* 771 of 774 LGAs endemic as over 100m Nigerians remain at risk
* Regulatory bottlenecks to free medicines could derail 2030 targets, experts say
* Calls grow for stronger PHC integration, domestic funding, ‘whole-of-govt’ push
* Insecurity, donor exits slow field assessments despite progress
* WHO figures show Nigeria bears 25% of global NTD burden, 50% of Africa’s
As countries mark the 2026 World Neglected Tropical Diseases Day (NTDs), Nigeria’s campaign to eliminate the diseases is at a crossroads.
After years of steady progress that include Guinea worm eradication and major reductions in trachoma and lymphatic filariasis, donor exits, insecurity, and restrictive import policies are now threatening to reverse hard-won gains.
While life-saving medicines are donated free of charge, regulatory bottlenecks and a lack of domestic funding are creating artificial shortages.
At the same time, poor Primary Health Care integration, insecurity in endemic areas, and dwindling international support are exposing the fragility of Nigeria’s NTD response.
With over 100 million Nigerians still at risk and 771 of 774 LGAs affected according to official records, experts warn that unless the government urgently increases funding, fixes medicine supply systems, and embeds NTD services into routine healthcare, the country may miss its 2030 elimination targets, and millions of vulnerable Nigerians will continue to suffer preventable disability and poverty.
Nigeria remains one of the highest-burden NTD countries globally, with multiple diseases co-endemic across many states, especially in communities affected by poverty, inadequate WASH (water, sanitation, and hygiene) services, and weak access to primary healthcare.
Available statistics show that of the 21 NTDs listed by the World Health Organisation (WHO), 15 are endemic in Nigeria, while all 36 states and the Federal Capital Territory are endemic for at least one NTD.
NTDs are a group of 21 communicable and non-communicable diseases that primarily affect rural poor and disadvantaged urban populations. These vulnerable groups often lack access to safe water, adequate sanitation, and decent housing. Most significantly, poverty remains the underlying driver of NTD prevalence.
Some of the most common NTDs in Nigeria include lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, and trachoma. These are managed through preventive chemotherapy, mainly via mass administration of medicines.
Although Guinea worm has been eliminated in Nigeria, yaws has resurfaced, which was initially eliminated in 1945.
Based on the national master plan costing, about N8.6 billion is required to effectively tackle NTDs in the country.
Some partners, including Research Triangle International, have exited Nigeria following the U.S. funding cuts.
Nigeria accounts for 25 per cent of the global NTD burden and 50 per cent of Africa’s burden. According to the WHO, about 1.6 billion people worldwide are affected by NTDs, while more than 100 million Nigerians are at risk of at least one of the diseases.
NTDs are predominantly found in poor rural communities, especially in areas without a safe water supply, poor sanitation, substandard housing, and visible poverty.
Findings show that some medicines — including Mebendazole (all strengths and dosage forms), Albendazole and Praziquantel (all strengths), which are drugs of choice for treating intestinal worms — are listed in the National Agency for Food and Drug Administration and Control (NAFDAC) Ceiling List of products prohibited from importation into Nigeria, published in November 2021.
The Ceiling List aims to prevent the importation of pharmaceutical products that domestic manufacturers can produce locally.
World NTD Day is observed on January 30 each year to raise awareness of the 21 diseases that affect more than one billion people in the world’s poorest populations.
Recognised by the World Health Assembly in 2021, the day seeks to highlight the impact of NTDs, advocate for better, more equitable care, and promote global action, funding, and collaboration to control, eliminate, and ultimately eradicate the diseases.
Experts emphasised the need to address medicine stock-outs, prioritise NTDs, and increase domestic funding to enable the country to meet the 2030 NTD elimination target.
They urged relevant stakeholders at the federal, state, and local government levels, as well as communities, to unite, act, and eliminate NTDs, warning that the war against poverty and inequality will not end until the diseases are defeated.
Why routine care, funding gaps threaten NTD elimination
Speaking with The Guardian, Chairperson of the International Federation of Anti-Leprosy Associations and National Director of The Leprosy Mission Nigeria, Dr Sunday Udo, noted that beyond the “mass-treatment” NTDs, Nigeria continues to record a significant burden from case-managed NTDs, notably leprosy, Buruli ulcer, and other skin NTDs, where elimination depends heavily on early diagnosis, stigma reduction, and strong routine services.
He observed that for several preventive-chemotherapy NTDs, including lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, and trachoma, medicines are often donated to communities through mass drug administration campaigns.
Udo said that for case management, NTDs such as leprosy complications, hydrocele, and lymphedema care for lymphatic filariasis; trachoma surgery; and snakebite, patients may still face out-of-pocket costs for transport, diagnostics, wound supplies, surgery, and long-term follow-up.
He emphasised that a realistic path to the 2030 elimination target requires a “whole-of-government, whole-of-society” approach, stressing the need to increase predictable domestic financing at both federal and state levels, with dedicated NTD budget lines.
Udo also called for integrating NTD services into Primary Health Care to support Universal Health Coverage, noting that routine diagnosis, referral, morbidity management, and surveillance must become part of everyday services, not just campaign-based activities.
He said that in 2024, Nigeria experienced a serious delay and shortage of leprosy multi-drug therapy (MDT) linked to regulatory and bureaucratic bottlenecks, which disrupted treatment, adding that the situation risks recurring as the 2025 drugs have yet to be received.
Udo further observed that NTD programmes rely heavily on partner support, and that sudden donor cuts can disrupt community delivery and supply chains.
He said: “Insecurity, displacement, and difficult terrain reduce campaign coverage and continuity of surveillance. There is weak routine health system integration, and NTDs still depend largely on campaign mode, whereas elimination requires strong routine Primary Health Care, laboratory support, referral systems, and community health worker networks.
“Without sustained water and sanitation improvements, reinfection continues, especially for intestinal worms, schistosomiasis, and trachoma-related risks. Stigma and late presentation, particularly for skin NTDs such as leprosy, delay care-seeking, increase disability risk, and undermine contact management.”
Udo noted that The Leprosy Mission Nigeria remains a critical partner in the country’s NTD response, with support including community-based case finding and referral, especially for skin NTDs such as leprosy, to reduce delays and disability.
He urged the government to address insecurity with context-appropriate delivery strategies, strengthen surveillance for more sensitive case detection, improve laboratory support where needed, and ensure rapid response to hotspots.
He also appealed to authorities to de-risk access to medicine by simplifying and strengthening supply systems, noting that the MDT disruption illustrates the damage that such bottlenecks can cause.
Insecurity, donor exits slow progress despite gains
In an interview with The Guardian, Sightsavers Country Director, Prof. Joy Shu’aibu, said Nigeria is home to about 25 per cent of the global burden of Neglected Tropical Diseases and accounts for an estimated 50 per cent of Africa’s NTD burden, adding that one in every three Nigerians is affected by at least one NTD, according to the World Health Organisation.
She noted that NTDs are driven by several factors, including poor hygiene and sanitation, poverty, inadequate or lack of access to safe drinking water, environmental changes, vector abundance, and poor awareness, especially among underserved populations, all of which contribute to their spread.
Shu’aibu observed that from a control and preventive care perspective, NTD treatments are largely available and affordable. She explained that mass administration of medicines campaigns are conducted annually, biannually, or more frequently, where applicable, by community drug distributors across the country at no cost to beneficiaries.
However, the Country Director pointed out that persistent insecurity and hostile environments affect the delivery of quality, effective, and efficient programme implementation, adding that this has seriously slowed progress.
She said: “For the past four years, we have been exploring the safest ways to conduct assessments in 14 LGAs in Zamfara to enable the country to make decisions on stopping long-term treatment for elephantiasis in the state, but this has not been feasible due to the volatile security situation.
“In Imo State, the NTD programme had to wait for more than five years before completing assessments in December 2025. New government policies and restrictions on the importation of donated NTD medicines also have far-reaching implications for sustaining gains towards eliminating NTDs in Nigeria.”
According to her, other challenges include inadequate commitment and programme ownership by government and communities, dwindling donor funding for NTDs, especially following recent USAID cuts, and high attrition of health workers in some states, which continues to affect programme delivery.
She said Nigeria has made significant progress towards eliminating NTDs, noting that Guinea worm has been eradicated in the country, while five other diseases: river blindness, trachoma, bilharzia, intestinal worms, and elephantiasis are targeted for elimination by 2030.
Shu’aibu explained that Nasarawa and Plateau states have eliminated river blindness, while 11 other states have reached the WHO and national thresholds for interruption of transmission. She added that the remaining 23 states and the Federal Capital Territory are making steady progress towards the elimination goal.
She further noted that the country is moving closer to eliminating lymphatic filariasis, with 434 out of 583 endemic local government areas having interrupted transmission. She added that trachoma campaigns have scaled down from more than 129 LGAs to fewer than 20 across the most endemic states.
Shu’aibu expressed optimism that by 2030, Nigeria will be among the countries that would have stopped treatment in more than 90 per cent of their at-risk populations for trachoma, lymphatic filariasis, bilharzia, and intestinal worms.
NAFDAC import rules stall access to free medicines
On his part, the National Coordinator for NTDs at the Federal Ministry of Health and Social Welfare, Dr Fatai Oyediran, told The Guardian that controlling the diseases is critical to achieving Sustainable Development Goal 3 and breaking the cycle of disease-driven poverty nationwide.
He said: “We also noticed that Nigerians who are at risk or exposed number over 100 million. To worsen the situation, there is what we call co-endemicity; the existence of more than one disease in a single person.”
Oyediran explained that the diseases are classified as neglected because they receive less attention compared with HIV, malaria, and Ebola, adding that NTDs often progress slowly, with many eventually leading to one form of deformity or another.
Decrying the myths and misconceptions surrounding NTDs, he said: “Some people believe that enlarged legs, breasts, or scrotum are inflicted by witches, or that someone you offended caused it. Whereas elephantiasis is caused by mosquitoes and river blindness by blackflies, some people still say it is witchcraft. All these misconceptions also affect how these diseases spread.”
Oyediran stated that although manufacturers such as Pfizer and Johnson & Johnson donate NTD medicines in large quantities to Nigeria, NAFDAC’s insistence that the drugs be sourced locally poses serious challenges to programme implementation, as there are no budgetary provisions for local procurement.
He disclosed that the ministry is seeking a three-year moratorium to allow continued importation of the medicines until the 2030 elimination target, while efforts are made to include them in government budgets and gradually transition to local content.
He said: “One of the challenges we are facing is the NAFDAC ceiling policy, which prohibits the importation of some commodities, including Mebendazole, Albendazole, and Praziquantel (all strengths), which are medicines of choice for treating intestinal worms.
NAFDAC is saying the government should prioritise buying them locally. We are not opposed to promoting the government’s local content policy, but we do not have funding to procure it locally. That is a big challenge, and it is affecting implementation.
“These medicines are donated, not procured. There is a waiver from the Federal Ministry of Finance, but the permit for them to come in is what is giving us problems. NAFDAC is saying the government should prioritise local purchase. Again, we are not against local content, but we don’t have the funding, and this is affecting programme delivery.”
He added: “We are going to have another meeting, probably this week, with stakeholders, including the Manufacturers Association of Nigeria and pharmaceutical companies. Some of them are pushing for the stoppage of these commodities so they can sell their own products. The question we are asking is whether they will also be able to provide them free, as other counterparts have done.”
Oyediran highlighted progress made by Nigeria in controlling onchocerciasis, trachoma, and other NTDs, acknowledging strong support from international partners such as Sightsavers, Reaching the Last Mile, and other development organisations.
He noted that more than 30 million Nigerians have been removed from NTD treatment programmes out of an initial 91 million treated nationwide, reflecting significant progress in disease control and management.
Oyediran also said about 39.5 million people have been cleared from lymphatic filariasis treatment lists, reducing the population at risk, adding that Nigeria has achieved an 84 per cent reduction in trachoma cases.
He stated that the country now serves as a model for other nations battling neglected tropical diseases globally.
