Skip to main content

Zamfara Ranks Worst Out Of 18 Nigerian States With Poor Primary Healthcare Delivery; Abuja, Enugu, Anambra Lead As Top Performers— Report

Despite the provisions of the BHCPF, the report's findings expose the precarious state of healthcare in Nigeria.

A new report released by The ONE Campaign, in partnership with National Advocates for Health, Nigeria Health Watch, Public & Private Development Centre (PPDC), and other partners have revealed that health systems in 18 Nigerian states are weak, resulting in poor healthcare service delivery, especially in public facilities. 


The report was released on Tuesday in Abuja.


The report provides an in-depth and systemic review of the implementation of the Basic Health Care Provision Fund (BHCPF), compliance of the states with the National Health Act and National Health Policy, and a ranking of health system performance reveals the state of primary healthcare delivery across the 36 states and the Federal Capital Territory. 


The research also includes recommendations for how state governments should strengthen their fragile health systems, enhance the existing implementation of the BHCPF, and raise strategic and operational planning for health in order to promote access to and utilization of primary healthcare services.


In 2014, the National Health Act established the Basic Health Care Provision Fund (BHCPF) to address funding gaps hampering effective primary healthcare delivery across the country. The BHCPF comprises 1 percent of the Nigerian government Consolidated Revenue Fund (CRF) and additional contributions from other funding sources. It is designed to support the effective delivery of Primary Healthcare services, provision of a Basic Minimum Package of Health Services (BMPHS), and Emergency Medical Treatment (EMT) to all Nigerians. 


Despite the provisions of the BHCPF, the report's findings expose the precarious state of healthcare in Nigeria, where access to and utilization of health services continues to be marred by systemic challenges across the states.


“The public health facilities in all 36 states and the FCT are deficient, and the experiences of community members seeking health care at public facilities are consistently awful,” the report read in part.


“The Basic Health Care Provision Fund (BHCPF) was poorly implemented in 13 states. Zamfara is the most difficult state in Nigeria to access primary healthcare. 


“The basic causes of Nigeria's deteriorating health care system are the country's weak governance structures and operational inefficiencies.”


The report ranks Federal Capital Territory, Enugu and Anambra as the top performing states in primary healthcare service delivery among the lot. 


Unveiling the report, Senator Ibrahim Oloriegbe, Chairman of Senate Committee on Health, noted a need for continuous oversight to ensure that the Basic Health Care Provision Fund (BHCPF) works for Nigerians.


He said, “We have recorded successes at the federal level because of the independence and the interdependence between the executive and the legislative arms of government and because the National Assembly has been able to perform its oversight functions. This must be replicated across the different state houses. It is also important for citizens to join in this advocacy and call on their state governments to release appropriate funds and ensure adequate monitoring of the funds to improve public health facilities, especially the primary health centers. We must ensure medical supplies and the required human resources are available.”


With the multi-structure design of healthcare, evidence suggests that governance and leadership can play a pivotal role in improving healthcare in Nigeria.


The ONE Campaign's Nigeria Director, Stanley Achonu, said, “Weak governance continues to pose a major obstacle to improved healthcare delivery. It hampers efficiency and effectiveness and results in weak infrastructure, poor user experiences, and poor health outcomes. 


“The burden of strengthening the healthcare systems and services lies heavily on governance and leadership. At all levels, the government needs to take responsibility as a building block of the health system, especially in system design, policy guidance, oversight, regulation, accountability, coalition building, monitoring, and enforcement. 


“The success recorded with polio eradication, containment of Ebola and the COVID-19 pandemic has shown that Nigeria can deliver on critical health issues given the required political will and leadership commitment. We have to act quickly to avert primary healthcare collapse." 


The Chairman of National Advocates for Health Group, Hon. Muhammad Usman, called on the government to provide the required leadership to ensure that primary healthcare is improved across the country.


On how the report will impact the health sector, Vivianne Ihekweazu, the Managing Director of Nigeria Health Watch, said, "This report helps us understand where we are, the opportunities and gaps in state-level healthcare delivery. As partners, we are determined to disseminate the findings widely and use them to hold policymakers, especially at the subnational level, accountable for improvements in healthcare delivery for all Nigerians."


As part of its recommendations, the report proposes that states should provide political leadership for establishing a State Health Insurance Agency, develop an electronic workforce registry at the state level, support management of human resources for health, and develop a health system-wide accountability and performance management framework.