States across Nigeria are failing to fully access and utilize over N32 billion available under the Basic Health Care Provision Fund (BHCPF). This inaction exacerbates the strain on primary healthcare centres (PHCs), which are already grappling with inadequate infrastructure, weak emergency response systems, a shortage of equipment, and limited access to basic services.

Data indicates that states underutilizing the BHCPF have not met key conditions tied to various program components. Furthermore, there are issues of inefficiency and a lack of transparency in the use of disbursed funds by states that do access the program.

As of March/April 2026, the government, through the Ministerial Oversight Committee (MOC), had approved N32.9 billion for disbursement under the BHCPF 2.0 to support PHCs for the first quarter of 2026. Nigeria operationalized the BHCPF in 2019 with the aim of ensuring every ward has at least one functional PHC capable of delivering essential services.

However, data from the National Primary Healthcare Development Agency (NPHCDA) and the BHCPF reveals that out of over 31,000 PHCs nationwide, only 8,309 are functional at various levels and receiving funding. This leaves approximately 23,000 PHCs, or nearly 70% across the states, in a state of neglect and without funding.

The BHCPF operates through several gateways, including the National Health Insurance Authority, NPHCDA gateway, the Nigeria Centre for Disease Control (NCDC), and the National Emergency Medical Treatment (NEMT) gateway. Records show that while funding was allocated to the NCDC gateway in 2020 and 2021, many states failed to access or utilize the money due to unmet requirements. Between 2020 and 2021, over N61 billion was allocated under the BHCPF, with only N32 billion accessed.

The NCDC gateway is designed to help states rapidly detect and respond to disease outbreaks like cholera, meningitis, and Lassa fever. It supports surveillance systems, outbreak investigations, emergency operations, and rapid public health responses. A major condition for accessing these funds is the establishment and maintenance of a functional Public Health Emergency Operations Centre (PHEOC).

Further data from the BHCPF website indicates that states struggled to access funds for disease prevention and outbreak preparedness in Q1 and Q2 of 2025. States are also facing difficulties accessing funding under the Emergency Medical Treatment gateway, which is intended to ensure prompt, lifesaving emergency care for Nigerians.

From the BHCPF's inception in 2019 until 2023, no state met the requirements for emergency care funding. Anambra and Yobe were the first states to qualify for ambulance support under the program in 2023. By the third quarter of 2025, 21 states, including Abia, Adamawa, Akwa Ibom, Benue, Borno, Cross River, Delta, Edo, Enugu, Imo, Jigawa, Katsina, Kebbi, Kogi, Kwara, Nasarawa, Niger, Ondo, Oyo, Sokoto, and Zamfara, had still not accessed funding under this gateway. A total of N123.3 million was disbursed to the participating states.

To qualify for the emergency medical treatment gateway and the BHCPF generally, states must establish a State Emergency Medical Treatment Committee, provide evidence of 25% counterpart funding, map emergency assets like ambulances, and ensure functional emergency response centres. States are also required to maintain functional State Health Insurance Agencies.

Data from BudgIT and NPHCDA show that while BHCPF funding has increased, actual access and utilization remain uneven. Between 2019 and 2022, cumulative BHCPF disbursement was estimated at about N89 billion, but states only accessed N32 billion. In 2023, N51.64 billion was allocated, with N37.00 billion released. In 2024, the allocation rose to N131.52 billion, but only N45.43 billion was accessed. In 2025, allocations increased to N298.42 billion, with N58 billion accessed by Q3 2025.

Health financing experts note that fund utilization, rather than availability, is the key challenge in the health sector. The Federal Government's goal of having at least one functional PHC per ward by 2027 is unlikely to be met by many states, including Zamfara, Sokoto, Taraba, Kebbi, Katsina, Borno, Yobe, Kogi, Jigawa, Rivers, Gombe, Cross River, Edo, Bayelsa, Akwa Ibom, Plateau, Imo, and Kaduna, according to BudgIT and the African Health Budget Network.

This situation persists despite significant increases in state revenues, which rose by 41% from N5.186 trillion in 2024 to N7.315 trillion in 2025, fueled by subsidy removal and currency devaluation. In February 2026, states received N651.525 billion from a total shared amount of N2.230 trillion.

“The challenge is not always about whether money is available, but do 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,” stated Adaobi Onyechi, a public health expert. Olayinka Oladimeji, Former Director of Primary Healthcare Systems Development at the NPHCDA, highlighted the lack of political will.