From gaps to gains: How Nigeria’s Kano State is building budgeting capacity for sustainable health reform

Across the globe, transformative health reforms are increasingly rooted in sound public financial management (PFM) systems. Nowhere is this more crucial than in subnational contexts, where the power to plan, prioritize and allocate budgets effectively determines whether health strategies translate into real-world outcomes.

In Kano State, Nigeria, the Planning and Budget (P&B) Committee of the Ministry of Health has emerged as a key engine of this transformation. Our recent experiences supporting this Committee as part of a Results for Development (R4D) technical assistance program reveals not just progress but promise — a story of intentional reform, collaborative learning and the slow but steady maturation of PFM capacity within the health sector.

The imperative: Strengthening budget institutions for health impact

The global health financing discourse has evolved from mere allocation to value-based budgeting, fiscal realism and performance-informed budgeting. But effective budgeting is about more than how much money is spent; it’s about how well those funds are deployed, and much of that effectiveness is reliant upon institutional capacity.

In Kano State, R4D’s Budget Process Reforms Capacity Assessment diagnosed the foundational strengths and limitations of the P&B Committee. The results were revealing: the Committee’s current budget formulation skills scored a modest 1.84, falling just below intermediate proficiency. More promising was its capacity for budget monitoring, which scored a 2.29, suggesting potential with targeted support.

Critically, the Committee also demonstrated a strong aspirational trajectory, scoring 2.99 and 3.29 as their respective desired competency levels in budget formulation and monitoring. This gap between current and desired capacity created a fertile ground for focused intervention.

The prescription: Tailored capacity building rooted in PFM best practices

Drawing lessons from countries such as Rwanda and Kenya, where structured PFM reforms helped institutionalize sector-wide approaches (SWAps), we knew that building budgeting capacity required more than a one-off workshop. It needed a comprehensive, adaptive strategy.

We deployed a Capacity Building Framework aligned with PFM good practices and tailored to Kano’s unique health financing ecosystem. The components included:

• Hands-on training grounded in sector-specific fiscal dynamics
• Mentorship and coaching, promoting applied learning and continuity
• Technical backstopping, ensuring real-time support
• Knowledge sharing sessions with peer states (e.g., Kaduna and Lagos)
• Monitoring & Evaluation (M&E) mechanisms to track progress and adapt strategies

The transformation: From capacity gaps to tangible gains

The first capacity-building session was a turning point. It focused on the Annual Operational Plan (AOP) and budget development—a critical intersection between health priorities and fiscal planning. Topics spanned from the Sector-Wide Approach (SWAp), AOP toolkits, and Key Performance Indicators (KPI) development, to cost estimation techniques and stakeholder engagement.

The results were powerful:

• 100% of participants reported improved understanding across all thematic areas
• 86% recorded significant knowledge gains on the linkage between State Development Plans (SDPs), HSS blueprints and budgeting
• KPI development — previously the weakest link (mean score: 1.29) — witnessed a 46% significant and 54% moderate improvement
• Budget drafting, costing and stakeholder engagement skills improved by over 68% across the board

The second training, focused on budget analysis, advanced the Committee’s ability to assess budget credibility, efficiency and performance — a hallmark of performance-based budgeting (PBB).

Using an Excel-based budget analysis tool, participants were taught how to interpret fiscal indicators, compute execution rates, evaluate alignment with strategic plans, and communicate budget insights effectively. The post-training evaluation revealed that 82% of participants demonstrated significant knowledge gains.

This training opportunity also led to the establishment of a P&B Community of Practice, creating a platform for continuous learning and peer exchange amongst all P&B committee members in the pilot states (Kano, Kaduna and Lagos).

These gains mirror international best practices: South Africa’s National Treasury, for instance, integrates budget analysts across line ministries and provides structured budget training to ensure sector leads can effectively defend and monitor allocations. Kano State is now mirroring this trajectory, step by step.

Sustaining momentum: Political will and institutional anchoring

While capacity is essential, it must be reinforced by political commitment and institutional incentives. Thankfully, Kano State’s leadership has demonstrated unwavering support for health sector reform, with over 90% of the budget reform roadmap now completed and AOPs harmonized within federal timelines.

However, to sustain and scale these gains, three strategic imperatives must guide the next phase:

• Institutionalization of budget literacy programs within State Ministry of Health (SMOH) and Local Government Areas (LGAs)
• Creation of a dedicated health sector budget monitoring dashboard
• Adoption of a Performance-Informed Budgeting Framework (PIBF) to link funds to results

The journey of the Kano State P&B Committee is a powerful reminder that budget reforms are not just technical — they are transformational. With the right mix of evidence, empathy and expertise, public sector institutions can evolve to become champions of health equity and fiscal accountability.

Kano State is charting a new course. What started as a diagnostic exercise is now a movement anchored in learning, lifted by collaboration, and driven by the belief that every naira spent should bring value to the lives of citizens.