Donor Dependency and Fiscal Sustainability of Public Health Programs in Nigeria
Abstract
Public health programmes in Nigeria face growing threats to fiscal sustainability due to prolonged dependence on external donor financing. This study examined donor dependence and the fiscal sustainability of public health programmes in Nigeria during 2020–2025. Specifically, it investigated the effects of financial, programmatic, and commodity dependence on the fiscal sustainability of public health programmes in Nigeria. An explanatory research design was adopted, and secondary data were drawn from the Central Bank of Nigeria Statistical Bulletin, World Bank Development Indicators, and other relevant international health financing databases. Multiple regression analysis was used as the analytical technique. Findings showed that financial dependence had a positive and significant effect on the fiscal sustainability of public health programmes in Nigeria. Programmatic dependence had a significant negative effect on fiscal sustainability, indicating that overreliance on donor-driven programme structures undermines long-term stability in health financing. Commodity dependence also had a significant effect on fiscal sustainability, reflecting the vulnerability of supply chains to fluctuations in donor funding. The study concluded that while external donor support has contributed to health programme delivery in Nigeria, it has simultaneously created structural vulnerabilities that threaten long-term fiscal sustainability. The study recommended that the Nigerian government develop comprehensive transition plans for all donor-funded programmes, with clear financing milestones; strengthen domestic resource mobilization through health-specific taxes and expanded health insurance coverage; and institutionalize government ownership of health programme commodities and supply chains to reduce external dependence.