INTERVIEW: How Nigeria is strengthening PHCs, developing local vaccine production

Nigeria’s primary health care system has long faced challenges, from underfunded facilities and staff shortages to service delivery and immunisation coverage gaps.

In this exclusive interview, Muyi Aina, the executive director and chief executive officer of the National Primary Health Care Development Agency (NPHCDA), discusses how Nigeria is strengthening primary health centres and developing local vaccine production. He outlines efforts to improve facilities, expand the frontline health workforce, and ensure the Basic Health Care Provision Fund (BHCPF) reaches the communities that need it most.

PT: The NPHCDA has been leading efforts to revitalise primary health centres nationwide, but many communities still report non-functional facilities. What concrete steps is the agency taking to ensure that revitalisation goes beyond infrastructure to include staffing, equipment, and service delivery?

Aina: Thank you very much, you have raised an important point. There are over 30,000 public primary health centres across Nigeria. Over the past few years, the federal government has identified about 8,300 of them to receive direct operational funding through the Basic Health Care Provision Fund (BHCPF).

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These facilities were selected based on fairness, equitable distribution, functionality, and quality. So, by definition, historically, these are the best of the facilities. When we came on board two years ago, only about one-fifth of those facilities met the criteria for being fully functional. We looked within our environment to determine, what do we call a fully functional PHC? Of course, there is the World Health Organisation’s definition of a functional PHC and other global standards, but when you contextualise that for us, we made a call that there are several requirements for a PHC to be called fully functional.

One is a decent, dignified building suitable for patient care. Two, there should be a minimum complement of health workers, including at least four skilled birth attendants, and a residence on-site to provide 24-hour service. The third is to have a reliable backup power supply to support continuous operations. The fourth one is for the facility to have adequate equipment and number five is to have functional water and sanitation facilities, including separate toilets for men and women, and accessibility for persons with disabilities.

You’ll agree this is a big leap from where many PHCs are. In the past couple of years, under the leadership of President Bola Tinubu, about 1,640 PHCs have been refurbished or upgraded, in partnership with states and the World Bank. Combined with those already in good shape, we now have around 3,500 relatively functional facilities—still far from the 30,000 total.

So yes, most facilities are still below standard, but we’re on a transformation journey. The PHC system had been neglected for a very long time, with no money invested in it and people were not being coordinated. This is the first time the government is working in a coordinated way to improve PHCs. So, we are moving as fast as we can to ensure we get PHCs to the most achievable standard.

It’s also important to clarify that it is not the responsibility of the federal government or NPHCDA to revitalise PHCs. We develop it, but we don’t own these facilities; they belong to the states and, in some cases, local governments. The delivery of services at that level is, structurally, by our health system, a responsibility of the subnational government. The federal government provides coordination, technical guidance, funding support, and oversight.

Because there are many gaps, we have intervened federally to complement state and local efforts. President Bola Tinubu has also signed a compact with states and development partners to jointly invest in improving PHC quality. States are now more involved, but we must accelerate the pace together.

PT: Nigeria faces an ongoing shortage of health workers at the primary care level, worsened by migration and poor working conditions. How is the NPHCDA addressing the retention and motivation of frontline health workers, especially in rural or hard-to-reach areas?

Aina: I agree with you that there is a need to focus on improving the health workforce. However, this is at multiple levels. This is to ensure we have enough health workers, the competence and skills to function effectively, and also to ensure they are retained in the facility.

Regarding having more health workers, we have created programmes and incentives for states and local governments to hire more staff.

The NPHCDA doesn’t directly hire PHC workers anymore. That responsibility now lies with states, and we’re supporting them with resources to pay salaries. So far, about eight states have hired thousands of new skilled birth attendants to work in health facilities. These states are: Kaduna, Yobe, Borno, Ebonyi, Adamawa, Kwara, Ogun and Plateau. Others are in various stages of their recruitment process.

We’ve also re-established a community-based health worker cadre. These workers provide basic services within communities, especially for people who can’t reach PHCs, under strict supervision and standard protocols. Five or six states have already begun recruitment.

In addition, the federal government has doubled the training capacity of health institutions nationwide. President Tinubu, who also serves as the African Union’s champion for community health workers, has mandated us to retrain 120,000 frontline health workers. As of last week, we had completed training for over 70,600, and the next batch is planned. Selection of these health workers is based on a few criteria: they must be employed in a government facility (not volunteers), prioritised for maternal and newborn care, and licensed professionals. We typically select three or four per facility that provides delivery services.

We’re also digitising these trainings so that health workers can access them easily and affordably on their phones.

We’re also improving motivation through better working conditions. In partnership with the Renewed Hope Initiative led by the First Lady, Oluremi Tinubu, 60,000 health workers have received new protective kits like scrubs, shoes, and uniforms. Many workers have expressed excitement about this support.

We’re also promoting on-site accommodation for health workers in remote or insecure areas so they can stay safely after night shifts. Through the BHCPF, facilities can now pay performance-based incentives to retain staff, especially in rural areas.

These combined measures are helping morale and, over time, should improve retention.

**The Executive Director and Chief Executive Officer of the National Primary Health Care Development Agency, Muyi Aina.**

PT: Despite progress in routine immunisation, coverage still varies widely between states. What innovative approaches is the agency implementing to close these gaps and reach zero-dose children, particularly in insecure or underserved regions?

Aina: According to the 2023–2024 Nigeria Demographic and Health Survey (NDHS), the Penta 3 coverage, which is the standard metric that is used to assess routine immunisation in Nigeria, was put at 53 per cent. That means nearly half of Nigerian children haven’t received their third dose of the pentavalent vaccine. The performance varies by state; some states are as high as 80 per cent, while others are below 10 per cent.

We’ve mapped areas with large numbers of “zero-dose” children and are conducting targeted interventions by enumerating, line-listing, and vaccinating these children one by one. In the first phase of our campaign, over 300,000 previously unvaccinated children were reached.

We’re also implementing the “Big Catch-up” initiative, targeting children who missed basic immunisations. Our integrated measles, rubella, and polio campaign aims to reach over 106 million children nationwide, and we are on target to achieve that. So far, 21 states have been covered, and the rest will follow early next year.

All of these efforts are to cover existing gaps in vaccination coverage to reduce the number of outbreaks and deaths from vaccine-preventable diseases. In security-compromised areas, we’re working with security forces to ensure safe delivery of vaccines.

PT: Nigeria has discussed vaccine production for years, yet progress has been slow. What practical steps are currently underway to ensure that local manufacturing moves beyond talk to actual implementation?

Aina: Several years ago, Nigeria produced yellow fever and even rabies vaccines, but that was abandoned for quite a while. Vaccine production is highly technical as it involves live organisms and complex processes. There have been discussions on this before now, and maybe even efforts in that direction. However, what this government has done is accelerate that effort through the Presidential Value Chain Initiative in Health. We’re partnering with global vaccine manufacturers to transfer technology and begin producing basic vaccines suited to Nigeria’s needs.

Part of the problem that has made it not sustainable in the past is that the process and the cost to establish vaccine manufacturing require a large market to buy from for it to be worth it. To make this sustainable, we’re collaborating with other African countries to build a continental market. Each country will specialise in certain vaccines to achieve economies of scale.

Building the facilities, transferring technology, and obtaining rigorous licensing takes time to ensure global-quality standards. We’re proceeding carefully to protect public confidence in vaccines.

PT: Are you optimistic that Nigeria will eventually produce its own vaccines?

Aina: I’m almost certain because we do not have a choice at this point. As the number of children is increasing, as our vaccine portfolio has expanded, the cost of buying and importing those vaccines is becoming more and more difficult for us to meet.

So, it’s economically and strategically necessary. Local production means we can pay in Naira and reduce dependence on foreign currency. Moreso, it also ensures supply security. During COVID-19, many countries prioritised their citizens first, leaving others waiting. We don’t want to be in that situation again.

PT: Vaccine hesitancy remains an issue in Nigeria, and it’s now being fuelled by some assumptions that the COVID-19 vaccine causes infertility in Women. What’s your take on this?

Aina: That assumption is completely false. There is no scientific evidence linking the COVID-19 vaccine to infertility, none at all. Infertility affects both men and women for many well-established medical reasons, but vaccination isn’t one of them. Unfortunately, we have a cadre of health workers who don’t follow the science and the evidence. The prevalence, causes, and remedies of infertility are well known, and the COVID-19 vaccine has no link to this. The components of the vaccines are publicly available and have no connection to reproductive organs or hormones.

It’s also important to remember that correlation isn’t causation. Someone could take a vaccine and later fall ill or have an accident; that doesn’t mean the vaccine caused it. Vaccines may have mild side effects like pain or fever, but they prevent severe diseases and save lives.

Many myths about vaccines persist, often spread by people who overlook scientific evidence. We’ve seen tragedies where parents refused vaccines for measles or polio and their children suffered lifelong consequences.

Everyone has the right to choose, but such decisions should be based on credible evidence, not misinformation. Vaccines remain one of the most effective public health tools in history.

PT: The NPHCDA is a key gateway for the Basic Health Care Provision Fund. Can you share how much the agency has received and disbursed so far under the fund, and what proportion has directly reached primary health facilities?

Aina: The Basic Health Care Provision Fund (BHCPF) is the anchor fund for Primary Health Care services in Nigeria, and it’s disbursed through four gateways. The largest is the National Health Insurance gateway, which takes about half the funds. That portion provides financial protection for vulnerable groups, offering free maternal and child health services in many states, including free caesarean sections for pregnant women.

The second is the NPHCDA gateway, which focuses on ensuring the service readiness of health facilities. Through this channel, funds are sent directly to PHCs every quarter to help keep the lights on, maintain essential operations, procure basic supplies, and hire ad hoc staff where necessary.

Since we came on board in the last two years, we’ve disbursed N50.8 billion under the BHCPF. For Q1 and Q2 of 2025, N14.01 billion was disbursed through our gateway, and these funds have gone directly to the health facilities.

For Q3, you might have heard about the Minister’s Red Letter and the N32.9 billion he mentioned for all four gateways. That allocation is currently being finalised. The slight delay is because the government made additional funds available, allowing us to expand the number of supported facilities and increase the amount each facility receives. We can add about 5,212 PHCs to the existing 8,300 based on our calculations.

PT: Several reports indicate that disbursement of BHCPF funds to states and facilities has often been delayed or inconsistent. What are the major challenges causing these delays, and what steps is the agency taking to ensure the timely and transparent release of funds?

Aina: I think it’s important to put this in context. We all want to see funds reach facilities efficiently, but we also have to ensure that public resources are properly accounted for and not wasted. In our environment, funds can easily be misused or spent on non-priority items if there aren’t the right checks and balances.

So, what we require is that each facility account for how the funds they previously received were used. We then review those reports on a facility-by-facility basis before making the next disbursement. That verification process can sometimes lead to delays.

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In this particular instance, as I mentioned earlier, we’re also implementing a few key changes. We recently launched new BHCPF guidelines that increase both the number of participating facilities and the amount allocated to each one. We’re also working closely with states and local governments to determine how the additional facilities will be distributed. These adjustments take some time, but getting them right is important as we don’t want to be careless with public funds.

To minimise delays going forward, we’re digitising more of our processes and leveraging technology to improve transparency and efficiency. We’re currently rolling out the PHC Financial Management System across facilities to make disbursement faster and more accountable.

PT: Beyond the financial releases, what mechanisms does the NPHCDA have to track whether BHCPF funds are improving service delivery at the facility level — especially in rural or hard-to-reach areas?

Aina: We have several mechanisms to ensure funds are used effectively. First, we routinely review facility reports before disbursing additional funds. We also have Performance and Financial Management Officers in every local government, who check the books, provide technical assistance to states on fund application, and verify all submitted information.

In addition, we partner with the Independent Corrupt Practices Commission (ICPC), which conducts checks in selected areas with potential concerns, and reports back to us.

Very importantly, we are rolling out a Financial Management App that limits the amount of cash facilities can withdraw and encourages them to transfer funds electronically for all expenses. This allows us to track how money is spent in real time.

We believe that combining these approaches will significantly reduce the incidence of fraud and ensure that BHCPF funds are improving service delivery across all facilities, including those in rural and hard-to-reach areas.