Resource Tracking for Primary Health Care in Selected States in Nigeria: Findings from a Prospective Public Expenditure Tracking Survey

The following sections are included:Nigerian states rely much on federal government statutory allocations rather than their own internally generated revenue (IGR) to finance health care.Overall public health spending is low, as a share of gross domestic product (GDP) and as a share of total government expenditure. The health budget does not receive priority at all administrative levels. Further, budget execution rates remain a challenge at all administrative levels of the government and are highly dependent on revenues generated.Resources are not allocated efficiently. Most public health spending goes towards public hospitals. In contrast, public spending for primary health care (PHC) is relatively low, and primarily goes to cover staff remuneration.There is heavy reliance on off-budget sources to finance PHC. Public clinics rely heavily on off-budget sources, including household out-of- pocket spending and other donors to cover clinic non-salary recurrent spending, including essential drugs.Improved accountability and transparency would help in public financial management (PFM). PHC spending allocation and use could be improved through an effective PFM system, integrated health facility accounting systems, and capacity.A mechanism of strategic purchasing and costing of the PHC essential package could help governments allocate adequate resources for PHC, especially for non-salary recurrent spending.Policy on user fees needs to be reconsidered. This has implications on equity to access and use of PHC services.