Need to re-visit proposed health budget

President Muhammadu Buhari on December 22 last year presented the 2016 proposed budget estimate of N6.08 trillion to a joint session of the National Assembly. Out of the estimate, N257.3bn was proposed for the Ministry of Health. This represents 4.23% of the budget, lower than that of 2015 (5.78%). Although the capital expenditure budget is […]

President Muhammadu Buhari on December 22 last year presented the 2016 proposed budget estimate of N6.08 trillion to a joint session of the National Assembly. Out of the estimate, N257.3bn was proposed for the Ministry of Health.
This represents 4.23% of the budget, lower than that of 2015 (5.78%). Although the capital expenditure budget is 13.86% which is more than 8.73% of the 2015 budget, the health budget’s value for this year also ranks the 5th largest allocation.
The proposed budget is now awaiting deliberation and approval by the National Assembly and thereafter presidential assent. However, the proposed 2016 health budget is not only inadequate but is also a far cry from the 15 percent “Abuja declaration”. In April 2001, heads of state of African Union countries met in Abuja and pledged to prioritize the development of the health sector by allocating at least 15% of their annual budgets to improve the sector.
In spite of this commitment, a preview of the trends of budgetary allocations over the years shows that the federal government has been allocating between 5 % and 6% of the budget to health, and it has never exceeded that at any point in time while Rwanda, Swaziland, Ethiopia, Malawi, the Central African Republic and Togo have since kept to the promise of the Abuja declaration.
Keeping the “Abuja Declaration” promise will increase the amount of resources spent on health and if spent efficiently, could improve access to quality health services and save lives.
An analysis of the 2016 budget shows loop holes which if not addressed before appropriation will impact negatively on the sector and the health of Nigerians.
A coalition of non-governmental organisations (NGOs) under the aegis of Partnership for Advocacy in Child and Family Health (PACFaH) has also expressed concern over the inadequacy of the 2016 budgetary proposal for the country’s health sector.
The coalition in a statement signed by the national coordinator, Dr. Judith-Ann Walker, along with their 2016 pre- appropriation health budget analysis made available to Daily Trust, observed that the N257.3bn being proposed for the Ministry of Health is inadequate to achieve the desired goal of ensuring the wellbeing of the citizenry.
“By this allocation and with an estimated population of 173.6million, according to the World Bank, allocation to the healthcare sector by the federal government, on a per capita basis, amounts to N1,488.00 ($7.55, $1=N197). In 2015, with a total allocation of N259.75 billion and an estimated population of 168million, allocation on per capita basis was N1,546.00. In 2014, allocation was N264.46 billion, an estimated of 160million, allocation on per capita basis was N1, 653.00.00,” the NGOs said.
Other health allocations with other MDAs 24,696,899,693.00     Total Health Allocations at the federal level 282,079,051,439.00     Also analyzing the 2016 proposed health budget, Nigeria country representative of ONE campaign, an international non-governmental organization, Edwin Ikwuoria, says generally, there is an overall increase in health related allocations but a decline in the provisions for the Federal Ministry of Health and its agencies driven by the reduction in recurrent expenditure.
He says the increase in the capital votes for the health sector in 2016 is not enough to compensate for the decline, saying while there was a noticeable increase in the counterpart funding for HIV /AIDS including the global fund, there was no provision for counterpart funding for the polio eradication programme & routine immunization and other vaccines which has almost N16 billion in the 2016 budget.
In addition, allocations to the National Primary Health care Development Agency (NPHCDA) also experienced a major decline from N12.14bn to N7.8bn while allocations to hospitals and medical institutions increased slightly from N226.5bn to N230.6bn.
He adds that for other health related federal budget provisions, the most significant allocations in the 2016 proposal are mainly from the service wide votes and they include N5 billion for outstanding payments to health professionals, N3.87 billion for the State House Medical Centre under the presidency, N3.5 billion for providing counterpart funding for donor health interventions including the Global fund, 2.5 billion for NHIS premium for military retirees and 2.3 billion for the National Agency for the Control of AIDS (NACA).
Commenting on the National Health Act 2014 in relation to the 2016 budget proposal, Ikhuoria says there is inconsistency and the government of Nigeria appears to have disregarded its own policies in the new budget proposal.
“There is no evidence that the 2016 budget proposal complies with the statutory provision for health as documented in the new National Health Act of 2014. The intent of the new law was to correct the lopsidedness in the funding of the primary health care in Nigeria and aimed at providing the bridging funds needed to create a resilient health system,” he says.
According to him, the budget proposal is silent on funding priority areas like maternal and child health, and there is no evidence of the increased funding towards taking increased responsibility for funding vaccination, HIV/AIDS, Malaria and TB programmes, which are almost wholly dependent on donor funding.
“Funding for the health sector in the federal budget proposal is still grossly inadequate to achieve the health objectives of the SDGs especially at the primary health care level,” he says.
PACFaH member and head of the Civil Society Legislative Advocacy Centre (CISLAC), Mr Auwal Rafsanjani, noted that over the years there have been inadequate allocations to the health sector.
“There is no way a nation would be well when the health sector is neglected, and that is why we are saying the government should do something because a lot of people are dying due to the poor funding of the health sector. We call on the National Assembly to increase the budgetary allocation and ensure effective oversight of the budgetary allocation,” he says.
PACFaH NGOs also called on the authorities to ensure adequate financing for the four key areas of child and family health which are routine immunization, nutrition, family planning and essential medicines to stop under-5 diarrhea and pneumonia before the 2016 budget is passed into law.
The coalition comprises: Association for the Advancement of Family Planning in Nigeria (AAFP); Civil Society Initiative for scaling-up Nutrition in Nigeria (CS-SUNN); Community Health and Research Initiative (CHRI); Civil Society Legislative Advocacy Centre (CISLAC); development Research and Projects Center (dRPC); Health Reform Foundation of Nigeria (HERFON); Federation of Muslim Women Organizations in Nigeria (FOMWAN); and Pharmaceutical Society of Nigeria (PSN).
Coordinator of Africa Health Budget Network and Publisher Health Reporters, Dr Aminu Magashi, says adequate budget for the health sector will ensure proper infrastructure and health facilities, training and provisions of adequate man power, well equipped hospitals and proper health care for Nigerians.
He said there is need for the federal government to allocate adequate funding for the midwives service scheme and immunization in the 2016 Budget as well as ensure emergency drugs are available in all primary and secondary health care facilities like drugs for antenatal care, new born infection, and drugs for post partum bleeding saying doing so will help tackle maternal mortality in the country.