Just like the saying goes ‘a healthy nation is a wealthy nation’. What is the state of the nation without a good health facility? Out of the N6.06 trillion 2016 Budget proposal, only 4.23 per cent was allocated to the health sector, a far cry from the approved 15 percent WHO recommendation. AJUMA EDWINA OGIRI writes on what awaits the health sector with this meagre allocation
President Muhammadu Buhari on December 22, 2015, presented the 2016 proposed budget estimate on N6.08 trillion to a joint session of the National Assembly. Out of the estimate, N227.3bn was proposed for the Ministry of Health.
This represents 4.23% of the budget.
The health budget which is said to have been the most controversial, have also health sector has also faced serious backlash, especially from medical experts and Non Governmental Organisations (NGOs).
Firstly, the Nigerian Federal Ministry of Health disowned the budget proposal submitted on its behalf by the Ministry of Budget and National Planning. The Health Minister, Isaac Adewole, who addressed the Senate Committee on Health during its budget defence session, said the proposal drawn up by the ministry and submitted to the budget office had been doctored and that “foreign” appropriations, different from what was submitted, had been sneaked in.
“We have to look into the details of the budget and re-submit it to the committee. This was not what we submitted. We will submit another one. We don’t want anything foreign to creep into that budget. What we submitted is not there.
“In the revised budget as re-submitted, N15.7 billion for capital allocation has been moved to other areas. Some allocations made are not in keeping with our priorities. There is nothing allocated to public health and family health,”he said.
On the State House clinic whose capital vote exceeded cumulative capital vote for teaching hospitals, Mr. Adewole said, “The State House Clinic is not under the Ministry of Health. I hope it’s not the same rats that changed things in our budget that changed it.
“The amount is meant for procurement and purchase of medical equipment. It is very important that you engage them because what happened to us might have also happened to them. It is possible that what is there might not have been what they put there.”
The Nigerian Medical Association (NMA), also faulted the N221.7 billion to the health sector in the 2016 Appropriation Bill, saying it portends disaster. While suggesting that the allocation should be urgently reviewed in the interest of justice, the organisation called on the National Assembly to halt this looming disaster in the healthcare delivery sector in 2016 immediately.
The association described the allocation as a sharp departure from the prescribed 15 per cent of the national budget for health made during a meeting of African Heads of States and Government which Nigeria hosted in 2001 in Abuja.
In a statement by its President, Dr. Kayode Obembe and the Secretary-General of the association, Dr. Adewunmi Alayaki, observed that the deviation has posed a huge moral burden for the country in going against her own avowed commitment despite the emerging challenges and resultant burgeoning demands from the sector.
The association said although it was not ignorant of the current realities of dwindling oil revenue and contracting fiscal space, it was of the view that the markedly diminished allocation of 3.65 per cent in the 2016 budget would never encourage the advancement of Universal Health Coverage which is the only panacea towards improving availability, access, quality and efficiency of the health services to reduce the disparaging health indices that continue to malign the image of Nigeria in the comimtee of nations.
“We are also in shock as the 60 billion; equivalent of at least 1 per cent of the Consolidated Revenue Fund, envisaged to accrue as the Basic Health Provision fund as enshrined in the National Health Act 2014 was conspicuously absent from the budget proposal as presented.
“Coming at this auspicious occasion of budgeting under the reassuring change mantra, it is our considered opinion that Nigeria should show the way and provide leadership in Africa after having failed in this regard since 2001. Facts from available evidence show that whereas 33 per cent of countries have allocated at least 10 per cent of their national budget to health with only Tanzania, Rwanda, Swaziland, Ethiopia, Malawi and Central African Republic attaining 15 per cent. Nigeria has been revolving between 3 per cent and 6 per cent,” Obembe said.
The NMA also expressed dismay that contrary to the recommendation of the World Health Organisation that national budgets should allocate the equivalent of N6,908.00 per head, which is the General Government Health Expenditure per Capita, reports from the World Bank reveal that the 2016 federal budget only provided for N1448.00 ($7.55 at $1=N197) representing a retrogression from N1,546.00 in 2015 and N1,653.00 in 2014.
This according to the association “presents a precarious situation as all other contributions from state and local governments; donor agencies and other sources cannot bridge the deficit of N5,460.00 in this regard.
“It is on this premise that we call on the National Assembly as the only organ that could mitigate this looming disaster in the healthcare delivery sector in 2016 at this juncture, to look dispassionately without any partisan sentiments at what should be done to substantially increase the allocation to the health ministry in order to deliver better healthcare to the Nigerian people.”
The NMA however appreciated with great expectations, the lofty ambition of the Federal Government through the Federal Ministry of Health to revitalise 1000 primary health centres in Nigeria by 2017 beginning with one per senatorial zone in the first instance.
The organisation promised to assist government in playing her role in budget tracking to ensure that budgeted and released funds were used for the purposes they were appropriated.
While also calling on state and local governments to allocate substantial resources to the healthcare delivery sector and encourage donors and philanthropists not to be fatigued at this critical point in Nigeria’s history, the NMA restated its loyalty, commitment and readiness to partner with government to deliver prompt and efficient healthcare to Nigerians.
‘In this era of reduction in oil revenue, the economy will rest mainly on human resource potentialities and manpower developmental output. Therefore the only road to economic recovery is for the government to guarantee basic minimum package of healthcare to every citizen through UHC. The panacea for the UHC is Community Based Health Insurance. This is achievable by increased budgetary allocation to healthcare (15 per cent) and operationalization of National Health Act,” the NMA said.
An NGO, Centre for Social Justice (CSJ), also faulted the poor allocations meant for management of maternal, newborn and child health proposals in the 2016 federal budget.
CSJ noted that the preparation process of the 2016 budget was not backed by a Medium Term Sector Strategy (MTSS) but, on a Zero Base Budgeting (ZBB) framework.
The Programme Officer, Centre for Social Justice, Mr. Victor Emejuiwu, who made this known recently during a press briefing in Abuja, disclosed that the budget proposals were not underpinned by a MTSS and as such, did not undergo a prioritisation process and may not reflect the best strategies and activities for the realisation of high level policy goals in Maternal Newborn and Child Health (MNCH).
He explained that the process is in contravention of the provisions of the National Health Career Association (NHCA) and the Fiscal Responsibility Act (FRA).
According to him, “The central objective of this policy briefing is to review the estimates in the 2016 federal budget for maternal, new born and child health with a view to determining its adequacy for the task of protecting the rights to health and to life of persons who are to enjoy services to be provided from the budget.
“Ideally, the Zero Base Budgeting framework provides the opportunity to reconsider a lot of investment options and to determine the best way to spend available resources and to re-engineer the budget to deliver greater value, the NHA provides in section 2 (2) that the Federal Ministry of Health shall prepare strategic medium term health and human resources plans annually and ensure that the plan forms the basis of the annual budget proposal and any other government planning excise as may be required by any other law.
“The health budget as a percentage of the overall budget estimate is a miserly 4.23 per cent, which fails to meet the committee of African Heads of State to commit not less than 15 per cent of their budgets to healthcare. The percentage of health budget 2015 to the overall budget was N259.751 billion out of N4.493 trillion and amounts to 5.78 per cent.
“The total investment on MNCH in the 2016 estimate is in the sum of N19.44 billion. Unlike the 2015 financial year when the budget of the Ministry of Health Headquarters contained investments for malaria programme, contraceptives and information dissemination, 2016 estimate is silent on these MNCH issues. There were also investments from Subsidy Reinvestment Programme (SURE-P) which is no longer available under the present dispensation.
“Lack of prioritisation ends SURE-P programmes, Maternal and Child Health Insurance Programme under the National Health Insurance Scheme provided in 2015 budget is also missing from the budget. Also, the Roll Back Malaria Programme seems to be missing from the budget.
“We are greatly concerned that Nigeria still records high rates of maternal and child mortality and morbidity. The major reasons adduced for the deaths of mothers and children during and after birth have been traced to lack of proper funding. Hence, the need to improve funding and properly manage the funds allotted to primary health care services is the only way to mitigate this huge challenge.”
Notwithstanding the poor funding of the sector by the government, CSJ urges various stakeholders to monitor and coordinate resources accruing to the primary health care in the country as these funds are required to provide support services for antenatal and postnatal care, basic vaccines, immunisations anti-malaria drugs, hospital beds, medical equipments, anti-retroviral drugs, HIV test kits and insecticide treated nets.
“Government must learn to prioritise. Because, if government prioritise effectively, issues of malaria which is still a significant problem in Nigeria that is affecting women and children should not be removed from what was obtainable in the previous budget.
Experts had expected a total health budget to be higher than previous years considering the numerous challenges facing the sector. For instance, cost of immunising Nigeria’s children. Vaccines and the services that surround immunisation next year will cost $1.4 billion, according to official estimates.
Getting the vaccines could be some headache for the National Primary Health Care Development Agency, which coordinates immunisation nationwide, especially as the agency is seeking increased local funding to sustain immunisation in the country, as international donors withdraw support.
Experts of the Nigeria’s health sector have therefore expressed fears that Nigeria’s health service delivery could get worse in 2016 due to insignificant allocation, which they said would be worsened following the withdrawal of international donor agencies support in an area like HIV/AIDS.
In an exclusive chat with Blueprint, TheNMANational Vice-President,Dr Titus Ibekwe, said “Since 2001 till now Nigeria, has never met that 15 percent allocation that she signed for. The best has been 7 to 8 percent, and this year we are talking about 4.3 per cent.
“This is a far cry from the expectations. The reality is that it is not good enough for a growing economy like ours that really need a good health care system to be able to move forward. so we expected that as custodians of Nigerian health, atleast Nigeria should have moved very close to that 15 percent, the gap between 4.3 percent and 15 is very wide.”
