Money has health by the jugular, and it isn’t going well

Hadiza Amodu survived. Her mother still can’t believe it. The toddler was dead to her when she arrived on a camp in Maiduguri, after troops liberated them from Mungono. Care workers found faint heartbeat, weak rasping pulse—vital signs the infant was still alive, barely. They began treating her for malnutrition. Many others weren’t so lucky. […]

Hadiza Amodu survived. Her mother still can’t believe it.

The toddler was dead to her when she arrived on a camp in Maiduguri, after troops liberated them from Mungono.

Care workers found faint heartbeat, weak rasping pulse—vital signs the infant was still alive, barely.

They began treating her for malnutrition. Many others weren’t so lucky. An estimated 400,000 are at risk of severe acute malnutrition, possibly death, if nothing is done.

Their country can’t seem to find the money to help them. And clamouring for more allocation to health is not gaining traction as expected.

Stakeholders are pressed between pressuring the executive and lobby the legislature to guarantee and increase allocation to health care. The pressure has brought health financing into a new rage.

As more areas previously held by Boko Haram opened up to humanitarian, the emerging scale of need soared.

Stakeholders in health budgeting tried to figure out what to do about children facing severe acute malnutrition.

More than 2.5 million of them were considered wasted—too thin for their height. Hadiza was so wasted, she was close to death.

She still bears some of the telltale signs—hair thinned and straw coloured, limbs thin, eyes bulged out, cheeks sunken—despite getting on the road to recovery.

Ready to go

Pockets of treatment for malnutrition using ready-to-use therapeutic food (a power food of peanut, milk and minerals) have been on. Experts estimate it cost N50,000 to treat a child.

For 2.5 million children, the figure came out to N95 billion. That’s the amount the Senate health committee arrived, and it would pay for 1.9 million children.

The remainder 600,000 children would get treatment courtesy of contribution by the United Nations Children’s Fund.

“If we are going to take care of children confirmed for malnutrition, we need to make sure they are budgeted for,” said Senator Matthew Urhoghide, vice chairman of Senate health committee and also on the appropriations committee.

Last year, the federal health ministry proposed N2.4 million for nutrition, and the committee passed it.

Upping the ministry’s request for 2017 to N95 billion was required even before the appropriation process reached the Budget Office.

“We are saying this is what must go to the budget office before it comes to us,” said Urhoghide.

In the budget, only N1.2 billion is allocated as counterpart payment for power foods.

That’s just for children wasted. Without funding, nothing is to be said about children considered stunted, too short for their age. They face the brunt of difficulties involved in health financing.

Envelopes

Dr Chris Isokponwu was part of the team that prepared the N95b estimate on the cost of three major intervention—treat 1.6m children, disseminate messages to reach over 11m children on community nutrition and essential nutrition practices, then distribute micronutrient to about 11 million children aged six to 23 months.

The budget he last saw shows the addition was never made. Ministries work within envelopes, and “you can’t exceed this envelop,” says Isokponwu, head of nutrition department at FMOH.

“You also have to allocate resources within that envelop that you’ve been given. But, we also must realize that in health, nutrition is not the only priority. There are lots of competing priorities. I won’t say because I am the head of nutrition, all the money must go for nutrition. Sometimes, it’s really a difficult choice for the honourable minister to make as to how do I allocate resources?”

It isn’t just nutrition. Every health issue is a potential time bomb waiting to explode—routine immunisation, family planning, disease treatment, non communicable diseases, infectious diseases. Money just is never enough.

The Nigerian government still spends far more than any other contributor on health care. But far more visible return comes from little spending from international donor agencies.

The budget, pegged on petrodollars, has tanked with the falling price of crude on the international. And foreign donations are about drying up.

So calls to push health allocation to nearly 15% of national budget as Nigeria agreed to in the Abuja Declaration are not getting traction.

Funding the fund

The National Health Act of 2014 is in its second year since it got presidential assent. But it is far from being implemented.

The committees needed to drive it are up but can’t meet. The Act calls for at least 1% of consolidated federal revenue to be put into the Basic Health Care Package Fund—in the same manner 2% of federal revenue is put into the Education Trust Fund.

The Fund is meant to be a pool, sucking in monies from international donors and private sector. But the at-least-1% commitment has not seen budgetary favour.

“One percent minimum that we are talking about, it is now over two years, it has not been implemented,” said Senator Lanre Tejuoso, who chairs the senate committee on health.

But new research has found the current level of financing is insufficient for pregnant women and children alone.

“What we discovered is that in reality, the money is actually too small,” said Dr Felix Obi, a researcher with Health Policy Research Group.

 “If we focus only on 1%, we might not be able to achieve universal health coverage.”

Lawmakers have been painstakingly clear. They will appropriate only what comes before them, but it is left for the executive to implement the appropriation.

The present administration rolled into power on a bandwagon marching to chants of “Change”—and lawmakers who have seen weeks of intense advocacy to get on the side of health care say something has to give.

“The change that we are looking for in health must start from obeying the laws of health, which is that minimum one percent requested by the constitution to encourage our development partners.

“If money will be put into basic health and we now expect the private sector to participate, we must do our own bit as government, whereby minimum one percent in put into that Fund.”

It also comes with setting priorities. In the end, it isn’t just about percentages, but about populations that may never be able to sit at the table where decisions are made and taken.

It is about Hadiza—and many other Hadizas who will not survive.