As we prepare the 2017 primary health care budget
Seventy per cent of Nigerians benefits from Primary Health Care Services at the various health centres in Nigeria. It is at the primary health care centres that a patient establishes his or her first contact with a doctor before being referred to specialist if need be. At the Primary Health Care Centres, services such as treatment and control of communicable diseases like (Malaria/TB/STI/HIV/Aids), Nutrition, Maternal and Newborn Care, Non-Communicable disease prevention, Health Education and Community Mobilisation are accessed by a large percentage of Nigerians. Some of these services are to be offered free while others are accessed with a subsidised amount of money. There is need to state that providing for this service cost so much. As a result, government has not been able to fulfill its basic funding obligation to basic health care. The funding inadequacies are also met with lack of proper prioritisation of services in the primary health care and full implementation of projects in the PHC budget. As we approach 2017, careful efforts have to be taken to avert the shortfalls of the PHC 2016 budget in 2017.
In 2016, Health budget was generally too small as 4 per cent of the national budget was allocated to health. A total of N250 billion was approved for health while 11 per cent went for capital administration. The amount for capital projects is too small compared to the recurrent. There should be efforts to increase allocation to health in 2017.
Primary Health Care which received a total of N17 billion in 2016 made allocation of a little above N3 billion for vaccines provision, while N9 billion was allocated for polio eradication. Meanwhile, about 20 million Nigerian children are in need of different levels of vaccines. From the budget if the amount to be utilised for vaccines is divided per head, it is less than N160 per child. The cost of accessing vaccines for meningitis alone is $124 per child, there are more than 10 vaccines to be accessed from the day a child is born up to five years with various degrees of cost attached to each.
Nigeria has been supported by various donor agencies in the procurement of vaccines but we are aware of the threat by some of these funders to withdraw their support from Nigeria. We must beckon on them to continue supporting Nigeria in this regards; but it is also important that the Federal Government begins to make appropriate preparations in the 2017, to fund research of local production of vaccines in Nigeria.
To reduce infant and maternal mortality, the recommendations of the Integrated Maternal Newborn Child Health Strategy need to be implemented. Implementing this strategy requires increased allocation to the IMNCH. The IMNCH received only N20 million in the 2016 budget. Despite this poor allocation, it stills calls for applause because it was only in 2016 that the IMNCH received any allocation since it was drafted in 2000 at the millennium summit held in New York. The IMNCH focuses on linking health care from home to community to health facility, health policies, programmess and interventions in the fields of maternal, newborn and child health. They are to be approached together and incorporated into integrated programmes. For instance, there are health-care programmes domiciled in some Ministries and Agencies which need to be linked to Primary Health Care Services. It also looks at resource mobilisation and coordination for the attainment of Millennium Development Goal, MDG goal 4 and 5.
As the 2017 budget is being considered, the Federal Government should consider mobilising resources from programmes run in other sectors like Agriculture, Women Affairs and so on. Agricultural loans with reduced incentives can be given to women farmers to cultivate crops while they set aside some percentage of their profits after sales for health care service. The Ministry Of Women Affairs can organise its women skill acquisition and empowerment training for the benefit of pregnant and nursing women. These actions will directly support the goal of the IMNCH strategy.
Another important issue that needs to be taken on board in the preparation of the 2017 Primary Health Care budget is the improved allocation to Family Planning. The Federal Government still falls short of its 2012 FP agreement. The agreement mandates the FG to make an annual funding commitment of $11million to family planning. However, since 2012, this has not been fully adhered to and as a result the demand generation for family planning in Nigeria is still very low. The benefits of family planning cannot be overemphasised as it helps in the reduction of high incidences of maternal and neonatal death rates. It took the intervention of several health stakeholders to convince the Federal Government before it made a paltry allocation of N791 million for FP instead of N2.1bn at the dollar conversion rate of N197.
One last area the FG needs to consider in the preparation of the 2017 budget is in the prevention of frivolous allocations in the entire health budget. For instance in 2016, we observed in the National Health Insurance budget that allocation of N35 million was made to procure two SUVs. This sum should have been channeled to the Unified Maternal and Child Health Programme which got just a paltry N63 million. The FG must be able to define its health priorities and get them right. Another frivolous allocation was the provision of 250 beds for tertiary hospitals by the National Primary Health Care Development Agency. It brings to fore the question: why should NPHCDA utilise its funds for the tertiary institutions? It shows miss-alignment of mandate and priority. Efforts must be made to get it right in 2017. In conclusion, the implementation of the National Health Act of 2014 will go a long way to address some of the funding gaps raised in this article as we prepare the 2017 PHC budget.
• Victor wrote from the Centre for Social Justice.