Improving Primary Health Care Delivery in Nigeria is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank's ongoing research and to stimulate public discussion.<BR><BR>This paper, based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity, aims at understanding the performance of primary health care providers in four states in Nigeria. As possible ways to improve performance, the paper concludes that clearly defining lines of responsibility, implementing performance-based financing of local governments and providers, and collecting, analyzing, and sharing information are some options that can help realign incentives and improve accountability in the service delivery chain and service provision.<BR><BR>This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT. More information as well as all the products produced under the HSO program can be found online at www.worldbank.org/hso.<BR><BR>World Bank Working Papers are available individually or on standing order. This World Bank Working Paper series is also available online through the World Bank e-library (www.worldbank.org/elibrary).