Approaches for effective health sector budgeting

Budgetary allocations for the health sector by government at all levels in the country over the years have been abysmally poor. This negates the “Abuja Declaration” , a commitment and promise made by Heads of State of African Union countries when they met in Abuja in April 2001 and pledged to prioritize the development of […]

Budgetary allocations for the health sector by government at all levels in the country over the years have been abysmally poor. This negates the “Abuja Declaration” , a commitment and promise made by Heads of State of African Union countries when they met in Abuja in April 2001 and pledged to prioritize the development of the health sector by allocating at least 15% of their annual budgets to improve the sector.
Of outmost concern is the fact that these budgets are made without paying proper attention to the needs of the people , in other words most of the budgets are not a ‘peoples budget.’
According to Dr. Judith-Ann Walker, National Team Leader Partnership for Advocacy in Child and Family Health (PACFAH), many people in Abuja or in state capitals make their budgets in isolation from the people.
She said budgets  especially health budgets should not  be developed in isolation in offices, and that they should have a basis, common denominator from the people, the communities, and the understanding of felt needs.
Walker who is also the director, Development Research and Projects Centre (dRPC)  said there was need for the country to prioritize the people and communities for effective budgeting.
She stated this in an interview with Daily Trust during the second annual executive training course for senior civil servants on effective health sector budgeting organised by the National Institute for Policy and Strategic Studies (NIPSS)  in collaboration with the Development Research and Project Centre (dRPC) in Kuru, Plateau State.
“We need to be more efficient. We need to plan and coordinate better,” she said .
“We also need to prioritize based on felt needs and knowing what really affects the people, and the basic is your primary healthcare. Secondary and tertiary healthcare levels are important, but if we solve certain basic health problems at the primary and preventive level, we won’t need to get to secondary level.”
According to her, the annual executive training course for senior civil servants was aimed at building the capacity of a strategic cohort of civil servants at the federal and state levels for effective health budgeting that is consultative and addresses the felt needs of vulnerable communities and is funded from sustainable domestic sources.
It was convened under the auspices of Partnership for Advocacy in Child and Family Health (PACfaH) Nigeria project, a three- year health advocacy project funded by the Gates Foundation.
The participants were made of up of 30 senior civil servants (at directorate level) from the federal and states which are Bauchi, Kano, Kaduna, Nasarawa, Niger, Lagos, and Oyo, with direct responsibility for priority setting and budgeting for the health sector.
Experts and participants during the training course brainstormed on  strategies and the way forward for effective health budget in the country.
Kyauta B. Tanyigna  Directorate of Research , National Institute of Policy and Strategic Studies, Kuru  said there  was poor funding of the health sector as evidenced by the federal government’s budget for the year 2016 adding that Nigeria has failed in its leadership role in Africa by refusing to set aside the 15% allocation of its budget to the health sector since 2001. 
He said:“This has become more worrisome considering that the agreement was reached at a forum of African Heads of States hosted by Nigeria.  It has also become shameful when taken into consideration that up to 33% of the African countries in attendance have allocated 10% of their budgets, many others have kept to the agreement,”
He recommended that the federal government and the state governments should increase budgetary allocation to the health sector to meet her own avowed commitment in the 2017 and subsequent budgets
Secondly, he said the federal government should without delay set aside a loop sum amount to salvage the comatose health facilities and as panacea in improving availability, access, quality and efficiency of health services.
The third recommendation he gave is that the federal government  should ensure that the appropriated budget to the National Primary Health Development Agency (NPCDA) is fully released for full implementation for the projects before the year 2016 runs out.
Finally, he said that the federal government should release from its special intervention fund in the 2016 budget money needed by the Federal Ministry of Health but not appropriated for in the 2016 budget.
Professor Obinna Onwujekwe of the University of Nigeria Enugu-Campus  in his presentation titled “The National Health Policy and Universal Health Coverage in Nigeria: agenda for effective implementation” said budgets at all levels of government in Nigeria have been weak and have not led to any significant achievements nor improvement in the health sector .
He advised the civil participants to  ensure that their budgets are targeted to put their Ministry, Department and Agency at any level on the road to achieving the Sustainable Development Goals(SDGs) especially Universal Health Coverage UHC, and is aligned with the National Health Policy.
“We need evidence based budgeting system.  We need to start taking decisions based on evidence. We must find a way to involve the citizens.  The commissioner should be truly in charge of the ministry. Things have to change. We can’t keep waiting for the governor to approve everything.  We need predictability of resources and policies in the budget process,” said Dr. David Olayemi,
Director Advocacy and Campaign, Save the Children.
 He said if Nigeria continues to do budgeting the same way without audit, even if the country puts in 10 times the money it has now, nothing will change and it will only enhance corruption.
He added that the oversight functions of ministries should be by the commissioner and not governor.
“The oversight should be by the commissioner.  The governor should hold the commissioner accountable. That is the way it should be. A situation where the governor has to give approval for even N5,000 is not going to make the system work. Many of these governors are never available.  If we are talking about people running the affairs of  what affects the lives of Nigerians on a daily basis, and you are putting all that in front of a man who is never going to be available, how justifiable and how judicious is the use of resources in that state?” he said.
Mohammed Mustapha, permanent Secretary in charge of Niger State Planning Commission and participant in the course said the participants were going back to the drawing board to harmonize things saying it had begun in Niger State. 
“I am the chairman of the committee in charge of that. Donors, development partners will be brought together and activities identified and we find a way of bringing them together for effectiveness and to avoid duplication,” he said.
 In his presentation, Remi Adeseun, Program Director (Strategy), PSN-PACFaH  said critical budget issues to address include harmonisation of the Fiscal Projections of National Development Plans, increased resource allocation to the sector and full release and cash-backing of all appropriated funds, among others.