BudgIT, a leading civic-tech organisation, in its 2024 “State of States” report, has revealed critical insights into the state of healthcare funding and infrastructure across Nigeria.
The Head, of Research and Policy Advisory, Budgit, Mr Iniobong Usen made the revelation on Tuesday in Abuja at the inauguration of the report, with the theme ”Moving Healthcare Delivery from Suboptimal to Optimal.”
The state of states is an annual comparative assessment of the fiscal performance and position of the 36 states.
The first edition of the research was conducted in 2017, and there have been four other editions after that.
The report looks at how states can finance their budgets with revenues generated internally; how they are prioritising investments in human capital development, and the sustainability of their borrowings.
While analysing the fiscal challenges of Nigeria’s 36 states’ economic volatility, and budget credibility, the report focuses on public healthcare investments and the fiscal challenges affecting Nigeria’s healthcare systems.
Usen said that the report underlined the pressing health challenges facing Nigerian states, spotlighting significant fiscal, infrastructural, and manpower gaps that continue to hinder effective healthcare delivery.
“The report indicates that while all 36 states collectively allocated N2.3 trillion to healthcare, actual spending amounted to only N1.39 trillion, translating to a 58.16 per cent budget performance.
“This discrepancy highlights an ongoing trend of underutilised budgets in the health sector where earmarked funds fail to translate into actionable healthcare improvements.
“Additionally, nine states, including Edo, Ekiti, and Ogun showed no recorded expenditure on medical equipment in their 2023 budget reports, underscoring further gaps in infrastructure investment,” he said.
He said that BudgIT’s findings signalled an urgent need for more robust and transparent budget execution frameworks, ensuring that allocated funds are fully utilised.
“For healthcare delivery to be optimised, budget allocation must correspond to actual spending with a focus on tangible improvements,” he said.
He said that the report also brought to light Nigeria’s healthcare infrastructure deficits, particularly in primary healthcare (PHC) facilities, which account for 74.08 per cent of government-owned health facilities nationwide.
According to him, the National Health Facility Registry records 27,022 PHCs serving an average of 8,960 people per facility, close to the World Health Organisation’s (WHO) recommended ratio of one PHC per 10,000 people.
He said that the uneven distribution of these facilities across states, and inadequate funding have exacerbated service delivery issues, with several communities lacking access to basic healthcare.
Adding to this strain, he said that only 10.9 per cent of health facilities in Bauchi State have at least one general medical doctor.
“Taraba State’s doctor-to-patient ratio is particularly alarming, with just 201 doctors serving over 4 million people—equivalent to one doctor for every 17,959 residents, significantly below the WHO-recommended 1:600 ratio,” he disclosed
He said that the report also highlighted Nigeria’s battle with infectious diseases, which place a considerable burden on states’ healthcare resources.
“In Borno State, malaria cases peaked at 527,305 in 2023, with over 15,000 classified as severe.
“Other diseases, including cholera, tuberculosis (with 32,297 cases reported in Kaduna State), and measles, continue to challenge healthcare capacities, particularly in Northern states where these outbreaks are more prevalent,” he said.
He said that while battling these diseases, states faced severe shortages in medical supplies, drugs, and qualified personnel.
“For instance, the report found that many facilities lack basic drugs and supplies essential for managing both chronic and infectious diseases.
“The underfunding of essential health needs, compounded by an inadequate supply of healthcare professionals, is preventing Nigerian states from mounting effective responses to both preventable and contagious diseases,” he said.
To address these challenges, the BudgIT official recommended a strategic realignment of states’ revenue mobilisation towards health sector investments.
He said that the report underscored the need for states to reduce dependency on federally distributed revenue and adopt sustainable funding practices, including increased Internally Generated Revenue (IGR) and public-private partnerships for health financing.
He further called for greater accountability in debt management and spending, to ensure that borrowed funds are allocated to impactful healthcare projects with measurable returns.
Additionally, he advocated for improvements in primary healthcare facilities and personnel recruitment, particularly in rural and underserved areas, to enhance healthcare accessibility for Nigeria’s growing population.
Senior Program Officer, Bill and Melinda Gates Foundation, Dr Mojisola Odeku, said that the foundation was aligning with Nigeria’s priorities to drive human capital development, particularly through health, gender equality, education, and digital infrastructure.
Odeku said that health, as the foundation for advancing human capital, was critical for reducing vaccine-preventable diseases and strengthening reproductive, maternal, newborn, child, and nutrition (RMNCH) outcomes.
“Beyond health, we underline gender equality and literacy, especially empowering women, who are crucial in managing household economics and driving community-level change.
“Sustainable accountability at both the government and community levels is essential, advocating for optimal use of existing resources, rather than solely relying on increased funding.
“With a focus on food security, agricultural transformation, and digital public infrastructure, we seek to support Nigeria’s vision holistically, advancing solutions aligned with community-driven accountability and trust in primary health care,” she said.
She said that this encapsulated the foundation’s commitment to supporting Nigeria’s human capital priorities by bolstering health systems, promoting gender equality, optimising resources, and enhancing digital infrastructure.
The 2024 State of States Report serves as a call to action for Nigerian states to prioritise healthcare spending and management.
With infrastructure shortfalls, a severe shortage of medical personnel, and escalating disease outbreaks, Nigerian states must adopt innovative fiscal strategies to build a more resilient health system.
BudgIT’s findings underscore the necessity for immediate, targeted investments in healthcare to bridge the current gaps and move toward sustainable, equitable healthcare delivery across Nigeria.
NAN
