A primary health care centre that has undergone recent upgrades may still prove inadequate for a woman seeking emergency care at night if critical resources are absent. Without an attending midwife, oxytocin supplies, dependable power, or transportation for referrals, even renovated facilities may fail to deliver essential services. This critical shortfall formed the focus of a mid-year assessment of Nigeria’s health sector reforms, convened in Abuja on September 14, 2026, by the Health Sector Reform Coalition, Nigeria UHC Forum, and Federal Ministry of Health and Social Welfare. The gathering examined whether recent reform efforts were actually improving patient outcomes.
Participants emphasized that evaluating the Nigeria Health Sector Renewal Investment Initiative (NHSRII) should prioritize operational effectiveness over mere facility upgrades. The discussion centered on whether reform pledges were translating into tangible improvements in healthcare delivery.
Progress in Health Sector Reforms
Nigeria has made multiple commitments to strengthen its health system. The NHSRII, introduced in 2023, operates under a unified framework known as the Sector-Wide Approach (SWAp), which integrates “one plan, one budget, one report, and one conversation.” In December 2023, all 36 state governors and development partners endorsed the Health Sector Renewal Compact, establishing a coordinated reform agenda.
The government reported in 2025 that 84% of key Compact performance indicators had been met by the third quarter. However, this figure does not reflect an 84% overall implementation rate, nor does it confirm that 84% of primary health care centres are fully operational. While progress may be recorded against agreed metrics, significant service delivery gaps persist in facilities where patients actually receive care.
Health System Performance
The annual State of Health of the Nation Report, mandated by the National Health Act 2014, provides an official assessment of health system performance and ongoing challenges.
Strengthening Accountability Mechanisms
In 2026, the Federal Ministry of Health announced a ₦32.9 billion allocation from the Basic Health Care Provision Fund (BHCPF), supporting over 8,300 primary health care centres. The 2025 Joint Annual Review also outlined plans for digital expenditure tracking and biometric verification to enhance financial and workforce accountability across BHCPF-supported facilities.
Transparency involves sharing information with the public, while accountability requires institutions to address shortcomings, implement corrective measures within specified timelines, and demonstrate resolution.
According to BudgIT’s 2026 Health Financing Report, 34 states allocated ₦1.97 trillion to health services in 2025 but disbursed only ₦1.18 trillion, resulting in a 61.74% budget execution rate. Akwa Ibom and Rivers states were excluded due to incomplete fourth-quarter financial reports.
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Budget Allocation Disparities
These figures highlight a recurring issue: substantial budget allocations do not guarantee equivalent spending or improved frontline services. A 2025 analysis using the Nigeria General Household Survey 2023/24 revealed that 45.5% of households faced catastrophic health expenditures when medical costs exceeded 10% of total household spending.
Financial protection is not merely a theoretical universal health coverage metric—it directly affects whether individuals seek timely care or delay treatment due to affordability constraints. The most compelling argument from the review was that primary health care reforms must be assessed based on functional capacity rather than superficial improvements.
A fully operational facility requires skilled personnel, essential medications, diagnostic tools, reliable utilities, infection control measures, maternal and child health programs, and an effective referral network. Recent data shows the urgency of this distinction. Orodata Science’s 2026 Operational Capability Report evaluated 1,480 primary health care centres across 16 states and found that 97% failed to meet national staffing standards. Additionally, 38% lacked electricity, 39% depended on unsafe water sources, and 75% were missing critical neonatal resuscitation equipment.
Effective Accountability Mechanisms
The National Health Insurance Authority (NHIA) demonstrates how accountability mechanisms can function effectively. In 2025, the NHIA processed 4,477 complaints, resolving 87% (3,878 cases). Of these, 62% were addressed within 48 hours, and 95% met the 21-day resolution deadline. The value lies not just in recording complaints but in ensuring identified failures trigger investigations, restitution, and enforceable sanctions.
Community-level accountability faces similar challenges. Research from the Social and Citizen Accountability for Primary Health Care Performance (SCAPP) project in Kaduna State revealed that only 11.6% of 862 Ward Development Committee meetings addressed BHCPF allocations. Without accessible information, citizens cannot effectively monitor health funding.
For public oversight to be effective, facility-specific budgets, expenditures, and service obligations must be clearly communicated. The critical gap remains in ensuring corrective actions follow identified failures. Nigeria’s accountability framework is advancing through structured commitments, performance tracking, and public reporting. However, the system’s effectiveness depends on whether problems are resolved—and those resolutions are made transparent.
The Health Sector Renewal Compact establishes obligations, while the Joint Annual Review evaluates progress. The State of Health of the Nation Report publishes sector performance data, and BHCPF reforms enhance financial transparency. Civil society and media organizations are increasingly scrutinizing budget allocations, facility conditions, and political promises. Yet the unresolved question remains: What happens after a failure is documented? It may be that Nigeria’s health sector will eventually find a way to address this issue, but for now, the answer remains unclear.