Poor accountability and corruption in primary healthcare in Nigeria: sub-national governance deficiencies matter

TY - JOUR

T1 - Poor accountability and corruption in primary healthcare in Nigeria

T2 - sub-national governance deficiencies matter

AU - Agwu, Prince

AU - Orjiakor, Charles

AU - Odii, Aloysius

AU - Ogbozor, Pamela

AU - Hutchinson, Eleanor

AU - McKee, Martin

AU - Onwujekwe, Obinna

AU - Balabanova, Dina

N1 - © 2026 The Author(s).

PY - 2026

Y1 - 2026

N2 - The formal structures in a health system, characterized by the enforcement of rules and regulations, effective human resource management, and adequate funding, are critical contributors to effective governance and optimal health service delivery. Conversely, shortcomings in these domains could lead to poor accountability and corruption within the system. Therefore, this study assesses the state of Nigeria’s subnational governance structures that are conventionally and increasingly responsible for primary healthcare (PHC) delivery. In this qualitative phenomenological study, we conducted and analyzed interviews with senior managers within the PHC system. We found significant informalities and deficiencies in four areas: (a) absence of local interest in strengthening PHC, (b) weak documentation and enforcement of written rules, (c) poor practices and processes of human resource management, and (d) erratic financing of PHC. These deficiencies are seen to encourage the continuation of corruption and weaken institutional capacity to provide effective PHC. We argue that investing in PHC without first addressing these deficiencies as key aspects of subnational governance may result in wasted resources. Based on our findings, we present critical areas to consider for a well-governed PHC system to enhance accountability and address corruption at the healthcare level. The findings of this study are now more important than ever, particularly in light of a Supreme Court ruling on the autonomy of Local Government Areas (LGAs) in Nigeria and the push for state governments to ensure effective PHC services. The study demonstrates critical areas for strengthening the subnational administration of primary healthcare institutions across low- and middle-income countries (LMICs).

AB - The formal structures in a health system, characterized by the enforcement of rules and regulations, effective human resource management, and adequate funding, are critical contributors to effective governance and optimal health service delivery. Conversely, shortcomings in these domains could lead to poor accountability and corruption within the system. Therefore, this study assesses the state of Nigeria’s subnational governance structures that are conventionally and increasingly responsible for primary healthcare (PHC) delivery. In this qualitative phenomenological study, we conducted and analyzed interviews with senior managers within the PHC system. We found significant informalities and deficiencies in four areas: (a) absence of local interest in strengthening PHC, (b) weak documentation and enforcement of written rules, (c) poor practices and processes of human resource management, and (d) erratic financing of PHC. These deficiencies are seen to encourage the continuation of corruption and weaken institutional capacity to provide effective PHC. We argue that investing in PHC without first addressing these deficiencies as key aspects of subnational governance may result in wasted resources. Based on our findings, we present critical areas to consider for a well-governed PHC system to enhance accountability and address corruption at the healthcare level. The findings of this study are now more important than ever, particularly in light of a Supreme Court ruling on the autonomy of Local Government Areas (LGAs) in Nigeria and the push for state governments to ensure effective PHC services. The study demonstrates critical areas for strengthening the subnational administration of primary healthcare institutions across low- and middle-income countries (LMICs).

KW - Accountability

KW - corruption

KW - governance

KW - informalities

KW - local government

KW - primary healthcare

UR - https://www.scopus.com/pages/publications/105033394377

U2 - 10.1080/23288604.2026.2630426

DO - 10.1080/23288604.2026.2630426

M3 - Article

C2 - 41855497

SN - 2328-8604

VL - 12

JO - Health Systems and Reform

JF - Health Systems and Reform

IS - 1

M1 - 2630426

ER -