By Ndidi Chukwu
In November 2016, Nigerian legislators participated in South African Parliament Retreat on Budgeting for health from 28th November to 12th December. Many African countries, the likes of Rwanda, Botswana, and Zambia, were there to discuss health budget allocation and the implementation of 2001 Abuja Declaration.
Nigeria’s reputable legislators in all innocence and dignity boasted, exhibiting the nation is indeed the giant of Africa, and has been doing a lot in health financing. They asked all the African nations to present their health budget to prove that the country’s budgetary allocation to health has been better than the health budget of all African countries put together. Rwanda presented 18% budget allocation to health, Botswana 17.8%, Niger 17.8, Malawi 17.1, Zambia 16.4%, Burkina Faso 15.8%, while Nigeria presented 6% as highest health allocation so far. How the legislators felt after this shame would be story for another day.
The legislators of the other African countries from presentations made during the retreat also had the right information about health financing, allocations and budget performance, their oversight responsibility was strong that at each point the executive made presentations the legislators asked important questions which indicated their knowledge on health financing, expenditure and quest for transparency.
What the Nigerian legislators learnt from that meeting is the obvious fact that Nigeria the giant of Africa and one which hosted African nations in 2001 were the declaration was made has not been committed to its pledge. Nigeria’s health outcomes since the Abuja declaration did not improve as compared to the countries that have reached the 15%
They understood that an investment in health has the potential of reversing the high rate of infant, maternal and child deaths which have continually made the country one of those with the highest disease burden in the world, the importance of adequate funding for health, timely releases of health funds and efficient scrutiny of health budget to ensure effective performance became pertinent.
Upon their return to Nigeria, the President presented the 2017 budget to a joint National Assembly on the 14th of December with a meagre 4.17 per cent allocation to health, which is just a marginal improvement on the 4.13 percent of 2016.
It was clear to the legislators that from the abysmally poor health allocation, the goal of universal health coverage through the National Health Insurance Scheme (NHIS) for Nigerians cannot be met, the National Health Act’s 1% consolidated revenue allocation for Basic Health Care Minimum package did not reflect in the proposed budget,
neither did the health allocation reach 15 per cent Abuja declaration of 2001 and the painful fact that 2016 health budget allocation and previous years remain poor in terms of performance.
Nigerian legislators represent over 170 million Nigerians, their role at the National Assembly are people driven. On several occasions Nigerians have seen these prestigious legislators debate on important issues that affect the masses and ensure that certain anti-people policies do not pass the approval of the house. Now the health budget is before the National Assembly with an abysmally low allocation and it is hoped that the legislators will not let this poor and frivolous health budget pass, except there is an increase.
According to the World Health Organization (WHO) data published in May 2016 on Life Expectancy, Nigeria has one of the lowest life expectancy ratio in the world (54.4%) with 55 years for women and 54 years for men, despite the embarrassing life expectancy, Nigeria’s budgeting process is still faced with the “cut and add” strategy, where very
irrelevant needs are given budget lines and awarded huge amounts of funds, whereas most of the country’s health capital allocation are left with nothing.
It has been reliably gathered from MDAs that the Budget Office caused a huge confusion during the 2017 budget planning process by assigning MDAs to plan with the Zero Budget envelop only to reverse this at the 11th hour, this led to the last minute rush that brings about fraudulent activities in the budget.
An example is the frivolous allocation of Nutrition funds to other ministries with no allocation to the Ministry of Health for treatment of malnutrition as recommended in National Strategic Plan of Action for Nutrition (NSPAN) whereas Ministries of Agriculture (N1 billion), Education (N13 million), Science and Technology (N24 million) Fggc
Efon (N10 million) Institute of Agricultural research Zaria (N377,056) Lake Chad Research Institute Maiduguri (N28 million) Nigeria Institute of medical research Yaba (N3 million) as the breakdown of N1.9 billion allocation in the 2017 budget to be used to fight malnutrition. There are over three million Nigerian children that are malnourished and in need of urgent treatment, if these funds go to these MDAs, it simply implies that these helpless children are left to die.
The implementation of the NHAct seem to have taken a political twist, and the Federal Ministry of health is segmented, some in support of the NHAct while others are bent on the 10,000 PHC revitalization agenda of the president which is allocated N3billion in the 2017 budget, but how this will be spent is not stated in the budget.
While Nigerians await adequate allocation in the 2017 budget, the National Assembly is encouraged to put a human face to the health care issues faced by the masses, funding of foreign medical trips with public funds, the horrible state of health facilities, non-payment of medical personnel, brain drain, immunization funding shortfall, increasing under five deaths as a result of malnutrition and other childhood killer diseases, maternal deaths, 5% health insurance coverage, out-of-pocket health service delivery system with the rising poverty situation in the country, displacement caused by insurgency, and many others and ensure that the 2017 budget captures NHAct’s 1 per cent CRF.
Renowned former minister of Health, Professor EyitayoLambo once said “it is the responsibility of every responsible government to meet the primary responsibility of securing the health of its people through increased domestic financing for health and ensuring that it is sufficient, efficient, equitable and sustainable” this is what the NHAct 2014 stands to achieve. But if this is not done more women and children are at the risk of losing their lives due to preventable causes.
It is therefore recommended that the legislators review critically the health budget, ensure that the 2017 budget captures the 1% CRF, improve on the health funding allocation to a reasonable percentage and drum it in the ears of the executives, the budget and planning ministry, who keep giving the excuse of competing sectoral needs that health is not like other sectors competing for funds, health is about the lives of Nigerians, only a healthy child will go to school, only a living mother will become an empowered woman, Nigerians need to be healthy to travel on the roads and use power.