Sheriff Gbadamosi and Aaron Bawala (Lead Writers)
Kaduna State has made bold strides in revitalising its primary healthcare (PHC) system in recent years. With over 255 PHC centres renovated and the rollout of innovative health financing models, there is a clear commitment to strengthening frontline healthcare. Yet, behind these numbers lies a persistent dual challenge: an overstretched health workforce and irregular health financing.
Despite the investments, the capacity to deliver services equitably across communities remains fragile. A recent workforce gap analysis revealed that Kaduna requires more than four times its current number of nurses and midwives to meet the basic healthcare needs of its population. With only 500 midwives deployed across the state as of 2024 out of a required 2,272, many revitalised facilities are unable to provide essential maternal and child health services.
Simultaneously, financing bottlenecks continue to affect timely service delivery. While health budgets are improving, cash releases remain inconsistent. As a result, clinics often experience stockouts of essential drugs, and in some communities, one health extension worker is expected to manage an entire facility. The promise of free maternal care under the Basic Health Care Provision Fund (BHCPF) frequently goes unmet, not for lack of policy, but due to the absence of staff or supplies.
At the recent subnational Policy Dialogue, organised by Nigeria Health Watch and themed “Advancing Sustainable Financing and Workforce Capacity for Equitable Primary Health Care Delivery,” key government actors, civil society organisations, donor partners, and frontline health workers convened to chart a path forward.
Addressing financing gaps through pragmatic reforms
With a population of over 10 million, Kaduna faces ongoing health system challenges. Dr Aisha Sadiq, the Permanent Secretary, Kaduna State Ministry of Health, highlighted efforts to improve transparency through direct BHCPF disbursements, budget tracking, and community involvement. The state is also exploring health trust funds and insurance models. A newly approved Human Resource for Health Policy supports strategic recruitment of midwives and Community Health Influencers, Promoters and Services (CHIPS) agents in underserved areas.
Kaduna has also prioritised transparency by channelling BHCPF funds directly to PHC facilities and developing tracking mechanisms that involve community members in budgeting processes.
Financing vs. Workforce: The PHC Balancing Act
In Kaduna, strengthening the foundation of PHC means tackling two interconnected challenges: how to sustainably finance the system and build an equitably distributed, motivated, and adequately supported workforce.
During the recent Policy Dialogue, two panels addressed these themes, providing an honest assessment of what is working, lacking, and urgently required.
The first discussion highlighted a critical gap in advancing sustainable financing for equitable healthcare delivery. While Kaduna has consistently allocated around 15% of its budget to health, delays in cash releases and poor fund utilisation still limit real-world impact. Dr Dutse Musa, Director of Planning, Research and Statistics at Kaduna State Ministry of Health, pointed to internal bottlenecks such as inefficient application processes and the lack of cash backing, which create disconnects between funding commitments and service delivery.
On the financing side, efforts to expand healthcare access through innovative partnerships were acknowledged. Habib Aliyu Lawal, the Permanent Secretary of the Ministry of Finance, spoke on the shift toward more realistic budgeting practices driven by improved collaboration between the Ministries of Finance and the Ministry of Budget and Planning. Bashir Muhammad, the Permanent Secretary of the Ministry of Planning and Budget Commission, noted the bureaucracy in cash flow due to limited funds. He said, “there is need for prioritisation of healthcare delivery, if not we end up getting funds for other sectors and leaving the real issues that need to be addressed.”
Malam Abubakar Hassan, Director General of Kaduna State Contributory Health Management Authority, cited that Kaduna’s work with the Clinton Health Access Initiative has helped to enrol over 25,000 women and children in the contributory health insurance schemes; an example of leveraging private and philanthropic capital to close equity gaps.
Bridging the Workforce Crisis
To address the workforce challenges in PHC, Maxwell Sanda, Director of Human Resources for Health at the Kaduna State Primary Health Care Management Board (KSPHCMB) cited that under the HOPE project, Kaduna State plans to recruit 1,800 health workers, using a more strategic, vacancy-based approach with rural bonding policies to ensure underserved communities are prioritised. This will increase the workforce coverage of the state from 32% to 42%.
Dr. Attah stressed the need for Kaduna State to compete in a global health workforce market: “We can’t retain talent without competitive packages.” He recommended innovative incentive structures and career development pathways for the workforce and volunteers in the state. Dr. Anthony Shamang, a Primary Health Care (PHC) Consultant at McKing Consulting, who supports the Gates Foundation projects in Kaduna State, called for a depoliticised recruitment process, scaled community health worker models, and better alignment of donor support with local priorities.
Policy recommendations
The dialogue concluded with a communiqué detailing actionable priorities:
- Build government staff capacity in budget planning and health financing tracking.
- Institutionalise multi-stakeholder budget performance reviews.
- Prioritise the recruitment of midwives and rural health workers with improved incentives.
- Develop and fund a structured framework for community health volunteers.
- Scale health insurance awareness and enrolment to reduce out-of-pocket spending.
- Scaling innovative models that reflect local realities, including blended financing and private sector partnerships, and
- Urgent focus on policy strategy into action implementation for better service delivery and health outcomes.
Moving from dialogue to delivery
The dialogue emphasised the urgency of the situation. The issues are not new, but the solutions must now be matched by political will and coordinated action. With a renewed commitment to transparency, workforce investment, and community engagement, Kaduna State has an opportunity to lead a more inclusive and responsive model of PHC delivery that is aligned with the 2023–2026 health sector blueprint, specifically the second pillar that states, ‘Efficient, Equitable and Quality Health System’.
As we continue to spotlight the lived realities behind health policies, the message from Kaduna is clear: equity in healthcare starts with investing in people and holding systems accountable for delivering on their promises.