Nigerian states have failed to meet up with the Abuja Declaration benchmark on healthcare in 2025 despite worsening pressure on public hospitals, a report by BudgIT has revealed.
The report also noted that the states had combined 2025 health allocation of ₦1.97 trillion out of a total budget of ₦26.52 trillion which is just 6.98 per cent. However, actual health expenditure was ₦1.18 trillion.
The Abuja Declaration had ratified that committed states to allocate at least 15% of their annual government budgets to the health sectors.
The report, titled Health Financing Report 2026, analysed health budget allocations, expenditure performance and financing patterns across 34 states in 2025 and proposed allocations for 35 states in 2026.
According to the report, only Borno State came close to the continental target by allocating 14.28 per cent of its total 2025 budget to health.
The report also showed that aggregate health spending across the 34 states accounted for only 6.98 per cent of total actual subnational expenditure, underscoring what it described as “low sectoral priority” for healthcare financing.
The combined 2025 health allocation by the states stood at ₦1.97 trillion out of a total budget of ₦26.52 trillion. However, actual health expenditure was ₦1.18 trillion, representing an average budget performance of 60.06 per cent.
States with highest and lowest spending performance
The report ranked Katsina State as the best-performing state in terms of budget execution after spending ₦82.81 billion against a health budget of ₦58.76 billion, translating to a performance rate of 140.92 per cent.
Yobe State followed with 99.89 per cent performance, while Delta State recorded 96.79 per cent.
Other high-performing states included Benue State, Bayelsa State, Edo State, Lagos State, Ondo State and Bauchi State.
In contrast, Cross River State recorded the worst performance, spending only ₦4.06 billion out of its ₦34.1 billion health allocation, representing 11.9 per cent implementation.
Other states with weak execution rates included Ogun State, Ebonyi State, Enugu State and Kebbi State.
“High allocation does not guarantee execution,” the report noted, citing Cross River as a major example of budget credibility concerns.
2026 projections show marginal improvement
For the 2026 fiscal year, states proposed a combined health budget of ₦3.33 trillion, representing 9.37 per cent of total proposed state budgets.
The report showed that Sokoto State proposed the highest health allocation ratio at 16.4 per cent, followed by Bauchi at 15.05 per cent, while Abia State and Yobe each allocated 15 per cent.
At the lower end were Ebonyi with 4.21 per cent, Cross River with 4.25 per cent and Ekiti State with 4.73 per cent.
The report observed that many states prioritised capital projects over recurrent health spending because infrastructure projects often provide greater political visibility.
For instance, Kano State proposed ₦131.85 billion for capital health projects compared to ₦82.99 billion for recurrent expenditure, while Ogun budgeted ₦145.94 billion for capital projects against ₦67.09 billion recurrent spending.
Per capita disparities widen inequality
The report also highlighted sharp inequalities in per-capita health spending among states.
Bayelsa recorded the highest per-capita health spending at ₦16,386, followed by Lagos with ₦10,812 and Delta with ₦8,390.
However, heavily populated states recorded much lower figures despite large nominal allocations. Kano spent ₦3,583 per resident, while Kaduna State recorded ₦2,978.
Cross River posted the lowest per-capita health spending at ₦808.
According to the report, states with smaller populations and stronger budget execution rates achieved better per-person investment outcomes than densely populated states.
The report warned that Nigeria could face worsening health financing challenges if states continue to rely heavily on donor support amid declining global official development assistance.
It stressed that domestic resource mobilisation and stronger political commitment would be critical to improving healthcare delivery.
“Health financing outcomes are driven more by political will and governance discipline than by revenue size alone,” the report stated.
The report further raised concerns over disparities in health workforce spending. Lagos budgeted ₦116 billion for health personnel in 2026, while Cross River and Ebonyi allocated less than ₦4 billion each.
