2023: Need to re-visit proposed health security budget

President Muhammadu Buhari presented the 2023 budget proposal to the National Assembly on October 7. Out of the N20.5 trillion proposed for the 2023 fiscal year, N1.179 trillion was proposed for the health sector. This represents 5.75% of the total budget. It is also a 42.59% increase from the N826.9 billion of the 2022 amended […]

President Muhammadu Buhari presented the 2023 budget proposal to the National Assembly on October 7. Out of the N20.5 trillion proposed for the 2023 fiscal year, N1.179 trillion was proposed for the health sector.

This represents 5.75% of the total budget. It is also a 42.59% increase from the N826.9 billion of the 2022 amended budget.

However, it is worrisome that the allocation for health security in the 2023 proposed health budget is not only grossly inadequate, but there were cuts in funding for the National Action Plan for Health Security (NAPHS) activities, and the allocations for the various Ministries Departments and Agencies (MDAs) compared to approved budgets for health security in 2021, and 2022.

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Health security involves activities and measures across sovereign boundaries that mitigate public health incidents to ensure the health of populations.

NAPHS is a comprehensive multi-sectoral document that sets out a strategy for strengthening health security of the country. It is a five-year strategic plan to be executed from 2018 to 2022.

With the backdrop of emerging and re-emerging epidemics and pandemics, there is a need for government at all levels in the country to prioritise and adequately fund health security.

In addition to the COVID-19 pandemic, the country has continued to witness disease outbreaks. This year alone the country has recorded persistent outbreaks of cholera, monkeypox, and Lassa fever among others.

Therefore, it is important for the National Assembly to revisit and increase the budgetary allocation for health security in the proposed 2023 budget.

Increasing the health security budget is critical to strengthening epidemic preparedness and response, and will also help the country in its journey towards attaining Universal Health Coverage (UHC).

The total health security budget across MDAs in the proposed 2023 budget is N9,475,736,692 which is a reduction of N1, 354,900,692, from the N10,830,637,384 approved for health security in 2022.This represents a variance of 13 per cent.

In some cases, there were over 50 per cent reductions or no allocations at all for key health security projects for MDAs.

N56, 788,494 was approved for strengthening public health emergency preparedness and response and global health security and coordination under the Federal Ministry of Health in 2021. However, only N28, 394, 247 was allocated in 2023.

 For development of national policies on disease surveillance and response, N23, 661, 872 was approved in 2021 while only N11, 830, 936 was proposed for 2023.

While N37, 858,996 was approved for port health services, safe port platform and surveillance activities for prevention and control of pandemics in the 2022 budget, N18, 830, 936 was allocated for 2023.   

In addition, the budget for COVID-19 pandemic response research for health security, strengthening the national health research ecosystem to support vaccine and pharmaceutical development in the 2023 budget is N94, 647,490 which is a 50 per cent reduction from N189, 294,980 approved in 2022.

There were also 50 per cent reductions in programmes such as food safety events, preparedness and response, management committee and other activities; rehabilitation of Port Health thermal scanners in the various points of entry, purchase of ambulances and consumables for PHs; strengthening of Port Health inspection capacity and PHS office remodeling, renovation and construction of new port health offices in the six geopolitical zones.

While N18,550, 908 was allocated for food safety events, preparedness and response, management committee and other activities, in 2022 it was reduced to N9, 275, 454 in the proposed budget, a variance of 50 per cent.

Also, for rehabilitation of Port Health (PH) thermal scanners in the various points of entry, N15, 616, 836 was approved in 2022 but N7, 808, 418 was allocated for 2023.

For purchase of ambulances and consumables for PHs, N85, 182 741 was approved in 2022 but N42, 591, 371 is in the 2023 budget.

N23, 661, 872 was approved for strengthening of Port Health inspection capacity in 2022 but was slashed to 11, 830, 936 in the 2023 budget. 

While N141, 971, 235 was approved for PHS office remodelling renovation and construction of new port health offices in the six geopolitical zones in 2022, for 2023, it is N70, 985,618.

Procurement of reagents, chemicals and consumables which are critical for screening for diseases also witnessed a decrease from N129,878,494 in 2021 to N61,868,333 in 2022 to now N28, 129,518, which is variance of 55%.

Analysis of drug residues in animal products for export under Nigeria Agricultural Quarantine Service has also witnessed a reduction; from N92,000 000 in the 2021 approved budget to N33,250, 000 in 2022 to now be further reduced to N2,000 000 in the proposed 2023 budget. This is a variance of N31, 250,000 between 2022 and 2023 and a whopping 94% variance.

Unlike in 2022, when N202, 594,468 was allocated for establishment and equipping of nuclear and radiological Emergency Preparedness Response (EPR) coordination centre under the Nigeria Nuclear Regulatory Authority, no allocation was made for it in the 2023 budget which is a 100% variance.

For the National Primary Healthcare Development Agency (NPHCDA), no allocation was made for deployment of and installation of DTR in states for real time monitoring of cold chain equipment functionality, procurement of freezer for NSCS in the six zonal cold stores, as well as printing and dissemination of Nigerian vaccine policy.

There were some improvements, for instance, the establishment of environmental health and sanitation surveillance systems in Nigeria under the Federal Ministry of Environment headquarters, witnessing an increase from N15,000 000 in 2022 to N50, 000 000 in 2023 , representing a 233 % increase.

Others include 159 % increase in immunisation supply chain strengthening at NCS and zonal cold stores, and 66% increase in vaccine distribution and transport (national to states and health facilities), and procurement of outbreak vaccine, devices and operational cost at 7%, under the NPHCDA.

There was also a 55% increase for surveillance, diagnosis and control of economically important animal disease in Nigeria for the National Veterinary Research Institute.

It is also important to note that while the budget for the NCDC increased from N1,293,651,516 in the 2021 budget to N1,959715,054 in the 2022 budget, it is now N1,721,399,608 in the 2023 budget which is a 12 per cent variance of N238,315,446.

This is coming when stakeholder advocate for more funding for NCDC to meet its mandate.

Suffice to say there are lots of deficits in the proposed 2023 budget for health security, and the budget has failed to prioritise funding for epidemics preparedness and response.

Experts say failure to invest in preparedness for future outbreaks will cost the country far more in the long run.

It is therefore important to increase funding for NAPHS activities and MDAs on health security.