Primary health care is the bedrock of any viable health system, hence, attention must be paid to its functionality and sustainability. This paper analyses primary health care (PHC) in Nigeria and showcases performancebased financing as a tool for health system reform. This study adopted content analysis methodology involving review of peer-reviewed and grey literature to analyse Nigeria’s PHC system thematically using the World Health Organization’s health system building blocks framework. The study shows that PHC in Nigeria is underperforming in all the six building blocks while performance-based financing is an approach to health system reform with capacity to strengthen each building block of the health system. With strong institutional arrangement, performance-based financing may be adopted as a national policy to reform PHC system in Nigeria for improvement in access, utilization and quality of healthcare in Nigeria.
