20 years after, health budget falls short of 15% Abuja Declaration threshold. Nigeria’s health sector got 4.75% in 2019, 3.83% in 2020, and 4.18% in 2021 fiscal years.
Experts identify corruption and lack of accountability as major pitfalls in the sector.
Consistent low budgetary allocations to the health sector by the federal government has contributed greatly to the challenges faced by the sector, and unless this is reversed by prioritising health, the country may not be able to bridge the gaps created in the sector, experts have said.
Despite the importance of the health sector, investigation revealed that the Federal Ministry of Health received the sum of N1.385.36trillion only in the last three years (2019 to 2021).
A breakdown of the budget in the past three years (2019-2021) shows that N6,534 was budgeted for each citizen, indicating N2,178 per citizen in a year, based on the 2021 proposed population of the country.
Only four to five percent of the country’s total budget is allocated to health annually, against the Abuja Declaration of 15 percent budget allocation to health in 2001.
In 2001, heads of state of African Union (AU) countries met in Abuja and committed to prioritise the health sector by allocating at least 15 percent of their annual budgets to the sector.
Now 20 years after this commitment, which Nigeria was part of, countries like Rwanda, Ethiopia, Malawi, Swaziland, Togo and the Central African Republic have since met this target.
Nigeria has not even been able to allocate half of the expected 15 per cent in these 20 years.
LEADERSHIP recalls that President Muhammadu Buhari, while addressing lawmakers recently, committed to improving the health sector by channeling the earnings from the increment in the Value Added Tax (VAT) from five per cent to 7.5 per cent to health and others.
He had said, “The 2020 Appropriation Bill is based on this new VAT rate. The additional revenues will be used to fund health, education and infrastructure programmes.”
However, the percentages of the country’s health budget allocations, even in the proposed 2022 budget, show that the country has not significantly impacted on health as a sector to influence wholesome population.
Sadly, despite the deplorable state of tertiary health institutions in the country, recurrent expenditure has continued to rise over the years while spending on capital projects continued to receive less budgetary allocation.
LEADERSHIP gathered that recurrent expenditure got about N1.93trillion while capital expenditure got N240bn in the years in question.
In 2019, for instance, of the total budget of N8.9 trillion, as contained in the Budget Office of the Federation document, the sum of N423.92 billion, representing 4.75 per cent of the budget, was allocated to health.
Meanwhile, N315.62 billion (86 per cent) was allocated to recurrent expenditure while N57.09billion (14 per cent) was allocated to capital expenditure.
In 2020, of the total budget of N10.810 trillion, the sum of N414.46billion, representing 3.83 per cent of the budget, was allocated to health: N336.60billion went to recurrent expenditure and N26.46billion to Basic Healthcare Provision Fund (BHCPF), bringing the total recurrent expenditure to N363.06 billion while N51.40 billion went to capital expenditure.
In 2021, of the total budget of N13.82 trillion, the sum of N546.98billion, or 4.18 per cent of the budget, was allocated to health: N380.21billion went to recurrent expenditure and N35.03billion to BHCPF, bringing the total recurrent expenditure to N415.24billion, while N131.74 billion was meant for capital expenditure.
This indicates that a large percentage of the health budget goes to salaries, pensions and overheads while only a fraction is allocated to investment in healthcare facilities, equipment and other infrastructure.
Experts in the health sector have blamed low budgetary allocation for the deplorable state of the country’s health sector. They, however, linked corruption and poor utilisation of the little money provided as major challenges.
Professor and head of department, Pharmaceutical Technology and Raw Materials Development, National Institute for Pharmaceutical Research and Development (NIPRD), Prof Martins Emeje, told LEADERSHIP that low budgetary allocation was a major reason our health sector is in a deplorable state.
“The truth is that even what is budgeted is not judiciously used. We should not be talking about whether the United Nations or World Health Organisation (WHO) or any organisation has set a standard on the minimum percentage that should be used. That is not the case; if we judiciously use what we have, we will be able to attend to ourselves to a large extent.
“It is true that the budgetary allocation is very low. It’s a shame, but the truth is that even the utilisation, the proper application and judicious utilisation of the little provided, is a huge problem. That is what people call corruption, but I don’t call it corruption, I call it stealing.”
Also, a reproductive health expert, Dr. Ejike Orji, identified corruption and lack of accountability as another challenge confronting the sector, saying even the little that is allocated is diverted.
According to him, a research by Bill and Melinda Gates on public health financing showed that out of every N100 that was meant for the health sector, only 40 per cent was spent while 60 per cent was stolen.
“How can a country grow like that? The allocation is poor; what is allocated is not used well and that is while people are dying unnecessary in the country. ““People are dying on a daily basis. In the past week I have counted people who have died who on a good day wouldn’t have died, and the reason is that the healthcare response to their needs was very poor.
“The few (medical professionals) we have are leaving the country. One of the major killers of people in the world is cardiovascular diseases. As we speak, we have less than 500 cardiologists in the country and they are leaving on a daily basis. I don’t know why we have not gotten to the point of seeing health as a priority.
“You have to be alive to be able to do anything. Health is central to anything in life. A sick person is a burden to his family and the community as a whole. The only credible workforce is the healthy workforce, yet our leaders have not seen the importance of giving health a priority in terms of allocation,” he said.
Orji noted that at the state level, the governors have not given health priority attention. According to him, the reason why the teaching hospitals and the federal medical centres are overburdened is because cases that are supposed to be treated in the primary healthcare and secondary facilities are all coming to the tertiary institutions, “and when you look at the allocation to health, it shows you that there is no leadership.”
