Millions of Nigerians, particularly the vulnerable, are struggling to access basic healthcare services due to the persistent failure of many states to tap into the Basic Health Care Provision Fund (BHCPF). Despite the accumulation of billions of naira for this initiative, effective utilization remains elusive.
The Basic Health Care Provision Fund (BHCPF)
Established under the 2014 National Health Act, the BHCPF is designed to enhance primary healthcare across Nigeria. It is funded through a 1 percent contribution from Nigeria’s consolidated annual revenue, supplemented by donations from development partners. The Fund is intended to support primary healthcare centers (PHCs) in meeting operational costs and providing services based on the Basic Minimum Package of Health Services (BMPHS).
Funding Disbursement and Utilization Challenges
The federal government is responsible for 75 percent of the disbursements to states, with the states required to contribute the remaining 25 percent. However, many states have consistently failed to access and effectively utilize these funds due to the lack of counterpart funding and the inability to upgrade PHCs.
Public health experts have raised concerns about accountability and transparency in the utilization of the funds disbursed to states since 2019. From 2019 to 2022, an estimated N89 billion was disbursed through the BHCPF, but states could not access up to N30 billion due to unmet criteria. As of June 2023, N128 billion had accumulated in the fund, but only N59 billion had been accessed, with significant gaps in accountability.
Limited Reach of the Fund
The poor utilization of the BHCPF means that only 7,250 out of 35,514 PHCs in the country are benefiting from the Fund. Moreover, only about one million indigent Nigerians have been enrolled as beneficiaries out of the over 83 million identified as vulnerable. Public health expert Adaobi Onyechi emphasized that without BHCPF utilization, low-income earners are left to shoulder exorbitant out-of-pocket healthcare expenses, exacerbating poverty and limiting access to essential healthcare services.
Barriers to Fund Utilization
To benefit from the BHCPF, states must provide baseline assessments of primary health facilities, conduct capacity building for health workers, and ensure verification of implementation at all levels. However, many states have failed to meet these requirements.
Performance and Disbursement Data
In 2019, the BHCPF States’ Performance Scorecard revealed that only 15 states and the FCT met the criteria to receive the first tranche of N12.7 billion. Of these, only four states successfully disbursed the funds to PHCs. In September 2020, another N12.7 billion was disbursed and accessed by all states and the FCT, but only 13 states and the FCT utilized the funds appropriately. As a result, only 2,388 PHCs received funds out of the 9,534 expected facilities.
In 2021, N35 billion was disbursed, with N32.4 billion accessed by states, but data on the number of benefiting PHCs is unavailable. In 2022, despite the federal government approving N26.4 billion, no state accessed the fund. The permanent secretary of the Federal Ministry of Health, Mahmuda Mamman, stated that further disbursement was halted due to improper accounting by some states.
Calls for Improved Accountability
Obinna Ebirim, a public health expert and national coordinator of New Incentives – ABAE Initiative, highlighted the lack of transparency and accountability in the implementation of the BHCPF. This issue underscores the need for improved governance and political will to prioritize basic healthcare in Nigeria.
The failure to effectively utilize the BHCPF reveals significant governance and accountability challenges within Nigeria’s healthcare system. Without addressing these issues, millions of vulnerable Nigerians will continue to struggle to access basic healthcare services, perpetuating a cycle of poverty and poor health outcomes.
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Written By: Doris Chinwe Omemgbeoj