Budgeting for health, development

Soon, the Human Development Index (HDI), a globally recognised measure of standard of living, would be released. One of the major indices is health- access to healthcare, adequate personnel and services and infrastructure development. Where will Nigeria be?

Already, after much controversy that trailed the 2016 budget processes and its associated 2016-2018 Medium Term Expenditure Framework (MTEF), there appears to be issues overhang in 2017-2019 MTEF, although endorsed by the Executive Council of the Federation and awaiting National Assembly’s approval in compliance with the Fiscal Responsibility Act (FRA).

The Health Medium Term Sector Strategy (MTSS), which forms part of the MTEF, includes focus on Maternal, New Born and Child Health (MNCH), is expected to articulate medium-term health goals and objectives. This is against the background of the overall goals of high level national health policies, international health standards and the attainment of the Sustainable Development Goals (SDGs).

The MTSS also identifies and documents the key initiatives that will be embarked upon to achieve the goals and objectives while the cost of the identified key initiatives should be presented in a clear and transparent manner among other objectives.

Of course, current health indicators in Nigeria should drive a robust investment plan that the MTSS should highlight based on the realities of the country.

Today, life expectancy in Nigeria is nearly the worst in the world at 53 years for males and 56 years for females. Still, government’s investments in health fall well below regional and global standards and much of Nigeria’s health sector is supported by donor financing- some of which is expected to decline substantially in the next five years due to dwindling resources and fatigue.

Health sector funding has also failed to translate to the desired outcomes- healthy mothers, thriving children, and a strong workforce.

Based on a critical review of the health sector, the current statutory obligations of the government, and in line with a sector strategy that considers the critical investments that must be made in the medium term, the Civil Society Organizations have reiterated the need for government to honor its commitments to Nigerian citizens.

For the CSOs, government must now implement the National Health Act by setting aside not less than one percent of the Consolidated Revenue Fund to the Basic Health Care Provisions Fund.

The Lead Director of Centre for Social Justice, Eze Onyekpere, said the allocation to the health sector should reach the 15 per cent, to reflect the Abuja Declaration benchmark, while the bulk of the new resources should go to capital expenditure to enhance access to equipment and health supporting infrastructure.

“Increasing the efficiency of health sector spending through greater value for money strategies. Ensure strict and efficient implementation of the resources allocated to the health sector by implementing open contracting standards as part of an open government strategy. Full and timely release of the capital budget of the Health Sector starting from the 2017 financial year.

“The revitalisation of one Primary Health Centre (PHC) per ward (a total of 10,000 across the Federation) is a noble intervention. It needs to be executed with the strong collaboration, dedication and commitment of states and local governments, which will eventually run these PHCs. This is imperative for the sustainability of the intervention,” he said.

But in a communique by a coalition of CSOs, they noted that care must be taken to ensure that Federal Government’s spending on health is dedicated to the issues assigned to it by the Constitution and extant laws.

“The experience of the nurses and midwives hired by Federal Government during similar interventions under programmes like MSS and SURE-P should be brought on board in designing the implementation strategies of the PHC revitalization initiative. Essentially, Federal Government, states and councils must come up with a clear strategy for sustaining the improvements after Initial withdrawal of its intervention.

“Although PHC is not the primary responsibility of the Federal Government, it should provide resources in form of grants to states and Local governments, given that it takes more than half of the Federal Account funds.

“Strong accountability frameworks and practices must be put in place to ensure efficient utilisation of approved funds. There should be more focus on development of national health policies and ensure all the existing ones are implemented.

“Public-Private Partnership schemes in the health sector should be encouraged, but made as transparent and efficient as possible. This will ensure that the areas that the public sector cannot delve into as a result of lean finances, the private sector actors can augment and fill the funding gap.

“However, necessary caution must be applied in adopting the public-private partnership model of health funding in order not to price public health facilities beyond the reach of the ordinary Nigerian.

“Government should explore innovative funding mechanisms for the health sector, including compulsory universal health insurance scheme for all Nigerians. The ministry should embrace civil society as a critical partner in achieving greater value for money in a bid to improve national health outcomes.

“Future preparation of the MTSS should rely on a full Sector Team, including all relevant stakeholders. The specific contributions of Development Partners should be identified and captured in the budget for purposes of transparency and accountability,” the activists said.

Section 18 of the Fiscal Responsibility Act (FRA) stipulates that annual budgets are to be derived from Medium Term Expenditure Framework (MTEF). It further provides that notwithstanding anything to the contrary contained in this Act or any law, the Medium Term Expenditure Framework (MTEF) shall be the basis for the preparation of the estimates of revenue and expenditure required to be prepared and laid before the National Assembly under section 81 (1) of Constitution.

The sectoral and compositional distribution of the estimates of the expenditure referred to in sub-section (1) of this section shall be consistent with the Medium-Term Developmental Priorities set out in the Medium-Term Expenditure Framework (MTEF).

CSO seeks to make inputs into the Medium Term Developmental Priorities of the Federal Government in the Health Sector, considering that this will form the basis for the preparation of the 2017 federal Health budget.

Beside national laws and policies, Nigeria is a member of the United Nations and signatory to a plethora of international standards that mandate States Parties to be more responsive to the bundle of rights encapsulated in health and MNCH.

The new focus of global development- Sustainable Development Goals supports the protection of the right to health. SDG 3 is specifically on ensuring healthy lives and promoting well -eing for all at all ages.

The first pillar of Vision 20:2020 is Guaranteeing the Productivity and Wellbeing of the People and one of its strategic objectives is focused on health – enhance access to quality and affordable healthcare.

The First National Implementation Plan targets improvements in the health indicators to achieve remarkable drop in maternal, new-born and under-five mortality rates.

The vision targets further a reduction by half of the HIV prevalence rate of 4.4% by 2015 and increasing immunisation coverage from 27 per cent at the base year (2009/10) to 95 per cent in 2015. This is yet to be achieved as at 2016.