Trends in Government Healthcare Budgets in Delta State, Nigeria, from 2018 to 2024: Implications for Universal Health Coverage

Background: Effective healthcare financing is crucial for Universal Health Coverage (UHC). Delta State's UHC efforts face funding and allocation challenges. This study analyses its healthcare budgeting from 2018 to 2024. Methods: It is a mixed-methods analysis of Delta State’s healthcare budget from 2018 to 2024, combined with extracts from a rapid qualitative assessment of residents' perceptions of executed healthcare projects and programmes relevant to UHC and SDG-3. Results: The healthcare budget increased by 152%, from ₦18.96 billion (2018) to ₦47.84 billion (2024), but remained below 5% of the state’s GDP of ₦4.05 – ₦4.87 trillion. It was less than 10% of the state's budget, peaking at 9.13% in 2020, below Abuja Declaration's 15% target. Personnel costs dominated the budget, capital expenditure rose post-2020, and overhead costs remained under 5%. Investment in the Delta State Contributory Health Commission dropped by 83%, while COVID-19 funding spiked to ₦2 billion in 2020. Infrastructure and equipment constituted most capital expenditure, peaking at 89.78% of the Total Health Expenditure in 2023. Overhead expenses varied, with hospitals seeing a 2,047% increase from ₦45 million in 2018 to ₦971 million in 2024. There was a focus on infrastructure and emergency responses, particularly during COVID-19, but these were not matched with sustainable funding strategies. Residents largely reported poor infrastructure and a lack of visible healthcare projects and interventions, indicating gaps between policy intent and community experience. Conclusion: To achieve UHC and health equity, Delta State must commit to increased and sustained healthcare financing, equitable resource distribution, and enhanced administration.