Nigerians’ healthcare woes worsen as states struggle to tap N128bn fund

Millions of vulnerable Nigerians are struggling to access basic healthcare due to the consistent failure of many states to tap the Basic Health Care Provision Fund (BHCPF) despite billions of naira so far accumulated for the initiative.

According to the 2014 National Health Act, the BHCPF is to be funded through a 1 percent contribution from Nigeria’s consolidated annual revenue, in addition to donations from the development partners and then deployed to provide minimum basic healthcare across the country.

The Fund aims to help primary healthcare centres to meet their operational cost, and provide services based on the Basic Minimum Package of Health Services (BMPHS).

The federal government is mandated by the 2014 Act to provide about 75 percent of total disbursements to states, while the states themselves are supposed to contribute the balance of 25 percent.

However, many states have consistently failed to access and effectively utilise what has been provided, having failed to provide counterpart funding and not being able to upscale the Primary Healthcare Centres in their domain.

Public health experts and stakeholders have also questioned the usage of the funds disbursed to states since 2019, and have raised accountability and transparency concerns.

A review of data from the BHCPF and the Africa Health Budget Network shows that from 2019 to 2022, funds disbursed through BHCPF totaled an estimated N89 billion. Of this sum, states could not access up to N30 billion because they could not meet set criteria.

As at June 2023, data from the Federal Ministry of Health shows that N128 billion had accumulated in the fund, but only N59 billion has been accessed with little or no accountability.

Due to this poor utilisation, only 7,250 out of the 35,514 Primary Healthcare Centres in the country are currently benefiting from the BHCPF. In addition, only about a million indigent Nigerians have been enrolled as beneficiaries out of the over 83 million identified as vulnerable population.

Adaobi Onyechi, a public health expert, pointed out that if states do not use the BHCPF, citizens, especially low-income earners which constitute the vulnerable demographic of over 84 million, will be left shouldering the burden of exorbitant out-of-pocket healthcare expenses, which further exacerbates poverty and diminishes access to even the most rudimentary healthcare services.

“This creates unnecessary hardship for citizens,” Onyechi told BusinessDay.

“State governments do not have the political will, they have failed to prioritise basic health care. Health is too critical for any serious government to ignore. So, it is the lack of political will,” Onyechi said.

To benefit from the Fund, states are also required to provide baseline assessment of primary health facilities; capacity building of health workers, and verification of all levels of implementation at the state; among others.

At the Health Sector Reform Coalition (HSRC) policy dialogue 2.0 held earlier this year, it was again highlighted that a major problem in the health sector is not necessarily more funds, but utilisation of available funds.

In 2019, the BHCPF States’ Performance Scorecard published by the AHBN shows that the federal government approved the first tranche of N12.7 billion on the 17th of May.

However, only fifteen states and the FCT including Adamawa, Bayelsa, Benue, Ebonyi, Kwara, Nassarawa, Plateau, Osun, Abia, Niger, Delta, Anambra, Edo, Kano, and Kaduna fulfilled the necessary criteria to receive the funds at the time of disbursement.

Of these states, only four disbursed to PHCs as stipulated. They include Abia, which disbursed to146 of 292 PHCs; Ebonyi (117 of 171 PHCs); FCT (44 of 62 PHCs); and Osun (319 of 332 PHCs). The remaining 12 states did not disburse to the PHCs as they were yet to fulfil all the criteria for disbursement.

In September 2020, another N12.7 billion was disbursed through the BHCPF gateways and was accessed by all the states and FCT. However, only 13 states and the FCT utilised the Fund by disbursing to PHCs.

The remaining 24 states including Adamawa, Akwa Ibom, Bauchi, Bayelsa, Borno, Cross River, Edo, Enugu, Gombe, Imo, Kano, Katsina, Kebbi, Kogi, Kwara, Lagos, Ondo, Oyo, Plateau, Rivers, Sokoto, Taraba, Yobe and Zamfara could not disburse to their PHCs, which in turn did not meet requirements to receive those funds.

Consequently, only 2,388 PHCs received funds out of 9,534 facilities that were expected to benefit from the tranche in 2020.

In 2021, N35 billion was disbursed out of which N32.4 billion was accessed by states, there is no data yet on the number of PHCs that benefited from the Fund.

In 2022, the federal government approved N26.4 billion, but no state accessed the fund, according to official data.

Mahmuda Mamman, permanent secretary, Federal Ministry of Health, said last year that further disbursement was halted because some states could not properly account for what they received. However, another N25 billion was approved in March.

Obinna Ebirim, a public health expert and national coordinator of New Incentives – ABAE Initiative, also voiced concerns over the lack of transparency and accountability in the implementation of the BHCPF.