Learning

Improving Budget Credibility in Nigeria’s Health Sector: Lessons from Civil Society-Led PFM Reform

Primary health care (PHC) services in Nigeria continue to face persistent challenges, particularly in immunization, cold-chain maintenance, outreach, and adequate staffing. Governments approve budgets to support these services, yet funds do not always translate into timely service delivery in health centers and clinics. What explains the gap between approved PHC budgets and services on the ground?

Developed through IBP’s Budget Credibility Initiative in Nigeria across Oyo, Ogun, and Niger states, this Learning Note explores how civil society analyzed PHC and immunization budget implementation and used evidence to better understand and address key public financial management (PFM) bottlenecks affecting frontline health services.

It demonstrates how civil society engagement can help translate technical budget analysis into reforms that improve the reliability of public spending on essential health services. Drawing on the experience of civil society partners engaging with government stakeholders, including State Ministries of Health, Ministries of Finance and Budget and Economic Planning, State Primary Health Care Boards (SPHCBs), and the Bureau of Public Procurement (BPP), as well as organizations such as BudgIT, the Justice Development and Peace Commission (JDPC), and the Federation of Muslim Women’s Associations in Nigeria (FOMWAN), the analysis shows how partners combined budget execution tracking, facility-level verification, and multi-stakeholder convenings known as PFM Action Labs, alongside a simple one-page reconciliation note to trace where resources stalled from approval to release, commitment, and expenditure.

The lessons highlight practical ways to use evidence on budget execution to support structured dialogue and joint problem-solving between civil society and government. By identifying specific execution bottlenecks and clarifying institutional responsibilities, partners were able to advance reforms that improve PHC budget reliability and strengthen the delivery of services to communities.

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Authors

Sally Torbert

Global Lead, Policy and Research, International Budget Partnership

Sally Torbert is the Global Lead for Policy and Research at the International Budget Partnership (IBP), based in Zagreb, Croatia. She provides strategic leadership for the design, implementation, and delivery of IBP’s global research and policy agenda, including the Open Budget Survey and multi-country initiatives on public finance and accountability. She leads the design of approaches that connect research, advocacy, and implementation across countries, oversees research design, methodology and quality assurance, and leads the translation of evidence into advocacy, capacity development, and engagement with governments, civil society, and other accountability actors. She leads and supports the policy and research teams responsible for delivering these initiatives.

Before joining IBP, Sally worked as a public sector and governance specialist with the World Bank, DAI, UNCDF, UNDP, and other international organizations. Her work focused on public financial management, fiscal decentralization and local governance, institutional coordination and capacity strengthening, service delivery and public sector effectiveness, and community and civil society engagement in monitoring public resources and holding institutions accountable in Afghanistan, Lao PDR, Nepal, Mozambique, and Timor-Leste. She has managed complex governance programs and multidisciplinary teams, designed and delivered capacity development for government and civil society actors, and advised on municipal budgeting, intergovernmental transfers, donor coordination, and the integration of public financial management into sector and governance reforms.

Sally holds a Bachelor’s degree from Princeton University and a Master of Arts in Law and Diplomacy from the Fletcher School at Tufts University.

Onyekachi Chukwu

Senior Program Coordinator, Nigeria, International Budget Partnership

Onyekachi is a recognized expert in various domains, including public finance management, citizen mobilization, and design research. Prior to joining IBP, he played a pivotal role in advocating for the adoption of the Open Contracting Data Standards (OCDS) in Nigeria’s public procurement processes at the federal level and he subsequently led the advocacy for its adoption in 10 subnational States. These Open Contracting portals have enhanced increased citizens access to government budget and contract information, enabling citizens make more informed decisions and hold their representatives accountable.

As a community engagement expert, Onyekachi has spearheaded community town halls across Africa, empowering youths to become community-based monitors, meticulously tracking budgets and contracts resulting in improved transparency and accountability at the local level. One of his notable contributions has been building the capacity of youth as community-based monitors by equipping them with the necessary skills to track and report on budgets and contracts in their communities. On a broader scale, Onyekachi has made significant impacts in collaboration with international organizations. He supported the World Bank’s SFTAS project by assisting states in Nigeria in meeting Disbursement Linked Indicators, leading to improved citizens budgeting and increased transparency and accountability in procurement processes through Open Contracting.

Additionally, his work with the UNDP on the Anti-Corruption Innovation Project (ACIP) has been instrumental in building the capacity of state and non-state actors, techpreneurs, and media professionals. They have been empowered to utilize open contracting portals for monitoring budgets and contracts and reporting infractions in Nigeria, contributing to anti-corruption efforts. Onyekachi also served as the Advocacy and Network Engagement Coordinator at the Africa Freedom of Information Centre (AFIC) in Uganda, contributing to several projects, spanning access to information, election transparency, freedom of expression, digital rights, data protection and safety for whistleblowers. On the academic front, Onyekachi holds a master’s degree in international relations, complemented by a master’s (in view) in project management from the University of Applied Sciences in Germany.

Faith Pienaar-Ngani

Global Learning, Monitoring and Evaluation Lead, International Budget Partnership

Faith brings more than a decade of civil society experience and is driven to develop adaptive and practical monitoring and evaluation systems that are useful to the people and partners who implement them. She joined IBP as the Global Learning, Monitoring and Evaluation (LME) Lead in August 2024 and is based in South Africa. Faith provides strategic direction and overall management for organisation-wide learning, monitoring, and evaluative work, working with program teams to align LME efforts with IBP’s overall strategy, and oversees LME across all programs.

Before joining IBP, Faith was the Impact and Accountability Officer at CIVICUS, World Alliance for Citizen Participation, where she was responsible for strategic impact measurement and MEL systems strengthening across a portfolio of donor-funded programs. She designed and implemented an internal Smartsheet-based MEL system to support the Alliance in surfacing and evidencing progress against its Theory of Change, and co-developed CIVICUS’s Integrated Results Framework and subsequent learning and measurement frameworks.

As a Strategic Facilitator, Faith has also supported teams at the Bill and Melinda Gates Foundation, Rockefeller Philanthropy Advisors, and Oxfam International in delivering high-level, in-person convenings. Faith is an Abe Bailey Fellow and an alumna of the South Africa Washington International Program.

Emmanuel Attramah

Learning and Knowledge Management Program Coordinator, International Budget Partnership

Emmanuel Attramah is a Learning, Knowledge Management, and Communications professional with expertise in designing and implementing systems to capture, store, share, and apply knowledge to drive impact. He joined IBP in April 2025 as the Learning and Knowledge Management Coordinator and is based in Ghana.

In this role, Emmanuel works closely with program teams, ensuring that key learnings from IBP’s work are effectively documented, leveraged, and shared to advance public budget systems that work for all people.

Before joining IBP, he held Knowledge Management and Communications advisory roles at leading international NGOs, including Democracy International, Jhpiego, and the International Republican Institute in Ghana. He holds a Master of Arts in Communication Studies and a Bachelor of Arts in Psychology from the University of Ghana.

About this resource
Related topics & Initiatives
Advocacy, Budget Analysis, Budget Credibility, Citizens Budget, Fiscal Policy, Water and Sanitation
Related Countries & Regions
Nigeria, Sub-Saharan Africa

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