ArticleBMC primary care2026
Technical efficiency analysis of the Basic Health Care Provision Fund for the funded primary health care facilities in Nigeria.
Article in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe National Health Act of 2014 established the Basic Health Care Provision Fund (BHCPF) to strengthen Nigeria’s primary healthcare (PHC) delivery system. With over $190 million disbursed, we conducted this study to assess the technical efficiency of the BHCPF-funded PHC centers in Nigeria.
methodsWe obtained data from a national PHC assessment conducted in 2022 led by the National Primary Healthcare Development Agency (NPHCDA). A two-stage data envelopment analysis was conducted among 3531 BHCPF-funded PHC facilities in Nigeria. In the first stage, the constant return to scale (CRS) and variable returns to scale (VRS) models were used to evaluate the technical efficiency of the PHCs using an input orientation. We used two inputs (number of clinical staff and number of facility inpatient beds) and four outputs (number of fully immunized children, outpatient attendance, antenatal care attendance, and facility deliveries). In the second stage, a Tobit regression model was used to assess the effect of the per-capita subnational allocation to health (PSAH), catchment area’s population (CAP), patient-reported quality of care (PRQoC), and patient-reported post-partum and newborn care (PPNC) on inefficiency among the PHCs.
resultsThe mean CRS and VRS efficiency scores of the 3,531 facilities were 11% (± 12%) and 30% (± 21%), respectively, with efficiency scores ranging from 1.2% to 100% for CRS and from 5.1% to 100% for VRS. The Tobit regression model showed that the exploratory variables assessed explain only 0.17% and 0.31% of the inefficiencies recorded by the CRS and VRS models among the PHC facilities. The Tobit regression model also showed that PPNC is significantly positively associated with VRS inefficiency, while the CAP and PSAH are significantly negatively associated with inefficiencies of health facilities. PRQoC was, however, not a significant determinant of the inefficiencies of health facilities.
conclusionOur study concluded that the level of efficiency of BHCPF-funded PHCs in Nigeria is very low. To improve the impact of BHCPF on Nigeria’s PHC system, there needs to be increased emphasis on efficiency. Efforts to improve efficiency should be consolidated by institutionalizing measurement of health facilities’ efficiency and tracking progress towards attaining health systems goals and universal health coverage.
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