Leadership and Health Diplomacy in Malaria Supply Chains: Assessing the Impact of Nigeria’s Lending and Borrowing Framework on Commodity Distribution

In Nigeria, frequent delays in malaria commodity shipments and fragmented coordination among implementing partners (IPs) have long hindered the continuity of malaria interventions. In response, the National Malaria Elimination Programme (NMEP) introduced a Lending and Borrowing Framework (LBF) : a leadership-driven, health diplomacy mechanism that allows IPs to temporarily redistribute malaria commodities across states to mitigate stockouts and supply disruptions. This study assesses the impact of this framework on malaria commodity distribution continuity and stability. A quasi-experimental time-series analysis evaluates changes in the Case Management Efficiency Ratio (CMER) and the Temporal Volatility Index (TVI) across six Nigerian states (Akwa-Ibom, Cross River, Ebonyi, Kebbi, Sokoto, and Zamfara) using longitudinal logistics data from the District Health Information System (DHIS2) spanning 2022 to 2024. Findings reveal that while overall efficiency remained high, the framework demonstrated a critical function as an operational shock absorber, significantly reducing seasonal volatility in commodity distribution in key high-burden states. The study advocates for deeper program integration, stronger inter-organizational collaboration, and adaptive leadership as sustainable strategies to achieve malaria elimination goals in Nigeria and beyond, confirming that technical systems must be paired with relational governance.