Wither Nigeria in AU’s 15% health sector budget (Features)

Although COVID-19 has presented several challenges, it also provides a unique opportunity for Nigeria to invest in long-term preparedness and re-commit to policies and declarations designed to do so, like the 2001 Abuja Declaration.

Twenty years ago, African heads of state and government came together at a summit to address the challenges posed by HIV/AIDS, tuberculosis, malaria, and other diseases plaguing the region. On April 27, 2001, several commitments, including Nigeria’s 15 per cent budget pledge, were made to bolster resources and improve health care across Africa.

According to the World Health Organization (WHO) Chief, Tedros Adhanom Ghebreyesus, the coronavirus crisis will not be the last pandemic, and attempts to improve human health is “doomed” without tackling climate change and animal welfare.

Ghebreyesus also condemned the “dangerously short-sighted” cycle of throwing cash at outbreaks but doing nothing to prepare for the next one.

The WHO director-general said it was time to learn the lessons from the COVID-19 pandemic.

“For too long, the world has operated on a cycle of panic and neglect,” he said. “We throw money at an outbreak, and when it’s over, we forget about it and do nothing to prevent the next one. This is dangerously short-sighted, and frankly difficult to understand.”

The Global Preparedness Monitoring Board’s September 2019 first annual report on world readiness for health emergencies — published a few months before the novel coronavirus broke out — said the planet is woefully unprepared for potentially-devastating pandemics.

“History tells us that this will not be the last pandemic, and epidemics are a fact of life,” said Ghebreyesus.

“The pandemic has highlighted the intimate links between the health of humans, animals, and the planet,” he added.

“Any efforts to improve human health are doomed unless they address the critical interface between humans and animals, and the existential threat of climate change that’s making our earth less habitable,” he said.

President Muhammadu Buhari has proposed a capital expenditure of N194.6 billion for the Nigerian health sector in the 2022 appropriation bill submitted to the National Assembly.

For the recurrent expenditure comprising personnel and overhead costs, the president earmarked about N516.6 billion, bringing the total budget proposal for health in 2022 to N711.2 billion from an overall annual estimated total of N16.3 trillion.

The Abuja Declaration was formed in 2001 following a pledge made by African Union (AU) countries to allocate “at least 15 per cent of the annual budget to improve the health sector.” Doing so ultimately ensures patient safety and healthcare worker safety worldwide amid the pandemic, and ensures that countries are adequately prepared to respond when a crisis like this happens again.

The most recent year for which data is available on the Abuja Declaration is 2011, which found that only Tanzania “achieved the Abuja Declaration target of at least 15 per cent, while 11 countries reduced their relative contributions of government expenditures to health during the period”.

While the 2022 proposed budget for the health sector is just 4.34 per cent of its total expenditure on health, unfortunately, this is less than half of the original commitment. The commitment under the Abuja Declaration is an investment in the future. Although some countries within the African Union stand out for their proactive response to COVID-19, that is not enough, according to some health experts.

The total budget size in Nigeria was increased from N15,507.76 trillion to N16.391.02 trillion. This represents 12.49 per cent, despite this increase, the total in the federal government capital budget was reduced by 9.04 per cent.

The overall federal government health budget (including funds under the service-wide vote) was increased by N695.04 billion in the approved 2021 budget to N 816.15 billion in the proposed 2022 budget. This also shows an increase of 17.42 per cent.

The Basic Health Care Provision Fund (BHCPF) was increased from N35.03 billion to N54.05 billion, an increase of 54.29 per cent.

The health recurrent increased to N462.63 billion (21.68 per cent) in the proposed 2022 budget from the N380.21 billion in the 2021 approved budget.

The Federal Ministry of Health (FMOH) and its agencies’ capital budget in the proposed 2022 budget was increased to N194.60 billion. This is N62 billion (44.59 per cent) more than the N134 billion in the 2021 approved budget.

While the capital budget of the National Primary Health Care Development Agency (NPHCDA) was reduced by 2.63 per cent, its recurrent budget was increased by 10.97 per cent. The total allocation of the agency in the proposed budget was reduced by 0.89 per cent.

Between 2009 and 2019, a total of N576.36 billion was allocated as capital expenditure for the country’s health sector. From this sum, N408.79 billion was released, but only N318.65 billion was spent.

The amount released in this period represented 70.9 per cent of the total cumulative allocation, while the total amount spent constituted 77.9 per cent of the released fund and 55.3 per cent of the total allocation. Of the funding released, 22.1 per cent was not used.

Despite alternative funding from the contingency budget, the budgetary allocation from the Basic Healthcare Provision Fund (BHCPF) to the health sector never surpassed 7 per cent. Even its peak of 6.2 per cent in 2012 is far less than the 15 per cent commitment in the Abuja Declaration. Amid the ongoing pandemic, the county’s allocation to the health sector for the 2021 fiscal year was 4.5 per cent.

Nigeria’s health sector in the 2022 proposed budget is about 4.34 per cent of the entire budget. This means that Nigeria is behind by 10.66 per cent to meet its 2001 health sector commitment.

Although the 2022’s budgetary allocation increased by 29.37 per cent and the cost of healthcare per person is pegged at N3,453 higher than the 2021 figure, what healthcare costs can it cover? Some health economists questioned?.

In 20 years, recurrent, also known as operational expenditure, represents 78 per cent of the total health expenditure, while capital only represents 22 per cent. Compared to the growth rate, recurrent expenditure has increased by 2,822 per cent between 2001 and 2021, while capital has only increased over 400 per cent.

Meanwhile, some experts argue that this significant difference shows the government has prioritized human resources and office overheads.

As the COVID-19 pandemic continues to wreak havoc, just like other infectious diseases, like Lassa fever and cholera, Nigerians were also expecting a rise in allocation in the Health Sector.

Dr. Abigail Banji, a Health Economist, said that an overwhelming addition in the aftermath of the pandemic shows that healthcare capacity building is now a key priority for the federal government.

Banji said that the health sector and the government’s commitment to improve it might have been one of the reasons for the 29.37 per cent increase in the proposed allocation to the ministry of health.

“Remember, President Muhammadu Buhari said in his budget speech that critical health projects will be carried out in 2022. We don’t know the projects for now” that’s what every Nigerian is waiting for.

“Now that the budget is passed, the cost of medical care budgeted for every Nigerian is N3,453. This is an improvement on last year’s figure pegged around N2,749 per citizen,” she explained.

According to her, this is the highest in the last five years, the 2022 proposed health budget still falls below the 15 per cent benchmark of health sector budget allocation which was reached by the leaders of the African Union (AU) in April 2001 in Abuja where the heads of state and government of the AU committed to allocate 15 per cent of their annual budgets to improve the health sector.

She stressed that Nigeria in 20 years had failed to meet the 15 per cent of AU commitment on the health budget.

Banji added that the proposed budget presented by President Buhari was all about prioritizing key issues like creating more jobs, ramping up healthcare spending, and boosting economic growth in the country.

“Health has become the biggest priority for Nigerians as the pandemic has exposed several loopholes in the system. To address the issue, the government has come up with various reforms,” she added.

Dr. Francis Ohanyido, Director-General, West African Institute of Public Health (WAIPH), said by April 2022 the declaration would be 21 years of a landmark event.

“Sadly, Nigeria which hosted the event has had consistently low funding for health, with the highest budget for health since 2001 to date being 6.2 per cent in 2012, a far cry from the 15 per cent target.”

“The average budget over these two decades has been just above 4 per cent which is abysmal when you consider that
the overall health capital is not growing to match increasing expenditure spread in the sector as well as inflationary trends and capital value. Beyond those considerations, other issues dog the performance, such as delayed and often inadequate releases of funds,” he said.

Ohanyido stressed that even the portion released may suffer from poor spending on the part of the Ministry of health and health agencies.

“For example, a retrospective analysis of a decade-long performance between 2009 and 2019 by PACFAH@Scale, shows an aggregate allocation of N576.36 billion for capital expenditure of which N408.79 billion was released but only N318.65 billion was spent out of it. A similar picture is also seen at the state levels too,” he explained.

According to Pharmacist Micheal Alagbile, Deputy Chief of Party Integrate Project, Society for Family Health (SFH), better and efficient use of the allocated budget may just be an option at this point.

Alagbile noted that under the prevailing situation, this would be a tough call, given the dwindling foreign exchange revenue from oil and other sources and the competing need for the scarce resources – insecurity, education and other areas in the country.

Meanwhile, Mr. Michael Idoko, Secretary of the National publicity committee, Association of Medical Laboratory Scientists of Nigeria (AMLSN), says Nigeria needs to start preparing now for the next pandemic.

Idoko, who is also a Public Health expert, noted that as the country grapples with the worst global pandemic in a century, it is, however, hard to think about preparing for the next one.

“Although the COVID-19 pandemic has been a human and health care disaster, scientific measures indicate that Nigeria and the world at large, may be lucky this time. COVID-19 was far less lethal than its predecessors, less contagious than previous pandemic viruses, and thanks to countries we’re able to quickly develop a cadre of effective vaccines.”

“The same way Nigeria invests in and prepares for national defence, it must also prepare for another pandemic. Though the next viral outbreak cannot be prevented, the next pandemic can but only with better preparation.”

“There is no doubt that the Nigerian pharmaceutical industry, governments, non-governmental organizations, and health care systems should have been better prepared for COVID-19 in part because the coronavirus that causes it, known as SARS-CoV-2, is closely related to other coronaviruses, particularly the one that caused the outbreak of SARS in 2003,” he added.

The expert, however, said that the massive human suffering and economic impact of COVID-19 underscore the significant investment that must be made for future preparedness.

“Dedicated public and private funding of such an effort would demonstrate a commitment to health care and create a defense against future pandemics that is founded on science and independent from political rhetoric,” he stressed.