Devolution and Health Sector Performance in the North Central Geopolitical Zone of Nigeria

This study empirically examines the relationship between devolution of health sector authority to state and local governments and health performance outcomes in Nigeria's North Central geopolitical zone, encompassing Benue, Kogi, Kwara, Nasarawa, Niger, and Plateau States. Decentralisation in the Nigerian health sector was intended to improve responsiveness and local resource mobilisation, yet health outcomes in the North Central zone remain below the national median. A multi-state comparative design employing panel data from 2018 to 2023 is used, drawing on health management information system (HMIS) data from state ministries of health and local government area reports. Devolution indices constructed from budget autonomy, staffing authority, and programmatic decision-making variables serve as independent variables, while child immunisation rates, outpatient utilisation, and facility delivery rates are used as dependent health outcome variables. Fixed effects panel regression is the primary estimation strategy. The Decentralisation Theory and the Health System Performance Framework provide the theoretical anchors. Findings reveal that fiscal devolution positively predicts health outcome improvements, while administrative devolution without corresponding financial resources has no significant effect. Plateau and Kwara States with the highest fiscal decentralisation scores recorded the best health outcome improvements over the study period. The study contributes original panel evidence on the health-decentralisation nexus in sub-national Nigeria. Keywords: devolution, health sector performance, North Central Nigeria, decentralisation, health outcomes.