where we work
Millions will be spared future suffering thanks to collaborative efforts of The Carter Center and Nigeria's Federal Ministry of Health to address widespread neglected diseases such as Guinea worm, lymphatic filariasis, schistosomiasis, river blindness, trachoma, and malaria. The Center also has assisted efforts to build democracy and peace in this, Africa's most populous nation.
For all but 10 years between its independence from Great Britain in 1960 and its historic presidential election in 1999, Nigeria was under military rule. For three decades, the country suffered from unfettered corruption and ethnic violence. After the death of dictator Gen. l Sani Abacha in June 1998, Gen. Abdulsalami Abubakar rose to power and instituted democratic reforms. He legalized political parties, political prisoners were released, and the press operated unhindered. The Carter Center observed elections in Nigeria in February 1999.
Since 2013, under the banner of the Mobilizing Faith for Women and Girls Initiative, The Carter Center has partnered with Christian and Muslim networks in Nigeria and trained religious and traditional leaders on human rights-based approaches, tools, and strategies to advance gender equality.
After the death of dictator Gen. Sani Abacha in June 1998, Gen. Abdulsalami Abubakar rose to power and instituted democratic reforms. He legalized political parties, political prisoners were released, and the press operated unhindered. The Carter Center was invited to observe elections called for February 1999.
The Carter Center and its partner, the National Democratic Institute for International Affairs (NDI), observed voting on Feb. 20, 1999, for National Assembly members. Observers, led by former U.S. President Jimmy Carter, saw a low turnout and serious irregularities nationwide, including ballot stuffing, inflation of results, and voter intimidation.
President Carter was joined by retired U.S. Army Gen. Colin Powell and former Niger President Mahamane Ousmane to lead a 66-member delegation to observe the Feb. 27, 1999, presidential election. The Center and NDI again found serious irregularities. President Carter sent a letter to the election commission asserting the Center could not verify the outcome of the election because of the seriousness of the flaws observed. Nevertheless, former Gen. Olusegun Obasanjo was later sworn in as president.
The Center and NDI again called for significant changes in electoral preparations for the 2003 presidential election. After a pre-election mission in March 2003, NDI and the Center called on Nigeria's election commission to put the voter register out for public review, publicize the number of registered voters, inform citizens how to acquire a voter card, and simplify the process for accrediting election observers. In addition, the government was urged to establish a national security plan for the elections. Nigeria's pre-election period was marked by violence, including the assassination of candidates and political activists, and the Center did not observe the April 2003 election.
Because a free press is vital to a strong democracy, The Carter Center arranged professional training workshops in 1999 for print and broadcast reporters in Nigeria covering the elections and political issues. Workshops focused on such topics as story structure, the media's role in free and fair elections, and how to deal with censorship and government interference. The project was a collaborative effort of the U.S. Information Service's Democracy and Governance Program, the Nigerian nongovernmental organization Media Rights Agenda, The Carter Center, and the DeWitt Wallace Center at Duke University in North Carolina.
To promote peace and democracy, The Carter Center often speaks out against human rights violations. In November 1995, President Carter wrote to Nigeria Head of State Gen. Sani Abacha to express his "profound dismay and shock" at the execution of nine environmental and minority rights advocates, including Ken Saro-Wiwa. President Carter called on Gen. Abacha to "release all other prisoners detained or convicted on the basis of the peaceful expression of their beliefs, to commute the sentences of other detainees facing capital punishment on politically inspired grounds, and to give full effect to the rule of law in Nigeria."
A letter also was sent to the secretary-general of the Commonwealth of Nations stating that the executions raised "serious questions as to Nigeria's continued good standing with the international community."
President Carter visited the Niger River Delta in February 1999 to meet with activists, who had grown more confrontational in protesting policies and practices of the government and major oil companies operating in the area.
After meetings with Ijaw Youth Council representatives and elders from the Ijaw, Urhobo, Isoko, Ogoni, and Itsekiri peoples, President Carter recommended consideration of several options. They included initiating a dialogue with representatives chosen by the Delta people themselves and establishing a clearer federal oil revenue-sharing formula to allow local and state officials in the Delta region to administer oil revenues for new roads and other projects. He also suggested that a social development trust fund be administered privately with local participation to support more such projects.
Nigeria has one of the highest burdens of disease in Africa. In 1988, the government of Nigeria invited The Carter Center to begin Guinea worm eradication programming in the nation. Subsequently, The Carter Center established six more health programs there. Even with its successes against Guinea worm and trachoma, Nigeria is still the Carter Center’s largest neglected tropical disease (NTD) partner country; the Center operates in nine states and targets four diseases there. Nigeria has the highest at-risk population for river blindness (onchocerciasis) in the world, the second highest for lymphatic filariasis (behind India), the highest for schistosomiasis, and the fourth highest for soil-transmitted helminths (behind India, Indonesia, and Bangladesh). The states where The Carter Center fights these diseases are Abia, Anambra, Delta, Ebonyi, Edo, Enugu, Imo, Nasarawa, and Plateau. Working with the Federal Ministry of Health as well as state and local governments, the Center supports tens of millions of mass drug administration (MDA) treatments each year, along with health education and disease impact assessments. USAID and RTI are key partners in this work, supporting Carter Center Nigeria programming through Act to End NTDs | East.
Current Status: Transmission stopped, November 2008 ()
Certification of Dracunculiasis Elimination: 2013
Since 1988, the Carter Center's Guinea Worm Eradication Program has worked with the Nigeria Federal Ministry of Health to spare thousands of people suffering from this devastating disease.
In collaboration with Nigeria's Federal Ministry of Health, the strategy for elimination consisted of several components, driven by health education. The goal was to change behavior and mobilize communities to improve the safety of their local water sources.
Approaches introduced to communities included health education and nylon filter distribution; treating stagnant ponds monthly with safe ABATE® larvicide (donated by BASF); voluntary isolation and care of patients in case containment centers; direct advocacy with water organizations; and increased efforts to build safer hand-dug wells. The program also trained and supervised village volunteers to carry out monthly surveillance and interventions.
In 2000, the government of Nigeria released more than 5 billion naira (approximately $50 million) for safe water to rural communities, with priority attention given to Guinea worm-endemic villages.
By November 2008, incidence of the disease had been reduced by more than 99 percent, with 38 indigenous cases reported, and all cases were contained. In December 2009, with 13 consecutive months of zero cases, Nigeria was provisionally determined to have broken Guinea worm transmission.
The Carter Center’s Nigeria River Blindness Elimination Program has assisted in the largest number of Mectizan® treatments of any Carter Center effort, cumulatively over 200 million. The program strives to stop river blindness transmission via mass drug administration with Mectizan® (donated by Merck & Co., Inc.) and health education. The program also provides support to the Nigeria Onchocerciasis Elimination Committee (NOEC), which meets annually and includes representatives from the Federal Ministry of Health (FMOH), the World Health Organization, and the U.S. Centers for Disease Control and Prevention. The NOEC makes key recommendations to the ministry and has a classification system to identify each state’s progress toward the goal of elimination. This system also determines whether a state should treat once or twice per year.
As of mid-2021, the Federal Ministry of Health had eliminated transmission of river blindness in two of the nine Carter Center-assisted states, Plateau and Nasarawa, protecting about 2 million people. Delta state interrupted transmission of river blindness, allowing it to stop MDA for another 2 million residents; Delta thus entered three years of post-treatment surveillance that will conclude with an entomology assessment to determine if it too can move to “transmission eliminated” status. Transmission interruption is suspected in Ebonyi state, while the other five states the Center assists have ongoing transmission. Upcoming assessments will help to reclassify these states as they progress toward the goal of elimination.
Two states in Nigeria, Plateau and Nasarawa, eliminated trachoma as a public health problem in 2018. Since these states already supported Guinea worm eradication, lymphatic filariasis elimination, and control efforts for river blindness and schistosomiasis, the integration of trachoma control in these two states was a logical next step and began in 2003.
The Carter Center's Trachoma Control Program in Plateau and Nasarawa states focused on health education targeting those at highest risk of infection, primarily children and women in rural communities; promotion of household latrines to eliminate the breeding ground of eye-seeking flies; and mass distribution of antibiotics to treat active infections.
Health education activities are conducted through school-based programs, and mobilization for trachoma control is performed in communities, marketplaces, churches, and mosques. The national program uses television and radio as its mass media outlets. Health education and mobilization are conducted by trained community-based health workers, including village volunteers. To increase the coverage of household sanitation, The Carter Center assisted the federal Ministry of Health to promote household latrine construction in rural communities.
In 2010, in partnership with the Ministry of Health and Sightsavers, the first mass treatment of blinding trachoma with azithromycin (Zithromax®, donated by Pfizer Inc.) was distributed in 10 local government areas in five states, including Plateau and Nasawara.
After three rounds of mass drug administration, in accordance with World Health Organization guidelines, community-based impact surveys were conducted in April and May 2014 in all accessible areas. The results of the surveys showed significant decreases in active trachoma from the baseline surveys conducted in 2007 and 2008. The Carter Center achieved its goal to significantly reduce active trachoma in Plateau and Nasarawa states. Due to this success, the Carter Center's Trachoma Control Program ended its assistance to the national program in both states in May 2015.
The Carter Center Lymphatic Filariasis Elimination Program targets elimination as a public health problem via combined annual treatment with Mectizan (donated by Merck & Co., Inc.) and albendazole (donated by GSK). Plateau and Nasarawa states declared elimination of LF as a public health problem in 2017. With support from Izumi Foundation, the focus of the Center’s program in those states has now shifted to the care of persons still suffering the lingering effects of the disease, and working to strengthen primary care support and referral networks for management of lymphedema and hydrocele surgery, as well as mental health needs (in “Hope Club” support groups).
The Center’s seven other assisted states continue to focus on mass drug administration (MDA), while more and more districts within those states, after five or more years of good treatment coverage, conduct assessments to determine whether transmission of lymphatic filariasis has been interrupted.
Carter Center-supported LF work is also linked with the global malaria effort to distribute long-lasting insecticidal nets (LLINs) in keeping with Nigeria’s national policy of co-implementation of malaria and LF programs.
In partnership with Nigerian health authorities, the Carter Center works to help control schistosomiasis in nine states. Unlike the river blindness and lymphatic filariasis elimination programs that use mass drug administration (MDA) to all eligible persons to interrupt transmission, the schistosomiasis program takes a control approach, using MDA to reduce disease manifestations associated with the infection. Treatments with praziquantel (donated by Merck KGaA) are given exclusively to children and are largely delivered in schools.
A recent impact survey saw reductions of schistosomiasis in Plateau and Nasarawa states, but MDA is still needed. With support from generous donors, The Carter Center delivers treatments that protect millions of children each year.
More deaths from malaria occur in Nigeria than in any other country; approximately one-third of the estimated 660,000 children who die annually from malaria worldwide are Nigerian.
In 2010, Nigeria launched the largest long-lasting insecticidal net distribution effort in history, with the goal of providing two nets to each household in the country. The Carter Center is a part of this epic activity, focusing efforts on the nine Nigerian states where The Carter Center has supported neglected disease control and elimination programs (lymphatic filariasis, river blindness, trachoma, and schistosomiasis). Since the same mosquito transmits both malaria and lymphatic filariasis in Africa, the distribution of bed nets — paired with health education — helps prevent both diseases at once.
In 2012, The Carter Center and its partners celebrated the distribution of 3.4 million of insecticide-treated bed nets for malaria control, the Center's largest amount in Nigeria to date. Previously, the Center had distributed more than 4.3 million bed nets in Nigeria from 2004 to 2011. As a result of the national program's dramatic scale-up, a Carter Center-supported survey found that the number of Nigerian households with at least two nets has increased from 34 percent in 2010 to 74 percent in 2012.
In addition, The Carter Center has developed and helped implement an innovative set of community-based interventions, including health education materials and continuous net distribution strategies, to increase and sustain the appropriate use of bed nets distributed to reduce transmission of both malaria and lymphatic filariasis.
With support from The Carter Center, the Nigeria Federal Ministry of Health recently issued a detailed set of co-implementation guidelines for a new effort to eliminate malaria and lymphatic filariasis. The first articulated guidelines of the kind in Africa, the plan takes advantage of shared interventions to tackle both diseases such as health education, distribution of long-lasting insecticidal bed nets, and mass drug administration.
Insecticide-Treated Nets (ITNs)/Long-Lasting Insecticidal Nets (LLINs) Distributed in Ethiopia and Nigeria with Assistance from The Carter Center, 2004–2012
The Carter Center along with the Nigeria Federal Ministry of Health launched the Nigeria Public Health Training Initiative in 2017 to improve the training of health professionals who work directly with women and children. The initiative focused on improving the learning environment of adult students and midcareer professionals such as nurses and midwives in select institutions across six states (Akwa Ibom, Gombe, Imo, Ogun, Plateau and Sokoto).
The Nigeria Public Health Training Initiative successfully transitioned to state ownership in 2020. At its transition, over 180 faculty members had received training to improve their teaching skills, more than 14,000 items such as furniture, laboratory equipment, classroom accessories, information and communication technology equipment, books and reference materials were supplied to health training institutions, and four training curricula for nurses, midwives, community health extension workers and junior community health extension workers were updated and adapted to the health needs of local communities.
Working hand in hand with Nigeria's Federal Ministry of Agriculture, The Carter Center, in partnership with the Sasakawa Africa Association, assisted Nigerian farmers in nine states with agricultural production starting in 1993. The program provided farmers with credit for fertilizers and enhanced seeds to grow test plots, which often yielded 200 to 400 percent more crops than more traditional methods. Participating farmers went on to teach others, creating a ripple effect to stimulate self-sufficiency.
The program was part of a larger partnership led by Nobel Peace Prize winner Dr. Norman Borlaug that helped over 8 million small-scale sub-Saharan African farmers in countries where malnutrition is a constant threat.
The Carter Center ended its agricultural activities in Nigeria in 2011.
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