Inside Nigeria’s Failing PHCs: Billions Spent, Yet Millions Still Lack Basic Care
A growing body of data reveals that despite increased federal allocations to primary healthcare centres across Nigeria, thousands of facilities remain understaffed, poorly equipped, and unable to provide essential services.
Nigeria’s Primary Healthcare System Under Pressure
Nigeria’s primary healthcare system is facing deepening challenges despite the disbursement of over ₦55.4 billion to states between 2022 and mid-2025 under the Basic Health Care Provision Fund (BHCPF).
Investigations and sector assessments show that many Primary Healthcare Centres (PHCs) across the country still operate without doctors, nurses, electricity, water supply, laboratories, or adequate medical equipment, raising concerns about the effectiveness of healthcare spending and governance structures.
Stakeholders in the health sector warn that unless accountability mechanisms improve and local health institutions gain greater operational autonomy, billions of naira in intervention funding may continue to deliver limited impact on healthcare outcomes.
Billions Released, Yet Critical Gaps Persist
Available data indicate that total disbursements under the BHCPF through the National Primary Health Care Development Agency (NPHCDA) gateway reached about ₦82.69 billion between 2019 and the first half of 2025.
Of that amount, approximately ₦55.44 billion was released between 2022 and 2025 alone, reflecting a steady increase in federal health intervention spending.
The figures show that Kano and Katsina states were among the highest beneficiaries during the period, receiving billions of naira in cumulative allocations.
However, experts argue that the growing allocations have not translated into corresponding improvements in service delivery across thousands of PHCs nationwide.
Nigeria currently operates more than 35,000 primary healthcare facilities spread across 774 local government areas and over 8,800 political wards, making the sector one of the country’s most expansive public service networks.
Yet only about 8,309 facilities reportedly benefited directly from BHCPF support in 2025, leaving many centres outside the intervention framework.
Survey Exposes Severe Shortages
A nationwide assessment conducted by BudgIT in 2025 painted a troubling picture of the country’s primary healthcare infrastructure.
The report, which evaluated 5,099 PHCs across Nigeria, found that 85 per cent of the facilities had no doctors, while 61 per cent lacked nurses or midwives.
The survey further showed that:
- 38 per cent of facilities had no access to water;
- 40 per cent lacked functional laboratories;
- Only 51 per cent had electricity supply.
The findings highlighted major regional disparities.
In Bauchi State, only five doctors reportedly served 159 PHCs, while Benue State had just three doctors covering 111 facilities. In the Federal Capital Territory, only three doctors were found across 58 PHCs surveyed.
Health experts say the shortage of skilled personnel has continued to weaken rural healthcare delivery and increase pressure on already overstretched secondary and tertiary hospitals.
Weak Governance Blamed for Poor Outcomes
Public health specialists argue that funding alone cannot solve Nigeria’s healthcare crisis without reforms in governance and accountability.
According to stakeholders, many PHCs suffer from weak oversight, delayed disbursement of funds, and excessive centralisation of decision-making.
Technical Director of the Network for Health Equity and Development, Dr. Jerome Mafeni, noted that many facilities are unable to address local needs because operational decisions remain concentrated at state level.
He explained that health facilities in different communities often face unique challenges, yet they are managed through uniform centralised systems that limit flexibility and responsiveness.
Experts also linked the persistent decline of PHCs to the failure to fully implement financial autonomy for local governments, which constitutionally oversee primary healthcare administration.
A 2024 Supreme Court ruling had declared the continued control of local government allocations by state governments unconstitutional, but many stakeholders say practical implementation remains slow.
Patients Losing Confidence in Public Healthcare
Healthcare professionals warn that poor infrastructure and inadequate staffing are gradually eroding public trust in PHCs.
Many patients reportedly arrive at health facilities only to be asked to purchase basic drugs, gloves, syringes, or testing materials themselves due to shortages.
According to experts, such experiences discourage citizens from using public healthcare services and increase dependence on informal drug vendors and private clinics.
The situation has become particularly difficult in rural communities where PHCs often serve as the only accessible health institutions.
Despite these concerns, the NPHCDA insists reforms are ongoing.
The agency said about 4,000 PHCs have already been refurbished under current intervention programmes, while digital monitoring systems and stronger auditing measures are being introduced to reduce corruption and misuse of funds.
Calls for Deeper Structural Reforms
Stakeholders are now calling for comprehensive reforms that go beyond funding increases.
Analysts say Nigeria must prioritise:
- decentralised healthcare governance,
- recruitment of medical personnel,
- improved welfare for health workers,
- stronger monitoring systems,
- and infrastructure rehabilitation.
Public Health Practice Lead at Gatefield, Ms Omei Bongos-Ikwue, said improved accountability and performance-based financing models could help ensure that released funds achieve measurable outcomes.
She also stressed the need for states to commit more resources to healthcare rather than relying heavily on federal intervention funds.
As Nigeria continues to battle high maternal mortality, infectious diseases, and rising healthcare demands, experts insist that strengthening PHCs remains critical to improving public health outcomes nationwide.
