Comprehensive Review: Governance of Antimicrobial Resistance in Nigerian Healthcare Settings

The governance of antimicrobial resistance (AMR) in Nigeria represents a critical intersection of public health urgency, systemic challenges, and emerging leadership within global health security. This comprehensive review examines the current state of AMR governance in Nigerian healthcare settings, analyzing the institutional frameworks, policy responses, implementation challenges, and innovative approaches that characterize Nigeria's national response. With a staggering burden of 64,500 direct AMR-attributed deaths in 2021 and associated economic losses including a 7% reduction in GDP and an 11% decline in livestock productivity, Nigeria's governance response has significant implications for both national development and global health security . This review synthesizes evidence from policy documents, institutional reports, and research studies to analyze Nigeria's evolving governance architecture, particularly in light of its upcoming role as host of the 5th Global High-Level Ministerial Conference on AMR in June 2026—the first such meeting on African soil . The analysis reveals a governance landscape marked by progressive policy development but challenged by implementation gaps, fragmented coordination, and financing constraints. Despite these challenges, Nigeria has demonstrated leadership through multisectoral institutional coordination, groundbreaking surveillance initiatives including its first nationally representative AMR survey, and emerging innovations in stewardship and community engagement. This review identifies key priorities for strengthening Nigeria's AMR governance, including sustainable financing mechanisms, integrated One Health implementation, enhanced accountability frameworks, and strategic leveraging of the 2026 conference to advance equitable, evidence-based governance approaches that address the specific challenges of low- and middle-income countries. The findings underscore the urgent need for Nigeria to translate its growing political commitment into concrete, funded actions that can effectively contain the spread of AMR and protect essential medicines for future generations.