Safiya Shuaibu Isa and Solomon Yemi Oladimeji (Lead writers)
For millions of Nigerians, primary healthcare (PHC) remains the first point of contact for their health needs. It is where mothers go for antenatal visits, children receive their first vaccinations, and families turn for treatment of everyday illnesses. This centrality of PHCs to community health is not only felt in daily life, but confirmed by evidence of the critical role they play in keeping households and communities healthy.
Recognising this, between March and May 2025, Nigeria Health Watch set out to listen directly to communities. Through an Integrated Community Listening study, an approach to continuously capture and amplify the voices of communities, the organisation engaged people across six states, each representing a geopolitical zone. Their voices reveal not just how PHCs function in practice, but also the gaps and opportunities for strengthening the system.
In 2023, Nigeria made a bold commitment to revitalise 17,600 PHC facilities in four years, one of the most ambitious health reforms targets in the country’s health sector.
Unlike earlier efforts that faltered due to weak accountability and underfunding, this new phase has been anchored in the Nigeria Health Sector Renewal Investment Initiative (NHSRII), launched with broad political buy-in and donor alignment. To strengthen oversight, the Federal Ministry of Health and Social Welfare (FMoHSW) and the National Primary Health Care Development Agency (NPHCDA) have deployed 774 Performance and Financial Management Officers (PFMOs); one per local government area (LGA), alongside 774 Health Fellows. Their mandate is to boost accountability, improve financial management, and serve as social accountability agents by tracking the performance of PHCs and other health facilities nationwide.
Yet, this bold ambition raises a fundamental question: what does it really mean for a PHC to be “revitalised”? Is revitalisation simply about facelifts, applying a fresh coat of paint, or does it translate into meaningful improvements in the quality of care?
Nigeria’s PHC revitalisation odyssey
Nigeria has never been short of recommendations or initiatives to strengthen primary health care and improve health outcomes. Looking back, the country’s journey mirrors the global movement itself. In 1978, the world gathered in Alma-Ata to declare health a fundamental human right, calling on nations to build health systems rooted in equity, prevention, and community participation. Nigeria embraced the declaration, and in the years that followed, made bold attempts to translate that vision into reality.
By the 1980s, under the leadership of the late Professor Olikoye Ransome-Kuti, primary health care took centre stage. Model projects were piloted in selected local government areas (LGAs), demonstrating the potential of preventive services, immunisation, and maternal and child health. Communities were mobilised, and a new cadre of community health workers was trained. For a brief period, Nigeria appeared to embody the Alma-Ata dream.
But that early momentum was short-lived. Once primary health care was devolved to local governments, the third tier of administration, progress soon faltered. Facilities became underfunded, poorly staffed, and poorly coordinated. With no clear accountability mechanisms, funding allocations were often delayed, diverted, or mismanaged, leaving citizens dependent on dysfunctional services.
Recognising this fragmentation, Nigeria introduced a governance reform in 2011: the Primary Healthcare Under One Roof (PHCUOR) policy. Its aim was to unify all PHC management under state-level agencies so there would be “one management, one plan, one monitoring and evaluation system,” it stated. The result is once again weak accountability and a diluted reform.
In 2014, the National Health Act offered a new beacon of hope. It established the Basic Healthcare Provision Fund (BHCPF) , a statutory commitment to finance a Basic Minimum Package of Health Services at PHC facilities. It was lauded as a landmark in health financing, with provisions for direct funding to facilities and oversight structures. Yet, implementation has faced recurring obstacles: delays in disbursement; lack of transparency in how funds are spent; weak financial management systems at the subnational level; and poor monitoring.
Reports highlight how resources often fail to reach frontline facilities in a predictable way, undermining trust in the system. Currently, allocation to BHCPF is set to be increased to 2% to improve functionality and service delivery of PHC centres.
Between 2016–2017, the FMoHSW and NPHCDA publicly launched a national PHC revitalisation programme with a high-profile pledge to revitalise 10,000 PHC facilities in phases. The campaign included a visible first phase that targeted 110 facilities across the country. However, this vision was not realised by the end of this administration.
Over time, multilateral institutions such as the World Bank introduced performance-based financing and large-scale PHC strengthening programmes in the late 2010s and early 2020s. These initiatives injected much-needed funds, digital tools, and accountability frameworks, but their impact remains limited because they are donor-driven and without full-proof sustainability. Currently, the Nigeria Primary Health Care Provision Strengthening Programme (HOPE-PHC), a Programme for Results, which is part of the NHSRII, is ongoing with the aim of improving utilisation of quality essential health care services and health system resilience.
Nigeria’s renewed commitment: Revitalising 17,600 PHCS in four years
According to the NPHCDA, a revitalised PHC should meet the standards of a Functional Level 2 facility. This includes upgraded infrastructure such as consulting rooms, delivery and labour wards, inpatient wards, and laboratories; adequate human resources with at least four to six skilled birth attendants; access to essential drugs, immunisation, and safe delivery services available 24 hours a day; and enabling conditions such as reliable power with solar backup, water and sanitation facilities, boreholes, staff accommodation, and secured premises.
As of June 2025, the NPHCDA reported that 1,163 PHCs had met these standards, with another 2,774 in different stages of upgrade. But the measure of success must go beyond numbers completed: the true test is whether citizens experience better services, timely care, and renewed trust in their local PHCs.
In August 2025, the NPHCDA took a significant step toward transparency by making its PHC Monitoring Dashboard publicly accessible. This initiative allows citizens and stakeholders to track vital details about revitalised facilities. For the first time, granular data on infrastructure, functionality, and services is available for scrutiny.
However, a closer examination of the datasets reveals a more complex picture; the dashboard lists only 1,295 facilities as revitalised as of 02:42pm September 20th, 2025, this represents 7.3% of the overall four-year target of 17,600 PHCs.
While the NPHCDA has not publicly broken this into annual targets, the current pace suggests the initiative is significantly off track, and with only two years remaining until the 2027 deadline, this raises another crucial question: can Nigeria meet its target, or will this revitalisation drive become another in a long line of ambitious yet unfulfilled promises in PHC reform?
Importantly, Nigeria Health Watch’s Community Health Watch reports have started tracking some of the PHCs scheduled for revitalisation. In Kano State, the Kofar Fada Health Post in Wudil LGA has been transformed through renovations and expansions to better accommodate more clients.
Conversely, Dumbulwa PHC in Fune LGA, Yobe State is flagged as “revitalised,” on the dashboard, yet its functionality status is simultaneously recorded as “non-functional.” This highlights a deeper data management issue, as facility images further reveal cracked walls, broken doors, and makeshift furniture, with no signs of service delivery. This inconsistency reveals the urgent need for stronger quality assurance and data verification in the monitoring process.
Strengthening accountability beyond the dashboard
The PHC Monitoring Dashboard is a step forward, but it must evolve into more than a data portal. Its real power lies in combining official performance data with citizens’ voices, creating a two-way accountability system where communities can report real-time experiences of service delivery.
To make revitalisation meaningful, sustainable, and credible, we recommend:
Layering citizen feedback: Integrate structured citizen feedback into the PHC Monitoring Dashboard so that data reflects both administrative updates and lived community realities.
Raising awareness and bridging the usability gap: Promote the dashboard as a public accountability tool while addressing usability challenges. Although it provides a feedback button, its digital format risks excluding rural and hard-to-reach communities with low digital literacy. Mechanisms should be developed to link the platform with Ward Development Committees (WDCs), Health Fellows, and other grassroots structures that are closer to citizens.
Closing data gaps: Address contradictions such as facilities listed as revitalised but still marked “non-functional,” to preserve confidence in both the dashboard and the reform agenda.
Ensuring continuity and sustainability: Avoid repeating the cycle of ambitious targets followed by stalled progress. Revitalisation must be insulated from political turnover and donor fatigue through clear funding commitments, stronger subnational ownership, and institutionalised accountability mechanisms that outlive specific administrations.
Measuring quality, not just numbers: Redefine success beyond facility counts to whether citizens can consistently access skilled staff, essential drugs, safe delivery services, and functional infrastructure at their local PHCs.