ADAM ALQALI reports on how the efforts of civil society organisations in Kano state led to increase in the state’s 2018 health budget from less than 10% to over 13%, which saw the state edged closer to achieving the 15% target of the 2001 Abuja Declaration
Achieving Universal Health Coverage (UHC) is one of the major development challenges facing African countries hence the prevalence of public health challenges to with maternal, newborn and child mortalities on the continent resulting from infectious and non-infectious diseases such as Malaria, malnutrition.
It was in a bid to improve access to quality healthcare services for all in Africa that the 2001 Abuja Declaration came about, in which African countries pledged to commit at least 15% of their annual budgetary expenditures to public health. In Nigeria, 17 years after the Abuja Declaration the Federal Government is yet begin committing 15% of its annual budget to public health and at the state level, only Bauchi state has achieved the 15% target, thus far.
Kano which is the most populous state in Nigeria has also achieved progressive increase in budgetary allocation to health since the coming into office of His Excellency Governor Abdullahi Umar Ganduje in 2015. For example, whereas Kano state budgetary allocation to health in 2015 was 5.15% it was increased to 9.74% in 2016, in 2017, 12.6% of the state budget was allocated to public health.
In a move that was seen to be akin to drawing the state backward in the quest to achieve Universal Health Coverage, the 2018 appropriation bill presented to the Kano State House of Assembly by Governor Ganduje in November, 2017 had less than 10% of the budget as the proposed allocation to the critically-important health sector.
Thus, the Governor’s budget presentation was followed by series of outcries by civil society organisations in the state who had expected to see an increase over the 2017 health budget and thus began series of advocacy engagements with relevant stakeholders in both the executive and legislative arm of government in Kano state.
Eventually, the state’s health budget was increased to 13.01% which had since been passed into law; the figure was obviously an improvement over 2017 and saw Kano edged closer to achieving Abuja Declaration’s commitment of 15%.
“The 13.01% allocation to health in the budget will have a lot of impact in terms of achieving Universal Health Coverage in Kano State; it means we will have more skilled health workers providing maternal and child healthcare services in the state and therefore improved services,” says Hafsat Kolo, co-chair of the Accountability Mechanism for Maternal and Child Health in Kano state (AMMKaS)
“We will follow it up by reaching out to relevant ministries, departments and agencies to know when requests for releases are made and whether or not approvals are made, as at when due. And if approvals are made, we will also follow up to ensure timely releases and appropriate utilization of funds for health in the state,” pledged Kolo who is also the chair of the Partnership for the Promotion of Maternal and Child Health (PPMCH); a coalition of civil society organisations working in the area of health in Kano state.
Kabiru Saidu Dakata of the Kano State Budget Working Group also agrees that Kano state’s 2018 health budget provides a sense of hope that the healthcare system in the state will witness improvement adding that the challenge ahead of the civil society in the state – considering that 2018 is an election campaign year – was to continue to advocate to the government to ensure prompt releases as well as sensitize the general public to also hold the government accountable in terms of releases.
Dr Dayyabu Mahmud Yusuf is the Kano State Team Leader (STL) for the UK-DFID funded Maternal, Newborn and Child Health (MNCH2) programme who commended the Kano State Government and the Kano State House of Assembly for their responsiveness to the call for increasing the state’s 2018 health budget.
The MNCH2 programme had supported series of advocacy engagements with relevant stakeholders in government, legislature and civil society which led to the increase in the state’s 2018 budget for health.
“When the 2018 appropriation bill was presented to the State Assembly we realized it was around 10% and the budget didn’t make provisions for the implementation of the Kano State Health Trust Fund (KHETFUND) law, among others. Therefore, when the health budget was eventually increased we ensured the increase goes to funding very critical issues such as Human Resource for Health (HRH), Free Maternal and Child Health (FMCH),”says Dr Dayyabu.
Dr Dayyabu added that the 2018 health budget would amongst others; fund the establishment of 1 secondary health facility in each of the 16 Kano LGAs where there are no general hospitals at the moment which he said would improve access to healthcare services to the poorest of the poor in Kano state.
He also said they were optimistic that in 2018 the budget releases for the health sector would be prompt unlike in 2017 when the fall in oil prices affected the state’s revenue, cash flow and consequently budget releases for the health sector.
“We are working with the the civil society to continue to advocate to the government to ensure timely releases. We also have the commitment of the speaker of the State Assembly, chair of the assembly’s health committee and other principal officers of the assembly to ensure timely releases. Therefore, we will continue to engage with the assembly, civil society as well as the media to ensure that releases are communicated to the general public,” he pledged.
Hon. Nuhu Achika is the chairman of the Health Committee at the Kano State House of Assembly who said the assembly was disturbed with the initial figures proposed as the state’s health budget for 2018, considering the fact that the health budget had been progressively increasing since the beginning of the Ganduje-led administration. Thus, he said they had to immediately begin to engage with relevant stakeholders including Governor Ganduje himself at the end of which the budget was increased to 13.01%.
“We are grateful to MNCH2 for supporting our meeting and discussions including the one held at Zaria over the health budget issue. The challenge now has to do with release which was affected by fall in government revenues in 2017. However, with the improvement in oil prices we hope to have better releases in 2018. There is also the lack of coordination between the Ministry of Health and the assembly, therefore we have asked the ministry to continuously update us on releases so that if there are hitches we will come in to ensure timely releases,” pledged Honorable Achika.
Also speaking about the 2018 health budget, Dr Kabir Ibrahim Getso, the Honorable Commissioner of Health in Kano state said the increment which had put Kano only 2% short of achieving the commitment of the Abuja Declaration would go a long way in improving maternal and child health indices not only in Kano state but also in the North West region as a whole, which has one of the worst statistics of maternal and child healthcare in Nigeria.
“We will continue to engage in advocacy with the Ministry of Finance to ensure timely releases for budget request to be able to execute projects. In 2018, we envision more improvement in cash releases towards enhanced budget performance including the implementation of the Kano State Health Trust Fund (KHETFUND) law,” said Dr Getso.