This technical policy brief critically examines the disconnect between Anambra State’s public budget allocations and the persistent deficiencies in water, sanitation, and hygiene (WASH) facilities across Primary Healthcare Centers (PHCs) in three key local government areas. Conducted by the African Centre for Leadership, Strategy & Development (Centre LSD), with support from IBP Spark, the study delves into the root causes of poor health service delivery in Aguata, Idemili South, and Nnewi South LGAs.
Using data from budget reviews (2014–2020), field assessments, and stakeholder interviews, the report uncovers systemic neglect in WASH infrastructure despite years of budgetary promises. For instance, despite budgeting approximately ₦11.89 billion for healthcare infrastructure between 2014 and 2020, actual implementation fell drastically short, with only a fraction of funds spent. Water projects targeting the focal LGAs were sparse, poorly implemented, and often entirely absent in execution.
The assessment revealed alarming deficiencies: most PHCs lacked potable water, functional toilets, sewage systems, and waste disposal facilities. In some cases, patients were required to bring or buy water, and toilets were either unusable or nonexistent, forcing open defecation near health facilities. The report links these sanitation gaps directly to poor health outcomes and erosion of trust in public healthcare.
Beyond documenting infrastructure gaps, the brief provides a sharp critique of Anambra State’s budgeting culture. While revenue collection exceeded 99% between 2015–2019, the health sector’s average budget performance was only 41%, with capital budget performance dipping as low as 6.96% in 2018. Recurrent expenditures consumed up to 74% of health spending in some years, leaving minimal investment in facility improvement.
This policy brief is not only a diagnostic tool but a strategic advocacy document calling on Anambra State Government, civil society, and development partners to urgently align fiscal policy with frontline healthcare realities, where clean water and safe sanitation are as essential as medicine itself.
