions of providing various
services to the people of Africa in general and Nigeria in particular, conducts re-
search and oer training in their specic elds. On training, the hospital facili-
ties would encourage African countries to stop sending their scholars to Europe
and reduce the brain drain from the continent. Besides, the WHO also con-
tributed to manpower development through fellowship awards to Nigerians
to train in various elds. Many Nigerians received training under this scheme
in public health, health education, nutrition, statistics, public health, nursing,
occupational health, leprosy control among others The smallpox eradication
programme and the control of cholera were outstanding achievements in the
assistance of the WHO for diseases control in the country. Other WHO assis-
ted campaigns was directed against malaria and tuberculosis among others.
Nigeria has shown her commitment to attaining the WHO goals
through its nancial contributions to the organisation’s Regular Budget
Funds (RBF) from 1961 to 2007. The constitution states that WHO is primarily
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Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
nanced by its member states’ assessed contribution calculated according to
the United Nations Scale of ability to pay based on Gross National Product
(GNP) and population (WHO, 1948).Between 1961 and 2007, Nigeria contri-
buted a total sum of $14,248,242.72 to the WHO’s Regular Budget Fund. It
is important to note that despite Nigeria’s civil war from 1967 – 1970 and the
economic recession of the 1980s, Nigeria WHO’s Regular Budget Fundon to
the fund. The Health Assembly never suspended Nigeria’s voting privileges
and services to which a member was entitled was never suspended by the
Health Assembly based on non-fullment of its nancial obligation.
Furthermore, in line with the WHO constitution which stipulates
that the ‘Health Assembly or the Executive Board acting on behalf of the
World Health Assembly may accept and administer gifts and bequest made
to the organisation provided that the conditions attached to such gifts or
bequests are acceptable and are consistent with the objectives and policies
of the organisation (WHO 1948).Nigeria has given many nancial assis-
tance and gifts to the World Health Organisation. For instance, in 1967,
Nigeria donated two pieces of artwork worth £5000 to both the new head-
quarters of the World Health Organisation Regional Oce for Africa and
the WHO general headquarters in Geneva (Daily Times, 1967). In 1974,
the Federal Government approved a Nigerian contribution of N20,000 to-
wards the WHO Appeal Fund for combating the health problems in the
drought-stricken Sudanese Sahelian zone of Africa (Daily Times, 1974).
Furthermore, in 1975, 1976 and 1977, Nigeria supported the following
extra-budgetary contributions; Special Regional Accounts of Bio-Medical
Research Centre in Ndola, Zambia and malaria eradicating special accou-
nt of the WHO African Region (Ogbang, 1978).In 1990, Nigeria made a 2
million naira donation to the 24 million naira Special Fund for Health in
Africa (New Nigerian, 1992).The Fund was used in nancing community
health priorities, especially child survival, safe motherhood, adolescent
health, better nutrition, water supply and health education. Other areas
include selective disease control, workers health and social welfare.
The organisation has derived signicant benets from the experien-
ce of high eminent authorities sent by Nigeria to attend the World Health
Assemblies, Executive Board sessions, and Experts Committees and
Regional Committees. According to Professor Adeoye Lambo, among
the developing countries, Nigerian scientists in the eld of medicine and
health are considered one of the best in the world. He recounted that
‘there is no day or week that I have walked in the corridors of WHO in
Geneva, without seeing a Nigerian scientist or consultant rendering one
advice or another” (The Statesman, 1987). This is a measure of Nigeria’s
commitment to the attainment of the WHO goals.
Nigeria was nominated as a member of the Executive body of the WHO
on many occasions (EB Members, E11/87/3/NIE. WHO Archives Geneva).
During the 28th session of the Executive Board on May 29, 1961, Nigeria desig-
nated Dr C. M. Norman Williams to serve at the Executive Board. However,
with Norman Williams’s appointment as the Director of Health Services in
the African Regional oce in Brazaville, he was replaced by Dr O. B. Alakija.
On May 31 1966, Dr M. P. Otolorun was designated to serve on the Executive
Board with Dr A. O. Austen Peters as Alternate. While Dr S. I. Adesuyi and
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estudos internacionais • Belo Horizonte, ISSN 2317-773X, v. 11, n. 1, (fev. 2023), p. 47-64
Dr G. A. Ademolu were advisers, Dr Otolorun served on the Board consecu-
tively from 1966 to 1969. He resigned in May 1969 and was replaced by Dr S.
L. Adesuyi. In 1990 and 1994, Professor Olikoye Ransome Kuti was designa-
ted to serve on the Executive Board. The moderation of their words and their
measure of judgment has represented a contribution to the WHO. Moreover,
this was a great honour to Nigeria in particular and Africa in general.
Nigerians have also featured prominently on high-level appointments
in the WHO. In 1971, Professor Adeoye Lambo was appointed Assistant
Director-General of WHO (New Nigerian,1971). As the Assistant Director-
General, he was responsible for organising medical education and trai-
ning, health promotion and protection, pharmacology and toxicology. His
appointment crowned a very long relationship between WHO and Professor
Lambo. Before this period, he was either delivering a WHO sponsored lectu-
re, carrying out a WHO project or advising the organisation on an aspect of
health in Africa.Professor Adeoye Lambo was elevated to the post of Deputy
Director-General in 1973(New Nigerian, 1971).As the Deputy Director-
General he was the second-in-command of the WHO, where Dr Mahler was
the Director-General. Professor Adeoye Lambo, as the Deputy Director-
General, was the Secretary to the Executive Board and played a signicant
part in planning, programming and budgeting for a technical programme
in the area of infectious diseases, cancer, and mental health, among others.
Before 1971, some other Nigerians had been appointed by the WHO
to serve in dierent capacities at the regional and headquarter levels. For ins-
tance, Dr David Jackson Amah was appointed in 1966 as Regional Adviser
in Public Health at the WHO Regional Oce for Africa in Brazaville (Daily
Sketch, 1966). In 1969, Dr Otolorin was appointed WHO representative
for two African countries, Liberia and Sierra Leone (Morning Post, 1969).
Furthermore, Dr Okezie, the Federal Commissioner of Health, at the 24th
session of the World Health Assembly in Geneva in 1971 was unanimou-
sly elected President of the African Group for 1971/1972 (Federal Ministry
of Information, 1971).Besides, Dr Olatunji Adeniyi- Jones was appointed
in 1970 as Director of Health Services, WHO Regional Oce for Africa
(Morning Post,1970). In 1973, Dr Ayo Bruties was appointed a consultant
to the WHO to set up psychiatric service in developing countries (Daily
Times,1973). In 1983, Professor Oladipo Olujimi Akinkugbe was appointed
WHO consultant in Geneva to coordinate the WHO’s eort to mobilise
universities throughout the world for the WHO primary drive towards
health for all, human and social justice (Nigerian Herald, 1985).
Another notable Nigerian that contributed to the growth of WHO
was Professor Adetokunbo Lucas. His work with WHO began in 1965
when he became a member of the Expert Panel for Parasitic Diseases and
consultant and temporary adviser for the Regional Oces. He was the
pioneer Director of WHO Tropical Diseases Research (TDR) for a decade
from 1976 to 1986. His tenure as TDR Director witnessed marked impro-
vement in the ght against tropical diseases namelymalaria, leprosy, on-
chocerciasis and lymphatic lariasis. Clear evidence was the huge invest-
ment of about US $200 million to combat these diseases. (Lucas, 2010).
Another index of Nigeria’s contribution is the hosting of some of the
WHO essential conferences and events. Nigeria successfully hosted the 23rd
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Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
session of the Regional Committee meeting in 1973. Nigeria also took active
participation in the negotiation, formulation and revision of WHO policy
instruments notably the Alma Ata Declaration with particular focus on the
Primary Health Care in 1978, the International Code on the Marketing of
Breastmilk Substitutes, the Bamako Initiative, the Framework Convention
on Tobacco Control 2003 and the Revision of the International Health
Regulation in 2005 among others. Nigeria has used the WHO to serve its
foreign policy interest in the area of health. Nigerians have also chaired
important WHO conferences. For instance, on February 10 1983, General
Olusegun Obasanjo chaired an extraordinary meeting of experts in Medical
Sciences and Public Health dealing with the eects of nuclear war on man’s
health and total wellbeing in all cultures(Nigerian Herald, 1983).
Nigeria and the Commonwealth
Nigeria has used the Commonwealth in the pursuit of her foreign po-
licy objectives in the area of health.Nigeria benets tremendously from func-
tional cooperation for development amongst Commonwealth countries.
The Commonwealth of Nations has demonstrated a signicant commit-
ment to international health. The Secretariat enables the Commonwealth
Ministers of Health to meet annually at Geneva, before sessions of the World
Health Assembly to discuss current issues, review action on past decisions
and evolve conventional approaches as necessary to the signicant issues
before the Assembly. The Secretariat also arranges triennial meetings of the
Commonwealth Ministers of Health for extensive discussions on specic
health issues and delineating courses for the future (Larby; Hennam, 1993).
A good deal of endeavour is directed towards improving essential health
and medical services, clean water, disease prevention, and control and para-
medical use, particularly in small rural areas where facilities may be limited.
Since its establishment in 1965, the Commonwealth Secretariat has,
in response to the wishes of its members, introduced wide-ranging health
operations nanced through the Commonwealth Fund for Technical
Cooperation CFTC. The CFTC has been assistingin health development
activities through the General Assistance Programme, thereby making
available advisers, and medical ocers, (Commonwealth, 1983). The
Fellowship and Training Programmes of the Commonwealth provide
opportunities fornationalsfrom developing countries to undergo training
attachments, specialised courses, and study visits to selected centres.
The Academic Exchange Programme includes providing facilities
for teachers in medical schools to undergo short periods of training, pur-
sue specic objectives, participate in seminars and conferences, and stu-
dy tours.Every year, through the CFTC, the organisation provide over
650 technical experts and consultants who help develop the skills of over
4000 Commonwealth citizens in critical areas. As a developing country,
Nigeria contributes to this directly through the Technical Aid Corps
(TAC), and many expert advisers come from Nigeria.
Another central platform of health cooperation between Nigeria
and the Commonwealth is the Commonwealth Medical Association,
which is concerned with maintaining professional standards and ethics
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and is committed to providing continuing medical education program-
mes, including distance learning. Primary health care is one of the central
concerns of the Commonwealth Nurses Federation, which operates on a
regional rather than a pan Commonwealth scale. Nigeria is also member
of the West African Health Community.
Nigeria and the UNICEF
UNICEF was created in December 1946 to assist European chil-
dren facing famine and diseases. Its mandate was extended in 1953 to
become the United Nations Development Agency for Children. UNICEF
presence in Nigeria was established in 1953(ISKANDER, 1987). Since
then, Nigeria has beneted from its interventions in the area of child and
maternal health. UNICEF rst intervention in Nigeria focused on ende-
mic disease control like leprosy, yaws and malaria.It sponsored research
projects to understand the prevalence and causes of malnutrition bet-
ter. In collaboration with the University College London and the World
Health Organisation, UNICEF established a Department of Food Science
and Nutrition in the University of Ibadan. In 1954, a milk drying plant
supported by UNICEF Africa was approved for Nigeria to produce and
distribute dry milk for infants and young children.
UNICEF provided humanitarian assistance to the war-aected areas
during the Nigerian Civil War through the provision ofmilk, protein-rich
food, vitamins and medical supplies to meet the needs of about5.5 million
children and women in the aected areas. In 1970, UNICEF contributed
massively to relief reconstruction eorts. Besides, the UNICEF Executive
Board provided funds to the tune of $7 million for the rehabilitation of
schools and health centres and the expansion of children services. Another
programme was launched by the UNICEF in 1982 geared towards the elimi-
nationof common infections of early childhood using simple growth moni-
toring, oral rehydration therapy, breastfeeding and immunisation. UNICEF
also commenced HIV/AIDS-related activities in the mid-1990s. In 2012,
when the Boko Haram insurgency in the Northeast posed serious humani-
tarian challenges, UNICEFNigeria prioritised critical emergency assistance
and essential services for aected communities. UNICEF supported govern-
ment eortsto contain the spread of Ebola in 2014 through the deployment
of social mobilisers to educate the public on prevention measures.
COOPERATION WITH REGIONAL ORGANISATIONS
Nigeria and the European Union
The 1970s saw the emergence of Nigeria’s cooperation with the
European Union (EU). The main event was when Nigeria led the delega-
tion of 46 African, Caribbean and Pacic states (ACP) during the negotia-
tion with European Economic Community (now EU), which culminated
in the forming the ACP-EEC Lome Convention on February 28, 1975, in
Lome, Togo. The policy framework for EU Nigeria partnership has been
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Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
the 2000 Cotonou Agreement. Besides, the main instrument of EU assis-
tance is the European Development Fund. Interestingly, the social sector
remains one of the priority sectors of EDF with particular emphasis on
support for routine and polio immunisation campaigns, improved access
to clean water and sanitation and reinforce livelihoods and revenue gene-
ration in rural populations through food and nutrition security.
The European Union, WHO and UNICEF in tandem with Nigeria’s
government work assiduously to strengthen health systems and eradicate
polio. Illustratively, the Minister of Health Professor Isaac Adewole sig-
ned on February 16, 2017 a €70 million European Union grant to support
Nigeria’s health sector (WHO, 2017). The EU Fund supported Maternal,
Newborn and Child Health, Nigeria health systems and elimination of
polio virus in Nigeria. Similarly, the UNICEF disbursed €50 million of the
grant to the wards in Adamawa, Bauchi and Kebbi States to ensure that
by 2020, 80 per cent of them will have functional primary health care cen-
tres that would provide regular services to about three million children
under age ve years and almost a million pregnant women and lactating
mothers. The remaining € 20 million was disbursed through the WHO to
support health care systems’ strengthening towards achieving universal
health coverage in Anambra and Sokoto states and support polio eradica-
tion in Nigeria. The EU also provided support to immunisation governan-
ce in Nigeria between 2014 and 2018. The project aimed to improve routi-
ne immunisation, Maternal and Newborn and Child Health by protecting
children and their mothers from vaccine-preventable diseases.
Nigeria and the African Union
Since its establishment, the Acan Union (AU) has developed legal and
policy instruments to address public health problems in the region (Onvizu,
2012). Nigeria has been part of several initiatives introduced by the AU. For
instance, Nigeria has been involved in health ministerial-level dialogues and
other high prole meetings. Nigeria has supported of the AU activities in
Africa and the hosting of its important conferences and events. In April 2001,
Nigeria hosted the Summit of Heads of States of AU member states where the
Abuja Declaration on HIV/AIDS, Tuberculosis and other related infectious
Diseases was adopted. Some crucial milestones of such meetings include:
1. The Lome Declaration in 2000. The Declaration requested
increased collaboration with WHO and UNAIDS and the
Decision on Polio eradication in Africa
2. AU Assembly Declaration on Malaria, HIV/AIDS, Tuberculosis
and Other Infectious Diseases 2003. The Declaration urged
the international community to provide more funding to go-
vernments and institutions in Africa. It also requested govern-
ments and international agencies to enhance partnerships with
African nations to help build the capacity to manufacture aor-
dable drugs at local and regional levels.
3. African Health Strategy, 2007 – 2015, to scale up health systems
and promote international health partnerships in Africa later
revised as African Health Strategy 2016 – 2030.
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4. In 2007, the AU Conference of Ministers adopted the
Johannesburg Declaration on strengthening health systems for
equity and development.
5. In 2006, the AU adopted the Abuja call for accelerated action to-
wards universal access to HIV/AIDS, Tuberculosis and Malaria
services by 2010.
6. In 2010, the AU Summit in Kampala adopted Decisions on
NEPAD and Eight G8 Muskoka Initiative on Maternal Newborn
and under-ve Child Health.
In 2014, Nigeria dispatched its medical team as part of the African
Union Support to Ebola Outbreak in West Africa (ASEOWA). ASEOWA
was the African Union’s contribution to stopping the transmission of the
Ebola virus disease in Guinea, Liberia and Sierra Leone. Nigeria has also
worked in tandem with the African Union through its specialised health
agencies such as the African Centre of Disease Control to ght against
the deadly Covid-19 pandemic.
Nigeria and ECOWAS
Nigeria was a founding member of ECOWAS, the regional body cen-
tral to Nigeria’s foreign policy. ECOWAS promoted social progress and colla-
boration in the social eld as one of the community’s objectives (Anaemene,
2013). It was against this background that the West African Health
Organisation WAHO was established in 1987 as the specialised agency of
ECOWAS saddled to promote cooperation among its members in health.
Its mission is to attain the highest possible standard and protect the peoples’
health in the sub-region. WAHO supports ECOWAS member states’ capa-
city in preparedness and response to epidemics through the establishment
of national emergency management mechanisms for public health emer-
gencies. In 2018, WAHO organised a yellow fever simulation exercise in
Lagos in collaboration with the Nigeria Centre for Disease Control. WAHO
has contributed to health workforce harmonisation instrument, health se-
curity agenda, setting and building of quality and resilient health systems.
ECOWAS Health Ministershold regular formal meetings.In June 2017, the
ECOWAS Assembly of Health Ministers adopted the Regional Strategic
Plan on Non-communicable Diseases. In 2016, the Dakar Resolution on the
“One Health” Approach was adopted during the ministerial meeting on
Combating Zoonosis and Related Public Health Threats. Nigeria has also
collaborated with other ECOWAS member States in the containment of the
Covid-19 pandemic. For instance, Nigeria donated 67 million naira worth
of Personal Protective Equipment to aid the ght against the coronavirus
pandemic in Sao Tome and Principe (Ojeme, 2020).
NIGERIA´S BILATERAL HEALTH COOPERATION
Nigeria’s health cooperation with other countries has been establi-
shed mainly by signing health cooperation agreements, regular dialogue
mechanisms, high prole visits, and joint health programmes. Among
all the developed countries, the United States is particularly active in
59
Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
Nigeria’s health issues.To achieve its foreign assistance for health, the US
relies heavily on some signicant US government agencies and promi-
nent foundation nongovernmental organisations (Global Health Watch,
2007). The major US government agencies are the United States Agency
for International Development (USAID), the Centre for Disease Control
and Prevention (CDC), the Department of Defense (DoD) and the
National Institutes for Health (NIH).
Nigeria has received tremendous support from PEPFAR in its ght
against HIV/AIDS. The US – Nigeria partnership on HIV/AIDS began in
2004 through PEPFAR, and from 2004 to 2009, the US-supported HIV pre-
vention, treatment and care and support programmes to the tune of $1.5
billion. On August 25 2010, the Secretary to the Government of Federation
of Nigeria, Alhaji Mahmoud Yayale Ahmed, and Dr Robin Sanders, US
Ambassador to Nigeria, signed a memorandum of understanding approving
a partnership framework HIV/AIDS 2010-2015 (United States Diplomatic
Mission to Nigeria, 2010).The partnership framework was a strategic plan
for cooperation between Nigeria’s government and the United States go-
vernment, the US President’s Emergency Plan for HIV/AIDS Relief.
It is instructive to note that USAID has been supporting malaria
control eorts in Nigeria for more than a decade. The USAID malaria
funding level increased to about $7million annually in 2007 and 2008
and then to $16million in 2009 and 2010. Nigeria became a PMI focus
country in 2011, with initial funding of $43.5 million(President’s Malaria
Initiative, 2015). The funding has increased yearly from $60.1 million in
2012 to $73.3 million in 2013 and $75.0 million in 2014. PMI was rst im-
plemented in three states namely Cross River, Zamfara and Nasarrawa.
In 2012, PMI expanded to six more states and in 2013 to two more states
to make a total of 11 PMI focus states (Federal Ministry of Health, 2012).
In each of the states, PMI works with all the local government authorities
for 230Local Government Areas (LGAs) from eleven states.
Another health priority of the US government in Nigeria is polio
eradication. CDC and USAID are the major implementing agencies for
US global polio eorts, with CDC as the US lead agency. Some of the
activities provided by the CDC includetechnical and nancial support to
Nigeria for polio eradication and measles pre-elimination activities. Other
activities are campaign planning, monitoring and supervision, acute ac-
cid paralysis surveillance, outbreak investigations, nomad outreach, spe-
cial project research and data management support. In recent times, the
National Stop Transmission of Polio Programme was expanded to inclu-
de specialised sta and activities to improve routine immunisation servi-
ces across the northern states. The US government was instrumental in
resolving the polio immunisation boycott in Northern Nigeria in 2003.
The impact of the CDC’s activities is that there has not been a recorded
wild poliovirus in Nigeria since July 2014.
Aside from the United States, there are also many bilateral agen-
cies active in Nigeria’s health sector. These include the UK Department
forInternational Development (DFID), the Canadian International
Development Agency (CIDA), and the Japan International Cooperation
Agency (JICA). The DFID has supported the government’s eorts in
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transforming health systems, HIV/AIDS, routine immunisation and me-
dical aid. The major projects are Partnership for Transforming Health
Systems (PATHS), Partnership for Reviving Routine Immunisation in
Northern Nigeria (PRRINN), and Promoting Sexual and Reproductive
Health for HIV/AIDS Reduction (PSRHH).
The Canadian International Development Agency (CIDA) has provi-
ded fund for the technical and physical upgrading of the Schools of Health
Technology and Health Facilities. It also supported the Comprehensive
health sector reform and strengthening between 2005 and 2007. Others
include support for contraceptive commodities from 2005 to 2008; su-
pport to stop polio virus transmission, support to Routine Immunization
and the National Programme on Immunization (NPI) now NPHCDA
2003 to 2009 and support for Integrated Sexual and Reproductive Health
and Service Delivery in Nigeria.
The Japan International Cooperation Agency also provided support
for infectious Disease prevention for children through the UNICEF. JICA
also provided technical assistance to the Lagos State Government on
health reform matters, environmental sanitation and malaria control
from 2005 to 2008.
NIGERIA AND NON-ORGANISATION ORGANIZATIONS
Non-governmental organisations (NGOs) have also played crucial
roles in international health activities. Over the past two decades, Nigeria
has stepped up its eorts in cooperating with these organisations and
institutions and has attracted funds, technologies and pharmaceuticals
for its health sector. Nigeria maintains favourable cooperative ties with
many NGOs worldwide, including the Rockefeller Foundation, Rotary
International, Kellog Foundation, Bill and Melinda Gates Foundation,
CARE, OXFAM, and Save the Children among others. Still, a few have
important overseas missions in Nigeria and are critical to emergency re-
lief, health care delivery and infrastructure development in many coun-
tries. The past two decades have witnessed an increase in global funding
by these foundations. One major foundation supporting Nigeria’s health
sector is Bill and Melinda Gates Foundation. Nigeria is a relevant focus
country for the Gates Foundation, which provides more than $400mil-
lion in funding to partner organisations operating health and develop-
ment programmes (GATES FOUNDATION, 2012).One example of the
Gate’s Foundation eorts to build eective partnerships in Nigeria is
its support for eradicating polio through international bodies such as
the World Health Organisation (WHO), United Nations International
Children Education Fund (UNICEF), Rotary International and the World
Bank. In partnership with all stakeholders, Gate’s Foundation is commit-
ted to implementing the National Polio Eradication Emergency Plan.
Other examples include grants to the Society for Family Health to im-
prove care for newborns and pregnant women in various communities
in Northeast Nigeria. Save the Children nongovernmental organisation
has been working in Nigeria since 2001 to improve health systems and
deliver maternal, newborn, and child health services, including reviving
61
Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
routine immunisation. In 2014, it protected12,662 children from harm,
provided 693,156 children with a healthy start in life, helped 2,791 fami-
lies feed their children and gave 4,409,772 children vital nourishment
(SAVE THE CHILDREN, 2023).
CHALLENGES FACING THE PRACTICE OF HEALTH DIPLOMACY
IN NIGERIA
Despite its many positive sides, there are indications that Nigeria’s
health diplomacy has not been fully maximised. It has been aected by
several factors. Nigeria is lagging behind in terms of health diplomacy par-
ticularly in formulating a country strategy on health diplomacy. This is
not unconnected to the diculties encountered in maintaining health as
a foreign policy issue. Scholars have accused foreign policymakers of com-
placency. This is because foreign policy makers engage with healthonly
during health emergencies. Still, as the crisis passes, attention shifts away
from the protection of public health and disease prevention. The threats po-
sed by emerging infectious diseases such as HIV/AIDS, Ebola and Covid-19,
among others, are now a cause for concern. Therefore, it is imperative for
states, including Nigeria, to work together in the ght against these deadly
diseases as they respect no national boundaries. Diplomacy, with its power
of negotiation, will become a critical element in this process.
Nigeria, as a developing country, has mostly been the recipient of
development assistance, including health. It has also relied on such support
to advance domestic health status. Nigeria must overcome the challenges
associated with development assistance for health, such as disease and mis-
match, with its priorities. Nigeria can maximise its gains from development
assistance for health if it takes leadership in coordinating health activities in
the country within a comprehensive national health plan. Nigeria should
ensure that donors align their contributions with national policies through
a donor mapping study and a systematic costing of the health sector strate-
gic plan. Each year all donors should liaise regularly with the government
to evaluate progress made and plan for future activities.
Available evidence shows that Nigerian diplomats and foreign policy
experts lack the requisite training and orientation to meet the diplomatic rea-
lities and challenges of the present global age. Indeed, the current training of
career foreign service and health professionals in the eld does not emphasise
health diplomats’ professionalisation. The Foreign Service Academy, which
was established in the early 1980s, only served the training needs of sta ne-
wly recruited into the service. Aside from this, the Nigerian Foreign Service
Academy has not integrated global health issues into its curriculum. Nigeria
should take a cue from other countries such as the United States National
Foreign Aairs Training Centre/Foreign Service Institute. They have, over
the years, integrated global health issues in their training curriculum. Nigeria
should provide public health professionals and diplomats with the practical
tools they need to recognise and manage their health diplomacy roles.
As a matter of fact Nigerian missions abroad attach more importance
to cultural, economic, military and trade Attaches, they do not have health
Attaches. This shows that the country does not pay requisite attention to
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bilateral health issues. Nigeria puts minimal eorts into developing pro-
tective frameworks to forestall global health threats in the future. In 2014
alone, the United States Department of Health and Human Services had
commissioned nine health attaches in 13 countries. Nigeria must begin to
explore new diplomatic paradigms and give a boost to health attaches. This
is particularly important when it comes to controlling the spread of disea-
ses like Covid-19. One of the challenges is the lack of political communica-
tion channels. Essentially, a new type of health diplomat is needed to better
harness and rationalise information to frequently equip decision-makers
with vital data and furnish plausible preparedness strategies.
Again, institutional pluralism and divided responsibilities in the
conduct of external relations have also aected Nigeria’s health diploma-
cy. It has been argued that the only Ministry which is by nature and res-
ponsibility best equipped for this is the Ministry of Foreign Aairs. This is
because the interests represented by the Ministry abroad are the totality
of Nigerian interests, whether in health, agriculture, nancial, economic
and military elds. The relationship between the foreign ministry and
other home ministries has been characterised by a personality conict,
rivalries and petty jealousies. Apparently, there is the absence of a focal
point for the coordination of the activities of the Ministry of Foreign
Aairs’ with those home ministries where external relations are concer-
ned, particularly the Ministry of health. As a corollary, inter-ministerial
meetings are often ad-hoc in nature, and participation rarely includes the
ministers themselves. Besides, enquiries and communications between
the foreign aairs Ministry and other ministries were often left unatten-
ded even on critical health relations issues with other countries or inter-
national organisations. Thus, to enhance the Ministry of Foreign Aairs’
capacity to perform this coordinating role, it is imperative to strengthen
further the Ministry’s in-house institutional and human resource capa-
city, particularly in international health cooperation and development.
CONCLUSION
This article has shown that health serves as an eective instru-
ment in supporting Nigeria’s foreign policy.The importance of health in
Nigeria’s foreign policy has been demonstrated in its bilateral and multi-
lateral relations. Besides, health meetings with high prole Nigerian lea-
ders have become more frequent. Foreign policy tools like negotiation
and lobbying have been utilised in the health sector to facilitatehealth
development.Nigeria has used health to promote its national interest.
Nigeria has an opportunity to improve the health and welfare of coun-
tries in the global south especially Africa. This is imperative as a strong
committed engagement in global health strategy is good foreign policy.
Thus, generating goodwill among other countries will likely make them
cooperate with Nigeria on other important bilateral issues. However,
Nigeria should endeavour to address the various challenges confronting
the practice of health diplomacy such as institutional pluralism, divided
responsibilities and non-professionalisation of health diplomats, which
have marred the conduct of Nigeria’s health diplomacy.
63
Benjamin Anaemene Interrogang the Health - Foreign Policy Nexus: The Nigerian Experience
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