STRENGTHENING BORDER HEALTH SYSTEMS IN NIGERIA: CORE CAPACITY REQUIREMENTS AND IMPLEMENTATION CHALLENGES AT GROUND CROSSINGS IN KWARA, LAGOS, AND KANO STATES

Abstract

Despite significant policy commitments to International Health Regulations (IHR, 2005) compliance, Nigeria's land 
border health systems continue to face profound structural and operational deficits that limit their capacity to detect, 
contain, and respond to public health threats. Core capacity gaps encompassing trained personnel, functional 
equipment, disease-specific infrastructure, communication systems, and inter-agency coordination have been 
persistently identified at Nigerian ground crossings, yet remain inadequately documented at the sub-national level. 
This study assessed the core capacity requirements for preparedness and response to disease outbreaks and evaluated 
the implementation challenges of exit and entry screening at selected land borders in Lagos (Seme), Kwara 
(Chikanda), and Kano (Jibiya) States, Nigeria. A descriptive cross-sectional mixed-methods study was conducted 
among 203 port health officers and border health personnel at the three selected ground crossings. Quantitative data 
were collected using structured questionnaires and analyzed using descriptive statistics and chi-square tests. 
Qualitative data were obtained through Focus Group Discussions (FGDs) with 6–10 purposively selected 
participants per site and subjected to thematic analysis. An observational checklist was also employed to corroborate 
quantitative findings. Findings revealed critical deficiencies in core capacities across all three states. Only 38.4% of 
respondents confirmed availability of trained staff, while functional equipment was reported by 48.3%. Reliable 
communication systems showed the strongest availability at 60.6%, followed by disease-specific infrastructure 
(56.2%) and staff adequacy (61.6%). Chi-square analysis demonstrated statistically significant associations between 
preparedness levels and training received (p < 0.001), equipment availability (p < 0.003), staff adequacy (p < 0.003), 
and communication systems (p < 0.014). Qualitative themes identified persistent implementation challenges 
including funding shortfalls, inter-agency coordination failures, inadequate infrastructure, high informal border 
traffic, and insufficient simulation exercises. Core capacity requirements at Nigerian land borders remain 
substantially below IHR (2005) minimum standards. Addressing implementation challenges requires sustained 
investment in workforce development, infrastructure upgrading, inter-agency coordination mechanisms, and 
standardized protocols to strengthen outbreak preparedness and response at ground crossings.