Functionality assessment of primary healthcare services in Ebonyi State under the basic healthcare provision fund

Primary Healthcare (PHC) constitutes the foundation of Nigeria’s health system and is critical to achieving Universal Health Coverage (UHC). Despite several reforms, PHC performance has historically been constrained by inadequate financing, shortages of skilled health workers, infrastructure deficiencies, and weak medicine supply chains. The Basic Healthcare Provision Fund (BHCPF) was introduced to address these systemic gaps; however, empirical evidence on the functionality of PHC services under the BHCPF at subnational level remains limited.

The aim of the study was to assess the functionality of primary healthcare services in Ebonyi State under the BHCPF and to examine the influence of essential drug availability, healthcare workforce adequacy, and effectiveness of BHCPF implementation on perceived quality of care and patient satisfaction.

A facility-based cross-sectional study with quantitative survey and qualitative Key Informant Interviews (KIIs) was conducted in 2023 across BHCPF-supported PHCs in Ebonyi State. Quantitative data were collected exclusively from healthcare workers and facility managers (n=200) using a 5-point Likert-scale questionnaire. Staff-reported patient satisfaction was measured as a proxy outcome and dichotomised at mean score ≥3.5 versus <3.5. Multivariable linear and logistic regression models adjusted for age, gender, and professional role were performed. Qualitative data were obtained through key in-depth Interviews on a sample of managers of health facilities and Coordinators of Local Governments. Qualitative data was processed through thematic analysis.
Of the 212 questionnaires distributed, 200 were valid for analysis (response rate 94.3%). Healthcare workforce adequacy and availability of essential drugs emerged as the strongest independent predictors of perceived quality of care (β=0.42 and β=0.35; p<0.001). Patient satisfaction was significantly associated with workforce adequacy (OR=2.50), essential drug availability (OR=2.10), and effectiveness of BHCPF implementation (OR=1.60).

BHCPF implementation has contributed positively to PHC functionality in Ebonyi State, particularly through improved access to essential medicines and workforce support. Sustained financing, strengthened accountability mechanisms, and equitable scale-up across PHCs are necessary to consolidate gains and accelerate progress towards UHC.