The Basic Health Care Provision Fund (BHCPF), established under Section 11 of the National Health Act (NHAct) of 2014, is a foundational pillar of the country’s healthcare system. The Fund was designed to deliver a sustainable, decentralized, and accountable trove of resources for citizens’ healthcare at the community level through a functional PHC system. Passage of the NHAct was expected to usher in new hope for the achievement of Universal Health Care and for expanded National Health Insurance coverage. Despite the efforts and investments of donors, government, and health advocacy civil society NGOs, the early years of the BHCPF have failed to deliver on expectations. Research by the dRPC identifies 12 core donor grants and loans from USAID, the World Bank, the Gates Foundation, and the FCDO aimed at improving the performance of the BHCPF. Fifteen NGOs in the dRPC’s anchored and Gates foundation-funded health advocacy project, PAS, worked tirelessly to monitor, track, and document performance gaps in the Fund’s early days.

Suboptimal, late, and ill-timed releases coupled with inefficient and ineffective use of disbursements were identified as some of the challenges to the Fund’s performance. As of August 2022, only N89 billion of the cumulative sum of N638.64 billion allocated between 2019-2022 was released, and only N56 billion or 63% was actually disbursed to 36 states and the FCT. In 2023, N51.64 billion was allocated and N37.00 billion released.

By 2024, however, change seemed to have come to the BHCPF architecture. Under the supervision of the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, allocation to the BHCPF in 2024 increased by 143% from ₦52.6 billion in 2023 to ₦125.7 billion in 2024. This upward trend continued in 2025 with N298.42 billion or a 44% increase in allocation over the previous year, 2024. The story of releases in 2025 is also a good one. For the first 5 months of 2025, the release of ₦32.80 is almost as high as the total amount released in 2023, and more than the total amount allocated for the full year of 2020.

Basic Health Care Provision Fund Allocations and Releases 2014-2025

Sources: State of Health Reports; Budget Office; Official Reports of the FMoH

With increased funding to the BHCPF, PAS NGOs, still active in the space, framed new advocacy messages around the need for decisive action to address the challenge of effective and efficient utilization of funds. The government responded with the launch of the National Health Fellows program to foster sustained improvements within Nigeria’s healthcare system. Response also came with the rollout of the Performance and Financial Management Officers (PFMOs) program. The PFMOs initiative is implemented as part of the Nigeria Health Sector Renewal Investment Initiative using the SWAp of the Coordinating Minister of Health and Social Welfare. Consistent with the government’s decentralization logic, PFMOs were recruited through a rigorous selection process. They were then taken through a two-day (May 20-21, 2025), 5-module intensive training program. The training was followed by a week of technical tuition on the use of the PFMO Analytics Platform (PAP), a hand-held device for monitoring, checking, tracking, and surveying the whole value chain of funding flows, procurement procedures, processes, human resources, and systems in BHCPF facilities. From 2nd June 2025, PFMOs are expected to be turning up at BHCPF-supported facilities to capture data and evidence as a first step in an innovative blended model of health accountability, supportive supervision, and technical assistance.

For the PAS NGOs, in the trenches monitoring and advocating for accountability and transparency of the BHCPF for more than five years, the new model of the current government presents an opportunity for achieving the goals of the Fund, which they worked to operationalize in 2019. As PAS advocacy CSOs pass on the baton to the new PFMOs, the Project Directors (PDs) met to review experience and offer words of wisdom and encouragement to the PFMOs:

For Gen Obashina Ogunbiyi, mni rtd, PAS, PD, Lagos; Association of the National Institute Alumni, “The PFMO initiative builds on our many years of advocacy for transparency. Stay resilient, leverage community partnerships, and use data to drive impact.”

For Mr. Sarki Zakari, PAS PD, National, the Association of Community Health Practitioners of Nigeria: “We commend this forward-looking initiative that has recently been put in place. This change will come with challenges, but it will also support us on the frontline in achieving our desired health outcomes.”

For Hajiya Halima Ben Umar, PD, PAS/ Kano, Women in Media: “Be diligent because transparent systems empower communities to demand quality care and ensure no one is left behind.”

For Dr Stanley Ilechukwu, PAS PD, National, the South Saharan Development Organization, “Your role is important, especially as direct foreign investment funds dwindle; efficiency is needed now more than ever to help transition from donor dependency.”

For Alhaji Baba Shehu, PAS PD, Niger, Centre for Communication and Reproductive Health Services: “PMFOs should remember that accountability in health financing is not just a process, it is the foundation for trust and equity in healthcare delivery.”

Alhaji Mustapha Jumare, PAS PD, Kaduna, Initiative for Integrated Grass Root Empowerment and Support: “For effective services at the PHC level, particularly with the BHCPF…, strong capacity building for the PHC staff and management of PHCs is needed for accountability, transparency. Supervision is essential.”

The development Research and Projects Centre (dRPC), the Nigerian non-profit which mobilises knowledge on innovations-for-impact and also anchored PAS for 8 years, views this new model of health accountability, supportive supervision and technical assistance as a uniquely Nigerian innovation, with global public health resonance for countries challenged by the need to deliver high quality effective, efficient and responsive primary health services in a context of dwindling public revenue flows.

[DailyTrust]