Transparency and Nigeria’s Health Budget

The post 2015 agenda globally is strategic enough to factor promoting transparency and accountability among the indicators that measure performance and progress. “Transparency, as used in science, engineering, business, the humanities and in a social context more generally, implies openness, communication, and accountability. Transparency is operating in such a way that it is easy for others to see what actions are performed.” Whereas  “Accountability means ensuring that officials in public, private and voluntary sector organisations are answerable for their actions and that there is redress when duties and commitments are not met.”

Coming back to the Budget Transparency, it is defined as the “full disclosure of all relevant fiscal information in a timely and systematic manner and a precondition for public participation in budget processes. The combination of Budget Transparency and public participation in budget processes has the potential to combat corruption, foster public accountability of government agencies and contribute to judicious use of public funds (OECD, 2002)”

The 2013 iERG Report on Every Woman, Every Child was explicit as it has projected that only 17 of 75 iERG countries will achieve MDG-4 by 2015 and only 9 of 75 countries are expected to achieve MDG-5. Our country Nigeria isn’t among the 17 and not among the 9 respectively. Also in W.H.O’s report to the iERG, progress on transparency was labelled Red, this goal will be difficult or impossible to achieve at current rates of progress. It further elaborated that transparency is much more than providing access to data. “It means being able to understand and act on those data. For the iERG, this means linking transparency to the process of accountability—the use of information in an open, inclusive, and participatory mechanism that enables the free exchange of evidence to improve the health of women and children. A commitment to transparency therefore means a commitment to building capacity to understand and use information.” WHO identifies two further areas of weakness in efforts to achieve transparency, 1^st was the lack of engagement of media to amplify messages about women’s and children’s health and 2^nd, the absence of civil society from country accountability mechanisms.

Having said that, can we say Nigeria’s Health Budget is transparent? Read below information extracted from the 2012 Open Budget Survey by International Budget Partnership. The survey measures the state of budget transparency, participation, and oversight in countries around the world. It finds that the state of budget transparency and accountability is generally dismal. Only a minority of governments publish significant budget information.

It further observed that;

1. More than one third of African countries do not present their budget in a way that permits tracking of the amount of resources allocated to health
2. More than one half of African countries do not present their budget in a way that permits tracking of the amount of resources spent on health
3. More than 60% of African countries do not make any effort to link spending to results
4. Less than a quarter of African countries publish a Citizens budget
5. More than half of African countries either do not publicly issue a timetable of key dates for the preparation and release of the budget, or do not stick to the main dates in this timetable.
6. Only 7 Sub-Saharan African countries have ever conducted a National Health Account according to WHO, and none have data more recent than 2007. Only three of these included a reproductive health or child health sub-account.

For Nigeria;

1. It scored 16% in Open Budget Index which implied scant or no information.

2. In terms of allocation to health, it scored low in being transparent and in spending on health, able to link funding to results, government publicly shares and sticks to a timeline and citizens budget is published and disseminated, the scoring were abysmally low.

Another report tagged ‘2012/13 Assessment of Politics, Power & Perceptions (PPP) and Data for Decision making (DDM) in Nigeria. Under the Transparency section the score was 23% with respondents giving the low scores to the ease of accessing information on national health budget, on Maternal and Health Budget (MNH) budget and on MNH outcomes at state and LGA level. The Nigeria Accountability Framework which is a tool for assessing and planning implementation of the country accountability framework for health with a focus on women’s and children’s health in April 2013 under the  thematic area of ‘Monitoring resources’ with a focus on national health account (NHA) had scored Nigeria   low. It revealed that Nigeria NHA team serves as the steering committee for NHA but it lacked involvement of local and national NGOs. It also observed that there was an officially approved NHA framework with formal governance mechanism/ committee and coordinated by Federal Ministry of Health however the committee functions in an adhoc manner with no clear system and budget line to support tracking of expenditure at all levels.

Why is budget transparency important for health?

1. As citizens, we can’t influence and/or contribute to what we don’t know…
2. Currently, an insufficient amount of funds is allocated to health sector in Nigeria and isn’t utilise efficiently. With greater budget transparency, civil society (including NGOs, ordinary citizens and the media) can better influence spending priorities and track whether the money is actually used for the purpose intended or not.
3. Without transparency, there can be no accountability. This means less progress on commitments such as those made to Every Woman Every Child, FP 2020, APR, National Health Bill etc.

If Nigeria is to improve its health budget transparency, it will require consistent dialogue, support and inclement of civil societies, media and parliamentarians in health budget cycle.

This article was 1^st published in Daily Trust Newspaper of 27^th May 2014 by Dr Aminu Magashi ( healthweekly@yahoo.com)