Why health sector deserves big pie in 2017 budget
When in April 2001, member countries of the African Union (AU) met in Abuja and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector, there was hope that the standard of living health-wise would improve remarkably.
The aim of the Abuja declaration was to mobilise resources for the health sector with the hope that they would be spent efficiently, and thereby improving access to quality health services across the continent.
Fifteen years after that declaration, there are fresh worries that the proclamation has hit the rocks in many countries similar to the fate suffered by many other commitments endorsed by the leaders of the continent.
While about 33 per cent of the AU member countries are recorded to have allocated up to 10 per cent of their budgets to health, countries like Rwanda, Swaziland, Ethiopia, Malawi, the Central African Republic and Togo are listed as the countries that have so far kept to the promise of the “Abuja Declaration” by allocating 15 per cent of their budgets to health.
Nigeria, which served as the ‘declaration ground’, is far behind. Available records indicate that Nigeria’s allocation to its health sector hovers between four to six per cent of its national budget over the years.
The health budget for 2016 is also far below the agreed 15 per cent of Abuja Declaration. Indeed, there is poor funding of the health sector as evidenced by the FG budget for the year 2016.
Experts say Nigeria has failed in its leadership role in Africa by refusing to set aside the 15 per cent allocation of its budget to the health sector since 2001.
There are fears that Nigeria’s health service delivery could get worse in months to come due to its not satisfactory budgetary allocation. This is especially that international donations in areas such as HIV/AIDS and the likes are drying up.
But as Nigeria perfects the 2017 budget estimates, experts posit that the health sector budget must look inward to accommodate threats and expectations in medical industry of 21th century.
Towards a more responsive 2017 health budget at the federal and state levels, the National Institute for Policy and Strategic Studies (NIPSS) and the development Research and Projects Centre (dRPC) under the Bill and Melinda Gates Foundation funded Partnership for Advocacy in Child and Family Health (PACFaH) convened a training fellowship for senior public servants in health policy and financing recently.
The conveners say they are motivated by a firm belief that there is no way Nigeria would be well when the health sector is neglected.
Mr. Kyauta B. Tanyigna of the Directorate of Research of NIPSS considers it shameful that Nigeria has not kept to its commitment of allocating 15 per cent of its national budget to health.
He, therefore, urges the Federal and State Governments to increase budgetary allocation to the health sector to meet its own avowed commitment in the 2017 and subsequent budgets.
On implementation, he noted: “National and State Assemblies should increase the budget of health to 15 per cent being the minimum of the “Abuja declaration” to provide proper infrastructure and facilities; training and adequate skilled personnel.
“Substantial amount of the budgets should be allocated to the key areas of child and family health such as routine immunisation, nutrition, family planning and essential medicines to control under 5 diarrhoea and pneumonia which is lacking in the 2016 budget.” He also wants the National and State Assemblies to ensure effective oversight and budget tracking of the total allocations to health.
National Team Leader of the Partnership for Advocacy in Child and Family Health (PACFaH), Dr. Judith-Ann Walker, explained that the training was aimed at building the capacity of a strategic cohort of civil servants at the federal and state levels for effective health budgeting that is consultative and addresses the felt needs of vulnerable communities and is funded from sustainable domestic sources.
“The participants are made of up of 30 senior civil servants (at directorate levels) with direct responsibility for priority setting and budgeting for the health sector,” she explained.
One of the issues raised was the need for government at all levels to ensure transparency on how the money budgeted for health is used. States were encouraged to audit health expenditures at the end of each fiscal year as a way of winning the confidence of the people and encouraging potential donors.
Government officials were also urged to make the budget process participatory.
“Many people in Abuja or in capitals make their budgets in isolation from the people. We have a long way to go. We had a very good session on international development partners’ funds. Funding from the international organisations is just four per cent of the total contribution to health. It is not enough, but it can address needs that government does not have funding to address. Polio, routine immunisation, HIV/AIDS are significant funding. But utilisation of that funding has been an issue. We had a session on optimal utilisation of international development funding, and in that session, government was challenged to coordinate better, to provide counterpart funding, and to be more efficient because if the basket is smaller, efficiency becomes more important.”
She went on: “So, the challenge was planning, coordinating and ensuring that you are efficient. Now that the basket is smaller, we need to be more efficient. We need to plan better, and we need to coordinate better. We also need to prioritise based on felt needs and knowing what really affects the people, and the basic is your primary healthcare. Secondary and tertiary are important, but if we solve certain basic health problems at the primary and preventive level, we won’t need to get to secondary level.”
She called for adequate provisions for the health sector at state level and at national level, but expressed hopes that the participants would go back and make positive impacts in their Ministries.
She noted that there would be similar retreats for legislatures from the federal and state levels to ensure adequate provision for the line item for health.
Some experts who spoke at the programme also stressed the need for the Commissioners of Health in the states to be better empowered to manage the health sector devoid of undue interference from their state governors.
Director, Advocacy and Campaign at international NGO, Save the Children Fund, Dr. David Olayemi stressed the need for evidence based budgeting system.
“We need to be clear about what we are doing with the money available from government. The little money from donors is achieving a lot more results than the government money. Why is this so? If we continue to do budgeting the same way without audit, even if we put in 10 times the money we have now, nothing will change. You will only enhance corruption. Have states audited accounts for 2015?”
He stressed the need for every Nigerian to be covered in one form of health insurance or the other. He called attention to the need to put the people at the heart of the budget process.
One of the participants, Mohammed Mustapha underscored the effectiveness of the training, saying it has broadened the understanding of the task ahead.
Mustapha, who is the Permanent Secretary in charge of Niger State Planning Commission, noted: “It has become necessary for us to implement whatever has been said to us. If there is anything that we are carrying home, it should be that unlike before, the moment we leave here, we should go back and put into practice whatever we have learnt. One other thing that we have said is that it has become clear that we have not been handling the issue of donor funding properly in this country.”
He pointed to the disconnect between budget allocation and release, stressing how the late release of budgetary provisions distorts health care delivery targets.
Former Chairman, Federal Inland Revenue Service, Mrs. Ifueko Omoigui, called for innovative financing from states to boost health funding.
She charged the states to develop a framework that would make well to do members of the public to be free to make donations of funds or structures to boost healthcare of the people.
“It does work. If you go to many developed countries that we love to visit, you could go to the emergency ward of a hospital, and on the wall you see something on the wall indicating that somebody donated the clinic in honour of their late father. Don’t you see that? You could go to a school and a whole building is built and donated in honour of somebody by their children. We see these things. It is just to grow it. Fundamentally, we as a people, must realise that we must have a belief, otherwise all these things that we are saying would not happen. You know what that is: there is no problem that cannot be solved. We have to first believe that whatever problem we have can be solved,” Omoigui noted.