Abstract

Background: Increasing primary health care (PHC) financing does not necessarily ensure sufficient resources at service-delivery points or an equitable distribution of funds.

Objective: This study examined recorded budget coverage and financing dispersion across PHC facilities and local government areas (LGAs) in Imo State, Nigeria, during 2020–2024.

Methods: A retrospective descriptive analysis was undertaken using administrative financing records for 304 facilities across all 27 LGAs. Verified receipts were compared with recorded facility budgets, and funding distributions were summarised using totals, per-facility averages, coefficients of variation (CVs) and Gini coefficients.

Results: Verified receipts represented 15.36% of recorded facility budgets in 2020, 96.86% in 2021 and 58.51% in 2022. Ratios exceeded 100% in 2023 and 2024. Across 2020–2024, recorded receipts totalled ₦1.21959 billion. Financing was more dispersed across individual facilities (CV 50.62%; Gini 0.264) than across LGA aggregates (CV 22.39%; Gini 0.124).

Conclusions: Administrative records reveal substantial temporal instability in budget coverage and greater dispersion at facility level. However, recorded budgets are not validated measures of service-delivery requirements, and funding inequality cannot establish inequity without population, workload and need indicators. Government should shift from allocation-based assessments of funding equity to needs-adjusted assessments of resource adequacy and distributional fairness.