Decentralisation of Health Services and Local Governance in Gombe State

This study evaluates the decentralisation of primary health care services to the local government level in Gombe State, assessing whether devolved management authority has improved service accessibility, quality, and accountability in a state facing significant health burden from communicable and non-communicable diseases. Primary health care decentralisation has been a centrepiece of Nigerian health policy reform, yet the gap between policy design and implementation outcomes remains substantial across many northern states. Using a mixed-methods design, the study combines quantitative analysis of primary health care utilisation data from 120 facilities across Gombe State's eleven local government areas with qualitative interviews involving local government health authority officials, facility managers, and community health workers. The health decentralisation framework and the fiscal federalism approach to service delivery are applied to evaluate management arrangements. Findings reveal that while Gombe State has made structural progress in devolving primary health care management to local government health authorities, the substance of decentralisation is undermined by continued central control of procurement, inadequate local fiscal transfers, and weak local government technical capacity for health planning and supervision. Community health workers report significant supply chain failures that leave facilities without essential medicines for weeks at a time. The North East geopolitical context of Gombe State, including its proximity to conflict-affected areas, creates additional demands for resilient health service delivery. Recommendations include formula-based health grants with transparent transfer conditions, local government health management training programmes, and community health committee accountability mechanisms. Keywords: health decentralisation, local governance, Gombe State, primary health care, service delivery