Aside from the domestication of the African Charter on Human and Peoples’ Rights by the National Assembly in 1983, Section 19 of the National Health Act (NHA) 2014, unequivocally affirms the right of all Nigerians to health. Section 19 of the Act provides that no person shall be denied emergency treatment and further provided for sanctions in the event of a breach. So any person denied emergency treatment can bring an action under this section.
The 1999 Constitution of Nigeria as part of what is commanded as the social objectives of the government also made provisions for the right to health of citizens in section 17(3) (d), which guarantees “adequate medical and health facilities for all persons.”
Under various United Nations declarations, every person has the right to health, including the right to access adequate, affordable, and effective health care. A chief goal of health systems is to treat the sick, to keep people healthy, and to protect individuals and families from the financial ruin that could arise from a need for highly technological and specialized care. Whether health is narrowly or broadly defined, conventional health systems (doctors and hospitals) are funded, organized, and structured to deliver care on the basis of these goals. Increasingly, health systems are recognized as being only one of the key determinants of health.
Thus, making the case for increasing the national and state budget allocation to the health sector is critical if more domestic resources are to be garnered for financing universal health coverage.
It is appreciated that there are competing priorities for more allocation for other sectors in many states in the face of the revenue cliff facing Nigeria at the moment. While political will remains pivotal to decisions on national priorities, against limited resources, fiscal managers- such as ministries of finance and the ministry of budget and economic planning – have a challenging job translating priorities into budget allocations for sectors.
As a result, like other sectors, the health sector must make a convincing case for more allocation. Strengthening the case for the health sector was a subject of the 2023 pre-health budget validation meeting organised by the Centre for Social Justice (CSJ) in Owerri, Imo State.
The meeting was part of activities for Nigeria Strengthening Civic Advocacy and Local Engagement (SCALE) project funded by the United States Agency for International Development (USAID) and implemented by Palladium.
The pre-budget memo advocates that the Imo State government should raise public investment in health. This is premised on the fact that the sustainability of healthcare services in Imo State is to a great extent dependent on the quantum and sources of healthcare financing.
From the review of existing budget commitments conducted by CSJ, Imo State’s public budget allocations do not meet the requirement of the funding needed to achieve Universal Health Coverage.
This is even as the Imo State health sector is faced with a number of challenges. Some of the challenges include the poor health indicators in the midst of dwindling financial resources. For instance, the under-5 mortality of 87 per 1,000 live births is so far off the SDG target mark of 25 per 1,000 live births. They are also below the expectations and targets set in other SDGs (beyond SDG3), National Health Policy, other relevant policies and ratified international standards on the best attainable state of physical and mental health.
The first major implication of the health indicators in Imo State is the urgency of taking deliberate and targeted steps within the context of available resources to begin to reverse the negative trends as well as sustaining and improving on the relatively positive trends. The second implication is the need to increase the resource outlay through domestic resource mobilisation for the task of promoting improvements in health indicators and the third is the need to improve value for money and resource optimization in the deployment and expenditure of the available resources. Finally, improving the standard of health in the state in a constrained fiscal environment will require the mainstreaming of health in governance through the whole of government and health in all policies approach to the realisation of the right to the highest attainable standard of physical and mental health using primary health care as the entry point towards UHC.
Further to this, the Imo State pre-health budget recommends among other things that it is imperative for the state government to increase health sector funding to ensure that the 15% target is met in actual releases and utilization of the vote. The Ministry of Health should also invest in value for money tools and processes to increase economy, efficiency, effectiveness and equity of its investments across the health value chain.
Some government official who spoke made inputs on the memo like Dr Okeji Austine, the Director of Imo State Public Health, Ministry of Health, who was also the representative of the Commissioner of Health, Imo State said the pre-budget memo will help the ministry to achieve its mandate of ensuring that all residents of Imo State have access to effective, quality and affordable healthcare services. Also, Dr Patrick Iwuchukwu, HOD, Standard and Quality Assurance at the Imo State Health Insurance Agency said the agency aspires to contribute to the wellbeing of Imo residents by providing equitable healthcare without financial hardship in an efficient manner. Emere Helen, Clerk, Imo State House of Assembly Committee on Health assured that the assembly will incorporate the recommendations of the pre-health budget memorandum into the 2023 budget.
The project is being implemented by CSJ in the Federal Capital Territory (FCT) and seven focal states of Bauchi, Sokoto, Adamawa, Nasarawa, Imo, Ekiti and Rivers. The project’s goal is to contribute to improvements in the realisation of the right to health in Nigeria through enhancing respect for extant laws and policies, reforming laws and policies as well as mainstreaming transparency and accountability in public health sector expenditure.
Okeke is a programme officer with the Centre for Social Justice (CSJ) Nigeria.
