Abstract

This study examined the political, economic, and institutional factors influencing health budget implementation and expenditure performance in North-Eastern Nigeria between 2021 and 2024. Specifically, it investigated the influence of political will on health budget execution rates, assessed the effect of security challenges on capital health budget deviations, and determined the effect of the timeliness of fund releases on unspent health budget allocations in selected states. An ex post facto research design was adopted, using secondary data obtained from state budget implementation reports, Ministries of Finance, Auditor-General reports, and relevant institutional databases. The data were analysed using Panel Least Squares regression. The descriptive results revealed an average health budget execution rate of 61.25%, an average capital health budget deviation of 29.78%, and average unspent health allocations of 22.16%. The regression results showed that political commitment to health had a positive and statistically significant influence on health budget execution (β = 2.714, p < 0.001). Security challenges also had a positive and significant effect on capital health budget deviation (β = 0.518, p < 0.001), indicating that increasing security pressures were associated with greater deviations in capital health expenditure. Similarly, the timeliness of fund release significantly influenced unspent health allocations (β = 3.104, p < 0.001). The findings demonstrate that health budget performance in North-Eastern Nigeria is shaped not only by the size of approved healthcare budgets but also by the political and institutional environment within which public health expenditure is implemented. The study concludes that strengthening political commitment, improving security coordination, ensuring timely release of approved health funds, and enhancing institutional accountability are essential for improving healthcare financing, budget execution, and public health expenditure outcomes in North-Eastern Nigeria.