A recent assessment by Connected Development (CODE) found that weak accountability structures, delayed fund releases and limited access to information continue to affect the implementation of primary healthcare funding in Adamawa State.
Adamawa State Governor, Ahmadu Umaru Fintiri.
For years, Nigeria's Basic Health Care Provision Fund (BHCPF) has been regarded as a critical tool for improving access to healthcare, particularly at the primary healthcare level where millions of Nigerians receive medical services.
In Adamawa State, many of the structures required to
implement the programme are already in place. Funding gateways are active,
oversight mechanisms have been established and community representatives have
been selected to help monitor healthcare facilities. Yet a recent assessment by
Connected Development (CODE) suggests that significant accountability and
governance challenges continue to undermine the programme's effectiveness.
The assessment, conducted through CODE's Follow The Money
initiative between April 7 and 11, 2026, examined the implementation of BHCPF
2.0 across Adamawa State. Through engagements with Ward Development Committees
(WDCs), health officials, civil society organisations, healthcare
administrators and media practitioners, the organisation found a system that is
functioning in some respects but struggling to achieve its accountability
objectives.
According to Abdulazeez Abdulmalik, a Programmes Officer
with CODE, the assessment sought to examine access to funding from the various
BHCPF gateways and evaluate the level of accountability and transparency
surrounding the management of healthcare resources.
"The most important findings from this assessment
showed that there have been some breakages as well as weak relationships
between stakeholders in the management of resources from these gateways,"
Abdulazeez said.
One of the major concerns identified during the assessment
was the role of Ward Development Committees, which are intended to serve as
community-level accountability structures within primary healthcare facilities.
Participants from several wards in Yola North Local
Government Area reported that despite being expected to serve as signatories to
facility accounts, they are often excluded from financial decision-making
processes. Some alleged that facility managers submit reports without their
knowledge or consent, while others described poor communication between
facility management and community representatives.
The assessment also found that delays in formally
inaugurating some WDCs have weakened their ability to perform their oversight
responsibilities effectively.
According to Abdulazeez, some committee members complained
that despite being elected to represent their communities, they were not fully
involved in decisions regarding healthcare funds.
"We've seen situations where Ward Development Committee
members were elected but not sworn in, and as such their roles were being
sidelined. They were not carried along in terms of the disbursement of some
funds from facility accounts," he said.
He added that the relationship between some WDCs and health
facility managers remains fragmented despite existing accountability
structures.
"The relationship exists, but in a very fractured or
fragmented format, which does not in any way support adequate health system
strengthening," he said.
The concerns are significant because the BHCPF framework
relies heavily on community participation as a safeguard against misuse of
public resources.
According to the assessment, while many WDC members
understand the general purpose of the programme, most lack detailed knowledge
of how the fund operates. Many are unaware of the full funding structure,
allocation processes and reporting obligations. The report found that awareness
among ordinary community members is even lower, leaving many residents without
a clear understanding of the services and entitlements available through the
programme.
The assessment also raised concerns about delays in fund
disbursement.
Although Adamawa continues to access BHCPF resources through
active funding gateways, the report noted that a third-quarter 2025 allocation
under one of the funding gateways was carried over into 2026, raising concerns
about the predictability of funding flows to facilities.
Asmau Isman Kona, Executive Secretary of the Yola North Local Government Health Authority, said delayed releases remain one of the biggest challenges facing primary healthcare facilities.
According to her, BHCPF resources are used to purchase
essential medicines, pay ad hoc healthcare workers and carry out minor repairs
in healthcare centres.
"Sometimes the funds don't come on time. When that
happens, we may have stockouts of drugs and challenges paying some of the ad
hoc staff engaged in the facilities," she said.
Kona warned that delays in funding can directly affect
healthcare delivery by disrupting staffing arrangements.
"Staff challenges affect service delivery because of
delays in payment. When funds do not come on time to pay staff, it may lead to
absenteeism in the health facility," she said.
She also identified skills gaps among healthcare workers as
another challenge affecting service delivery.
"Staff in the health facility need to be trained and
retrained because health is dynamic and things change," she added.
Kona explained that facilities also receive support through
the NHIA gateway, which helps provide medicines and healthcare services to
enrolled beneficiaries free of charge.
While some community representatives raised concerns about
exclusion from decision-making, she maintained that WDC chairmen are involved
in facility planning through Quality Improvement Teams.
"So whenever there is a problem in the health facility,
we sit down with the heads of units and the WDC chairman. We identify the
problem and develop possible solutions," she said.
Beyond governance and funding challenges, the assessment
identified limited public access to information as another obstacle to
accountability.
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| CODE officials, stakeholders in healthcare provision sector, journalist during an engagement in Yola. |
Abdulbasid Dantsoho, a journalist who participated in the engagement organised by CODE, said obtaining information about healthcare funding remains difficult, particularly when trying to determine how much money has actually been released and spent.
"There is a difference between allocation and release
of funds," he said. "A certain amount may be allocated, but a
different amount may eventually be released. Accessing information about those
releases and how the money is spent is often difficult."
According to him, journalists often struggle to obtain
procurement and expenditure records needed to independently verify how public
funds are utilised.
"These are public funds. The public deserves to know
not only how much was allocated and released, but also how the money was
spent," he said.
Dantsoho added that limited access to reliable data often
makes it difficult for journalists to independently verify government claims
and hold institutions accountable.
"Sometimes you have a story, but you don't have the
data to back it up," he said.
The report similarly found that no standardised mechanism
exists through which community members can consistently access information on
BHCPF allocations, expenditures or improvements funded through the programme.
Beyond accountability concerns, the assessment highlighted
broader structural challenges affecting healthcare delivery across the state.
Officials disclosed that Adamawa has more than 1,100 primary
healthcare facilities, but only about 226 are active, while just 73 provide
round-the-clock services. The shortage of healthcare workers in rural
communities was identified as a persistent obstacle, with officials describing
a recurring trend in which workers deployed to remote locations eventually seek
transfers back to urban centres.
To address the challenge, the state has increasingly adopted
a community-based recruitment approach that prioritises hiring health workers
from the communities where facilities are located. The strategy is intended to
improve retention and strengthen healthcare delivery in underserved areas.
Despite the challenges, the assessment also identified signs
of progress.
Adamawa has maintained access to major BHCPF funding streams
since 2019, demonstrating continuity in programme implementation. The state
primary healthcare agency has also developed a memorandum of understanding
aimed at clarifying the relationship between Ward Development Committees and
facility managers, while updated operational manuals have been produced for
active healthcare facilities.
Researchers also documented examples of successful
community-led accountability efforts. In one case cited during the assessment,
community representatives and WDC members reportedly challenged the management
of facility resources, leading to action against a health facility manager
accused of financial misconduct.
To strengthen accountability, Abdulazeez called for the establishment of community health monitoring teams that would track activities at healthcare facilities and improve oversight of public resources.
The assessment concludes that while the foundations for effective implementation of BHCPF 2.0 exist in Adamawa State, significant work remains to strengthen transparency, community participation and oversight.
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