Internally generated revenue and perceived performance of public healthcare institutions in Edo state, Nigeria: a cross-sectional analytical study

Background: In Nigeria, sustained constraints in federal health funding have increased public hospitals' dependence on internally generated revenue (IGR). Despite its growing importance, evidence on the link between IGR and healthcare institutional performance at the subnational level remains limited. This study examined the association between IGR and the perceived performance of public healthcare institutions in Edo State, Nigeria. Methods: A cross-sectional analytical design was employed. Data were collected from July to November 2025. Structured questionnaires were administered to 150 purposively selected administrative, financial, and clinical staff across four public hospitals in Edo State. A total of 120 valid responses were analysed. Reliability testing showed acceptable internal consistency (Cronbach's alpha≥0.76). Data were analysed using descriptive statistics, Pearson correlation, and simple linear regression in IBM SPSS version 26. Results: Respondents reported high perceptions of IGR functionality and institutional performance. IGR showed a strong positive association with healthcare performance (r=0.742, p<0.001) and significantly predicted performance, explaining 55.1% of the variance. Major challenges identified included weak accountability, limited autonomy, and inadequate monitoring. Conclusions: IGR is strongly associated with improved perceived performance of public healthcare institutions in Edo State, highlighting the need for stronger governance mechanisms.