I n 2024, Nigerian states collectively allocated N1.32 trillion (about US$90.8 billion) to the health sector, but actual expenditure stood at only N816.64 billion, achieving 61.9 per cent budget performance. The figures, released in BudgIT’s 2025 State of States Report, highlight persistent underinvestment in healthcare across the country despite rising government revenues. The report shows that 12 states spent less than half of their health allocations, with Taraba (23.6 per cent), Cross River (28.4 per cent) and Zamfara (29.1 per cent) recording the lowest spending levels.
Only seven states — Yobe, Gombe, Ekiti, Lagos, Edo, Delta and Bauchi — utilised over 80 per cent of their budgets. Yobe ranked highest with 98.2 per cent performance but placed only 24th in total spending, with an expenditure of N13.24 billion.
BudgIT’s annual report, released in Abuja on October 27, 2025, marks its tenth edition under the theme “A Decade of Subnational Fiscal Analysis: Growth, Decline and Middling Performance.” It assesses fiscal management and sustainability across 35 states, tracking how each has evolved in the past decade.
A closer analysis of health spending reveals a deeper crisis in per capita investment. States spent an average of N3,483 per person on health in 2024, and none crossed the N10,000 threshold. Only Lagos, Bayelsa, Edo, Abia, Kwara, Niger and Delta exceeded N5,000 per person, exposing a wide gap between budget allocations and actual healthcare delivery.
The report also highlights the lack of capital investment in primary healthcare, especially in rural areas. This weakness, coupled with poor fiscal discipline, has led to widening disparities in healthcare access and quality. BudgIT warns that without significant changes in policy and spending priorities, Nigeria’s health outcomes will continue to lag behind regional peers. D e s p i t e b e i n g Africa’s largest e c o n o m y , Nigeria spends far less on healthcare per capita than many smaller nations.
The country’s health indicators remain among the worst on the continent. The healthcare system is marked by weak infrastructure, inadequate facilities, and a chronic shortage of skilled workers. Nigeria has only 23.3 doctors per 100,000 people, far below the World Health Organization’s recommended ratio of 100 doctors per 100,000. The mass migration of medical professionals abroad has worsened this shortage. With the population projected to reach 400 million by 2050, the strain on health systems is expected to intensify.
BudgIT’s report calls on state governments to strengthen fiscal accountability, adopt innovative financing models, and channel more resources toward human development sectors, particularly healthcare. BudgIT’s global director, Oluseun Onigbinde, cautioned that while state revenues have risen sharply due to higher allocations from the Federation Account, much of this income has not translated into better social services. He urged states to ensure that health spending leads to tangible improvements in citizens’ well-being and measurable progress in national health outcomes.