Much Ado about the 2018 health budget

The 2018 budget allocated N340.45 billion to the health sector, which represents only 3.9 per cent of the total budget. This is a far cry from the ‘Abuja Declaration’, signed by Nigeria and other African leaders at an AU meeting in Abuja in 2001, where they pledged to devote at least 15 per cent of their annual budget to the health sector.‎ Will Nigeria ever abide by this commitment? AJUMA EDWINA OGIRI analyses.

Breakdown of the 2018 health budget
On November 7, 2017, President Mohammedu Buhari, presented the 2018 budget estimate of N8.62 trillion to the National Assembly. Out of this sum, a total of N340.45 billion was voted for the health sector; less than the N359.2 billion the country spends on medical tourism annually. This represents a meagre 3.9 per cent of the total budget, lower than the 4.1 percent in 2017.

With the N340 billion allocated to the health sector, it means the federal government plans to spend approximately N1,893 on the health of each citizen annually.

This low budgetary allocation is coming against a backdrop of the recent outbreaks of Monkey pox in several states in the country, high rate of malnutrition, especially in the North-east, high maternal and child mortality rate, and the fight to end polio.
This is coupled with World Health Organisation (WHO) rating of Nigeria as 187th out of 191 countries with the worst healthcare delivery, and the third highest in infant mortality in the world.

Details of the budget proposal revealed that health came 12th as Power, Works and Housing got the highest capital project proposal with N555.88 billion, almost eight times that of health.

In the 2018 health budget proposal, N269.34 billion was earmarked for recurrent expenditure, which refers mainly to expenditure on operations, wages and salaries, purchases of goods and services, and current grants and subsidies; while N71.11 billion is for capital expenditure.

Also, the top three arms of the Federal Ministry of Health with the highest budgets are Federal Ministry of Health, National Primary Health Care Development Agency (NPHCDA) and Federal Teaching hospital, Abakaliki, with N29.79 billion, N23.92 billion and N12.35 billion respectively.

Others includes, National Agency for the Control of AIDS (NACA): N4.27 billion; State House Medical Centre: N1.03 billion; counterpart funding including global fund/heath: N3.5 billion; counterpart funding to match grants from UNFPA, USAID, BMGF and UNICEF: N2.4 trillion; NHIS FGM contribution: N59.26 billion; rehabilitation/repairs of healthcare centres and hospitals: N305 million; and purchase of health/medical equipment: N1.18 billion.

Some focused areas in the health budget which includes routine immunisation; Maternal New-born Child Health (MNCH); family planning and nutrition; were allocated N18.36 billion.

African Union (AU) and the Abuja declaration
Nigeria hosted the Heads of State of member countries of the African Union (AU) in 2001, where they made the “Abuja Declaration” and the leaders pledged to commit at least 15 per cent of their annual budgets to improving their health sector.

The highest percentage since the declaration was in 2012 when 5.95 per cent of the budget was allocated to health. Being one of the signatories to that agreement, Nigeria has never lived up to that commitment, as the government has never allocated up to six per cent of its annual budget, let alone the 15 per cent pledged funding benchmark to the health sector.

Similarly, the National Health Act, which was signed into law in December 2014. by the immediate past President, Goodluck Jonathan, stipulates that one per cent of the consolidated revenue fund of the federal government be set aside to finance health initiatives in the country. That too has never been complied with.

Surprisingly, poorer African nations pay better attention to the health of their citizenry than Nigeria. For instance, Botswana budgeted 17.8 per cent; Malawi 17.1 per cent; Zambia 16.4 per cent, Rwanda 18 per cent and Burkina Faso 15.8 per cent, in their last expenditure plans.

Health experts’ reaction
Following the presentation of the 2018 budget, medical experts have expressed disappointment and decried the sharp decline in the allocation to the health sector.

During a recent press conference themed “understanding the falling 2018 Health budget”, organised by the Partnership for Advocacy in Child and Family Health at Scale, (PACFaH), the Director, Policy and Legislative Advocacy, (PACFaH), Aremu Fatai, said the proposal was short of expectation.

“The fact that the Abuja declaration was made in Nigeria, we should be taking the lead. But other smaller countries like Kenya, Gambia, Rwanda, Lesotho, Swaziland are the ones making bold steps in terms of budgetary allocation for health.
“This doesn’t speak well of Nigeria’s image as the Giant leader of Africa, and it doesn’t go well for the health sector because what this means is that the government does not prioritize health.

“Infrastructure, building roads and bridges are bad but then even when you build the road and bridges, it’s only a healthy population that can utilize them. When you talk about agriculture, it’s only when the farmer is healthy that he can be more productive in the farm,” he said.
Also, the acting General Secretary, National Association of Community Health Practitioners of Nigeria (NACHPN), Mr. Ibama Asiton, said the budget is not consolidating.

“We found that while the overall national budget of Nigeria has grown by 92 per cent from N4.49 trillion in 2015 to N8.61 trillion in 2018, the same cannot be said of the health budget.

“The health budget has only grown by a small-14%. The prosperity of the country reflected in the growth of the national budget has unfortunately not yet been fully felt in the health sector.

“But there is a bigger problem. This problem is that the 2018 health budget as a proportion of total national budget is only 3.9 %. This is the lowest share of national budget allocated to the health sector in recent times.

“This meagre allocation to health sector, is responsible for Nigeria’s abysmal global rating of the health system in the 2017/2018, where Nigeria was ranked 136th out of 137 countries.

“We all advocate for improved and adequate funding for Nigeria’s health sector, to ensure that the Nigerian government honours its policy commitments to the health sector in general and child and family health in particular,” he explained.

Furthermore, he said that the impact of poor budget on Nigeria is made very obvious by the fact that the federal government has about 30,000 primary health care buildings with only 20 per cent functional, that means that about 86 per cent is not functioning.”
“Does the 2018 health budget provide enough resources to consolidate the good work of the Primary Health Care Providers working within the policy of Primary Health Care Under One Roof.

“Will this budget enable the Federal Minister of Health to keep his promise of revitalizing 10,000 PHCs?” he asked.

An international campaign and advocacy group, ONE, also criticised the allocation to health in the 2018 budget, saying it casts doubt on the federal government’s commitment to addressing the many challenges facing the country’s health sector, especially at the primary level.
“The Nigerian health sector remains in crisis. In the last decade we have not seen appreciable enhancements to the quality of healthcare for Nigerians. Instead, we have observed a decline. How long will we continue accept such decay in the health sector?

“It is time for a step-change. It is time to ensure that all Nigerians have access to maternal, new-born, immunisation, emergency and routine care at a minimum standard. The National Health Act, which we agreed to, specifies that ‘all Nigerians shall be entitled to a basic minimum package of health services’.

“How long will Nigerians die from preventable tragedies for want of pills and injections that cost a few naira?” Nigeria Country Director, ONE, Serah Makka-Ugbabe, queried.
“It is quite worrisome because we know that in the last 10 years, especially 2009 till date, you will notice that we have been hovering between 4 and 5 per cent.
“This means we are retrogressing yearly in terms of our budgetary allocation. And this is totally unacceptable for a nation that truly wants to develop.

“The larger percentage of the spending on health would continue to come from the pockets of the poor people. And this without any doubt will further tilt them to abject poverty and impoverish them.

“A nation that wants to get it right must place the right premium on health because when you build all the roads, railways and other infrastructure, you need the human development indices to drive these processes,” she said.

“I think it is high time we began to accord the right priority to health. There is no nation that truly wants to develop that will not make health cardinal to that development. That is how to make a nation fulfilled,” Executive Director, Guaranteed Healthcare Foundation (GHCF), Dr Dayo Adeyanju, also stated.

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