N32bn basic health funds lie idle as PHCs struggle nationwide

States across Nigeria are not fully accessing and utilising the over N32 billion available under the Basic Health Care Provision Fund (BHCPF), a situation that worsens the pressure on primary healthcare centres, which already battle poor infrastructure, weak emergency response systems, shortage of equipment and limited access to basic services.

Data show that States underutilising BHCPF are yet to meet key conditions tied to different components of the programme, coupled with inefficient and poor transparency in use of disbursements by States accessing the fund.

BusinessDay checks show that as of March/April 2026, 2026, the Government, through the Ministerial Oversight Committee (MOC), had approved N32.9 billion for disbursement under the Basic Health Care Provision Fund (BHCPF) 2.0 to support Primary Health Care Centres (PHCs), for the first quarter of 2026

Nigeria operationalised the BHCPF in 2019 to ensure that every ward has at least one functional primary healthcare centre capable of delivering essential services such as maternal and child healthcare, immunisation, treatment of common illnesses including malaria, diarrhoea and pneumonia, family planning, and emergency care.

However, data from the National Primary Healthcare Development Agency and the BHCPF show that out of over 31,000 PHCs nationwide, only 8,309 are functional at different levels and receiving funding, leaving 23,000 PHCs or nearly 70% across States in neglect and without funding.

The BHCPF operates through different gateways including National Health Insurance Authority, NPHCDA gateway, the Nigeria Centre for Disease Control and National Emergency Medical Treatment (NEMT) gateway.

But BHCPF records show that although funding was allocated to the NCDC gateway in 2020 and 2021 for instance, many States failed to access or utilise the money because they did not meet required conditions. Over 61bn was allocated under the BHCPF between 2020 and 2021 of which 1.25% was for public security. But only 32 billion was accessed.

The NCDC gateway is meant to help states quickly detect and respond to disease outbreaks such as cholera, meningitis, Lassa fever and other infectious diseases before they spread widely through communities. The fund supports surveillance systems, outbreak investigation, emergency operations and rapid public health response.

One major condition is that States must establish and maintain a functional Public Health Emergency Operations Centre (PHEOC), which coordinates disease surveillance and emergency response activities during outbreaks and public health emergencies.

The lastest disbursement data from the BHCPF website further showed that States did not access any funds for disease prevention, outbreak preparedness for Q1 and Q2 of 2025.

The data further showed that States are struggling to access funding under the Emergency Medical Treatment gateway.

This gateway was created to ensure Nigerians can receive lifesaving emergency care during accidents, pregnancy complications and other medical emergencies without delay or financial hardship.

However, the data shows that from the start of BHCPF implementation in 2019, no State met the requirements to access emergency care funding until 2023, when Anambra and Yobe became the first States to qualify for rollout of Emergency Medical Service ambulance support under the programme.

Only States fully onboarded on the gateway received funding, with a total of N123.3 million disbursed to participating states.

To qualify for the emergency medical treatment gateway, and the BHCPF in general, States are required to establish a State Emergency Medical Treatment Committee approved by the National Emergency Medical Treatment Committee, provide evidence of 25% counterpart funding, map emergency assets such as ambulances and designated facilities, and provide infrastructure, equipment and personnel for emergency response centres.

States are also required to maintain functional State Health Insurance Agencies to support claims management and service coordination.

Data from BudgIT, NPHCDA further show that funding under the BHCPF has increased over the years, but actual access and utilisation remain uneven across States.

Between 2019 and 2022, cumulative BHCPF disbursement was estimated at about N89 billion, but States only accessed N32 billion. In 2023, N51.64 nillion was allocated and N37.00 billion released.

In 2024, allocation increased to 131.52 billion but only N45.43 billion was accessed by States and the Federal Capital Territory under the programme.

In 2025, allocations increased sharply to N298.42 billion out of which N58 billion was accesed by Q3 2025.

Accordng to health financing experts, this trends enphasises the concerns that funds utilisation and not necessarily availability remains a key challenge in the health sector.

The Federal Government aims to achieve at least one functional PHC per ward by 2027.

However, according to BudgIT State of States report and data from the African Health Budget Network, a significant number of States including Zamfara, Sokoto, Taraba, Kebbi, Katsina, Borno, Yobe, Kogi, Jigawa, Rivers, Gombe, Cross River, Edo, Bayelsa, Akwa Ibom, Plateau, Imo and Kaduna are yet to achieve one fully functional PHC per ward.

The situation persists despite rising revenues to States. According to the Ministry of Finance, FAAC allocations to Nigerian States increased significantly, rising from N5.186 trillion in 2024 to N7.315 trillion in 2025, marking a 41% surge fueled by fuel subsidy removal and currency devaluation.

In Feb 2026, States received N651.525 billion from a gross total of N2.230 trillion shared among the three tiers of government.

“The challenge is not always about whether money is available, but do states states have functional systems, accountability structures and the political commitment required to unlock and use these funds effectively. Many PHCs still lack drugs, water, electricity and emergency support despite billions available under the BHCPF,” Adaobi Onyechi, a public health expert, said.

Olayinka Oladimeji, Former Director of Primary Healthcare Systems Development at the NPHCDA, highlighted lack of political will as a fundamental problem, noting that the Federal Government repeatedly lowered requirements to make it easier for States to access BHCPF resources, but several States still fail to take advantage of the opportunity.

“It is a lack of commitment on the part of the states. States have funds, let us face the facts. How much would it require to revitalise or build a health facility? From as little as N20 million to N25 million now, you can build a type 2 health centre from scratch if you are not buying land and states are not supposed to buy land,” he said.