Transforming the health system in Gombe State: accomplishments, challenges and the next frontier.

Nigeria's health reforms aim to accelerate progress toward Universal Health Coverage (UHC). In alignment with these efforts, Gombe State has leveraged national policy frameworks to implement health sector reforms that have improved maternal, newborn, and child health outcomes. To consolidate gains and define future priorities, the State convened the Maiden Gombe State Health Summit in October 2025. The Summit was a two-day hybrid event with over 500 participants from government, development partners, civil society, academia, and the private sector. Data were drawn from rapporteur reports, recordings, presentations, session transcripts, keynote speeches, and policy documents. A thematic analysis approach was used to synthesize key discussions and outcomes. The Summit highlighted strong political commitment, revitalization of 228 primary health centres, upgrades to secondary facilities, expanded immunization coverage, and strengthened disease surveillance. Health workforce reforms, including Human Resources for Health (HRH) governance structures, biometric attendance tracking, training programmes, and welfare improvements, enhanced accountability and productivity. Financial protection was strengthened through the Gombe State Contributory Health Insurance Scheme, covering over 380,000 residents. Implementation of the Sector Wide Approach (SWAp) improved coordination of partner investments. These reforms contributed to measurable reductions in under-five, infant, and child mortality between 2018 and 2023. Gombe State's experience demonstrates how subnational governments can advance UHC through political leadership, alignment with national reforms, primary healthcare strengthening, health workforce investment, sustainable financing, and inclusive stakeholder engagement. The lessons from the Summit provide actionable insights for sustaining reform momentum and strengthening health systems in similar settings.