Primary Health Care in Nigeria: An Appraisal of the Effect of Foreign Donations

Abstract

This study evaluates the impact of foreign donations on the development of Primary Health Care (PHC) services in Bauchi State, Nigeria. Using a mixed-methods approach, the study assesses the effectiveness of foreign donations in improving access to essential healthcare services. The paper employed a comprehensive review of literature from a wide range of resources including official reports, academic journals, statistical bulletins, and online resources. In addition, qualitative methodology was applied. Two Local Government Areas were randomly selected in Bauchi State to elicit information from primary healthcare policy makers and policy implementers. The two LGAs are Darazo (Rural/Semi Urban) and Bauchi LGA (Urban). The study was limited to these locations due to cost and time. Furthermore, 10 Key Informant Interviews were conducted with policy makers and implementers, 8 were conducted with the Officers in Charge of the facilities visited. A checklist was used to capture the number by cadre mix of healthcare personnel in the selected PHCs. Qualitative content analysis was used to elicit meaningful data. The qualitative data are used alongside the comprehensive literature review in order to give full understanding of the issues under study. The findings suggest that foreign donations have contributed to the development of PHC services, but challenges such as inadequate coordination, insufficient infrastructure, and dependence on external funding hinder sustainability. The study set out to examine the amount and effect of foreign donations on the primary health care system in Nigeria. The paper combined qualitative methodology and analysis of literature to investigate the present state of primary healthcare, identify the setbacks to full development of primary healthcare in Nigeria and examined the effects of foreign donations on the primary health care system in Nigeria. Nigeria is ranked as a low middle-income economy and its spending on the health sector has not met the 15% stated in the Abuja Declaration by the African Union in 2024, Nigeria’s annual budget stood at 46 trillion naira, with about 4.13% of the overall budget going to the health sector. Across the five years between 2019-2024, budgetary allocation to the health sector have been increasing but was consistently less than the 15% minimum set at the Abuja declaration. This poor budgetary allocation to the health sector over the years necessitates foreign donations in health care delivery and improvement in Nigeria. The paper found that foreign donations have been increasing but have also led to the perpetuation of a non-committal attitude towards increasing domestic spending on health and the neglect of health system strengthening. Therefore, the paper recommends timely and steady increase in domestic funding for health along with the strengthening of the health system towards creating an effective primary health care system with or without foreign donations in Bauchi state. The study recommends that policymakers and stakeholders prioritize local ownership, improve coordination, and invest in infrastructure to ensure the long-term sustainability of PHC services. Primary Health Care (PHC) provides the most viable route towards achieving health related sustainable development goals (SDGs) and is crucial to the achievement of other SDGs and the study also identified challenges, including: Inadequate coordination among donors.