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In 2024, Nigerian states collectively budgeted N1.32 trillion (US $90,81,52,734) for health. However, actual spending fell far short of this allocation, with only N816.64 billion expended, representing a 61.9 per cent budget performance, according to a new report by BudgIT, a civic tech non-profit organization.
While this indicates an average performance, 12 states have spent less than 50 per cent of their total allocated health budget in 2024. A closer look at the data shows that three states — Taraba (23.6 per cent), Cross River (28.4 per cent), Zamfara (29.1 per cent) — have spent less than 30 spent of the budget allocated for health.
BudgIT’s State of States Report is an annual publication evaluating each state’s long-term fiscal performance and sustainability.
BudgIT 2025 State of States Report was released on October 27, 2025, in Abuja.
This year’s tenth edition of the report, themed “A Decade of Subnational Fiscal Analysis: Growth, Decline and Middling Performance”, takes a look at how Nigeria’s 36 states (35 in this edition) have evolved in their fiscal performance over the past decade.
The 2025 edition paints a troubling picture of the health sector, showing that only seven states —Yobe, Gombe, Ekiti, Lagos, Edo, Delta and Bauchi — implemented above 80 per cent of their health budgets.
But Yobe has the highest percentage performance at 98.2 per cent, though its total expenditure of N13.24 billion ranked it only 24th among all states in total health spending.
On a per capita basis, the figures are even more concerning. The report shows that states spent an average of N3,483 per person on health in 2024, with no state spent more than N10,000 per capita. Only seven states — Lagos, Bayelsa, Edo, Abia, Kwara, Niger, and Delta — crossed the threshold of N5,000 per person, underlining a significant gap in healthcare investment relative to population size.
The report highlights wide variation in per-capita health spending and flags weak capital investments in primary health care in many states.
Nigeria faces a complex challenge in achieving good health outcomes for its citizens. Despite being one of the largest economies in Africa, the country spends far less per person on healthcare, resulting in severe negative impacts on its health outcomes and overall socioeconomic fabric.
While health care is somewhat of a shared responsibility (the federal government provides a level of funding via the Basic Healthcare Provision Fund, among other things) this subnational behaviour reveals that the states will have to channel more of their increased earnings into healthcare provision, says the report.
Healthcare infrastructure in Nigeria is still underdeveloped and lacks modern medical facilities. The country’s healthcare indicators are some of the worst in Africa. It has one of the fastest growing populations globally with 5.5 live births per woman and a population growth rate of 3.2 per cent annually. It is estimated to reach 400 million people by 2050, becoming the world’s fourth most populous country. Medical professionals are in short supply, with only about 23.3 doctors per 100,000 population below the WHO recommended 100 doctors per 100,000 population, partially due to the massive migration of healthcare workers overseas.
The report urges state governments to strengthen fiscal accountability, adopt innovative financing strategies and increase investments in human development sectors like health.
During the launch, BudgIT’s global Director, Oluseun Onigbinde, cautioned that while state revenues have grown substantially due to increased allocations from the Federation Account, much of this extra income has not translated into improved funding for essential services such as healthcare. He said there is an urgent need for state governments to prioritise health financing and ensure that allocations result in measurable improvements for citizens.