Implementation Fidelity of the Basic Health Care Provision Fund in Selected States Across Nigeria’s Geopolitical Zones

The Basic Health Care Provision Fund represents a landmark financing mechanism under Nigeria's National Health Act of 2014, intended to improve funding for primary healthcare services. This study assesses the implementation fidelity of the Basic Health Care Provision Fund across six selected states representing Nigeria's geopolitical zones, examining governance compliance, fund disbursement timeliness, service coverage expansion, and community accountability structures. A cross-sectional multi-state evaluation design is applied, involving document review, key informant interviews with state health commissioners and local government health officers, and facility-level surveys in 48 primary healthcare centres. Data from the National Primary Health Care Development Agency scorecard and state implementation plans are triangulated with qualitative interview data. Quantitative data are analysed in SPSS, while qualitative findings undergo framework analysis. Preliminary evidence from the National Primary Health Care Development Agency 2022 annual report indicates significant variation in fund absorption rates across states, with northern states reporting greater fiduciary challenges compared to southern counterparts. The Consolidated Framework for Implementation Research informs the evaluation approach, examining inner and outer implementation contexts. Findings will provide policy-relevant evidence for the Federal Ministry of Health on strengthening fund governance structures and accountability mechanisms at state level. Keywords: Basic Health Care Provision Fund, implementation fidelity, primary healthcare financing, Nigeria, health policy.