Abstract

Background: Understanding primary health care (PHC) financing requires examination of both the volume of resources reaching frontline providers and the institutional sources through which those resources are channelled. Objective: This study examined annual changes in verified facility receipts and the composition of financing in Imo State, Nigeria, from 2020 to 2024.

Methods: A retrospective longitudinal descriptive analysis was undertaken using administrative financing records for 304 PHC facilities across 27 local government areas. Annual totals, percentage changes, facility-level receipt coverage, source shares, and financing concentration and diversity indices were examined.

Results: Recorded receipts increased from ₦7.59 million in 2020 to ₦605.17 million in 2024, with an intervening decline from ₦95.79 million in 2021 to ₦58.80 million in 2022. The proportion of facilities recording positive receipts rose from 35.86% in 2020 to 98.68% in 2024. Patient payments represented all receipts captured in 2020, whereas the Basic Health Care Provision Fund (46.60%) and Imo State Health Insurance Agency (45.42%) jointly accounted for 92.02% of recorded receipts in 2024. Financing concentration declined as recorded sources diversified.

Conclusion: Facility records indicate substantial nominal growth and a pronounced compositional shift towards pooled institutional funding. These findings describe recorded inflows, not total system expenditure, real purchasing-power growth, insurance coverage or reductions in household financial hardship. Strengthening harmonised source-level reporting and linking financing flows to service outputs would improve assessment of reform performance.