‘2023 proposed national budget for health not sufficient to improve sector’

•Again, despite extra N352.26bn, FG fails to meet 15% recommended allocation to healthcare
•Health budget increased by 339.19% from N278.31bn in 2015 to N1.179tn in 2023
•BHCPF reduced by 13.61% from N55.15bn in 2018 to N47.64bn in proposed 2023 budget
•Analysis decries very poor release as well as gross underutilisation of funds
•Recommends timely publication of heath budget implementation report for accountability
•Group urges NASS to careful scrutinise estimates to avoid wastage of scarce resources

Analysis by stakeholders in the health sector has shown that the proposed N1.179 trillion for healthcare in the 2023 national budget is not sufficient for Nigeria to achieve Universal Health Coverage (UHC) by 2030, meet the health-related Sustainable Development Goals (SDGs) and tackle emerging epidemics and pandemics.

Critics say the major implications are that the President and other political office holders would continue to travel abroad for medical treatment and Nigeria-trained doctors, nurses, pharmacists and other health workers would leave the nation for better working conditions and remuneration elsewhere.

The analysis by the Partnership for Advocacy in Child and Family Health At Scale (PACFaH@Scale), a coalition anchored under the development Research and Projects Centre (dRPC), shows that despite extra N352.26 billion, from the 2022 figure, the Federal Government (FG) has again failed to meet 15 per cent recommended allocation to healthcare in 2023 proposed budget.

Indeed, the Federal Government has failed for the umpteenth time to meet the Abuja Declaration by African leaders in 2001 and the World Health Organisation (WHO) to allocate, at least, 15 per cent of yearly national budgets to health.

In April 2001, the African Union (AU) countries met in Abuja and set a target of, at least, 15 per cent of their yearly budget to improve the health sector.

Key findings of the analysis include: increase from 4.7 per cent in 2022 to 5.75 per cent in 2023 of national budget for health; health budget increased by 339.19 per cent from N278.31 billion in 2015 to N1.179 trillion in 2023; Basic Health Care Provision Fund (BHCPF) reduced by 13.61 per cent from N55.15 billion in 2018 to N47.64 billion in proposed 2023 budget estimates; and scaling up of family planning (FP) services from zero budget in 2022 to N20 million in 2023 to procure commodities through counterpart funding.

The coalition decried very poor release, as well as gross underutilisation of funds; recommends timely publication of heath budget implementation report for accountability; and urged National Assembly to carefully scrutinise proposed estimates to avoid duplication and wastage of scarce resources.

The analysis titled “A Glance Review of the Federal Government of Nigeria’s 2023 Health Budget Estimates” concluded: “The findings of this analysis show that Nigeria is far from its intended and expressed commitment to allocating 15 per cent of its total budget to health. Despite the increase in allocation to the health sector, it is still below 15 per cent of the Federal Budget. There is also a clear indication that the healthcare investment per person has increased but is below 6,000 per capita. It was also established that despite an increase in budgetary allocation to the sector, there was a very poor release, as well as a gross underutilisation of the fund released. The findings also show that the federal is planning to scale the FP services and procure commodities through counterpart funding for 2023. In the same vein, the N1.117 trillion for the health sector in the 2023 fiscal year constitutes 71 per cent of the total proposed N1.65 trillion public investment for the realisation of the all-set goals outlined in the health sector in the National Development Plan (NDP) from 2021-2025.

“It is however recommended that there is a need for adequate and timely releases of fund to the health sector in order to achieve the set goal of the national development plan as relate to the health care. There is a need to revisit the proposed investment plan proposed for the sector in the NDP, as it is counterproductive to the health budget estimates. The proposed investment for the sector should be realistic. There is also need to ensure timely publication of the heath budget implementation report for accountability. We call on the National Assembly to scrutinise the propose estimates to avoid duplication and wastage of the scarce resources. We also urge the National Assembly to increase funding to the sector from their annual N100 billion Zonal Intervention Fund, which in the 2023 amended budget stop at N2 billion.”

PACFaH@Scale’s National Coordinator, who is also the National President, the Society for Gynaecology and Obstetrics of Nigeria (SOGON), Dr. Habib Sadauki, in a statement, said maintaining the January to December fiscal budgeting cycle is commendable and challenges incoming governments to adhere to the principle.

“We commend the Federal Government for appropriating the highest percentage (5.75 per cent) to the health sector in the 2023 budget since 2015 and for reintroducing a dedicated line and code to support the maternal health of Nigerian women for scale-up of implementation of the national family planning programme, services, and procurement of family planning commodities through counterpart -funding for 2023,” he said

Sadauki also described the allocation of N70 million for routine immunisation as a welcome investment, which is a 41 per cent increase for immunisation, over the 2022 budget allocation, from N50 million in 2022 to N70 million in 2023

“As the National Assembly (NASS) reviews and debates the health sector estimates for 2023, PAS Civil Society Organisations (CSOs) are concerned that 5.75 per cent is still 9.25 per cent away from the 15 per cent promised in the Abuja Declaration signed by the Nigerian government. It is therefore our collective prayer to the NASS that, the 5.75 per cent allocation to the health sector in the 2023 proposed budget must not be reduced, downsized, cut, or trimmed; if anything, it should be increased to approximate the 15 per cent Abuja Declaration.”

The coalition further described as inadequate the provision of N47.7 million to the BHCPF.

“The seven per cent increase in allocation to the BHCPF in 2023 of N47,649,312 over the 2022 allocation of N44,564,737,089 is inadequate if the goal of Universal Health Coverage (UHC) is to be achieved and should be increased,” he said.

Indeed, for the first time in the history of health funding in Nigeria, over N1 trillion was allocated to the sector in the proposed 2023 budget.

An analysis of the proposed budget presented by President Muhammadu Buhari in October showed that N1.179 trillion was allocated to the health sector out of the total of N20.5 trillion for the 2023 fiscal year.

The amount comprises of N404.08 billion for capital expenditure and N580.82 for recurrent expenditure. It also includes N2.5 billion for aids and grants and a provision of N62 billion for retained independent revenue, which could help the health agencies, execute their other activities.

The health sector also gets N81.47 billion under the service-wide vote. This includes N69.57 billion for Global Vaccine Initiative (GAVI)/immunisation; N7.4 billion for counterpart funding including global fund, health refund to GAVI and N4.4 billion for military retirees under the National Health Insurance Scheme (NHIS).

The 2023 budget shows a significant increase from the N826.9 billion allocated to the health sector in 2022 and the N547 billion allocated in 2021.

While the capital expenditure increased by 94.83 per cent from the 2022 budget, the recurrent health budget also increased by 25.54 per cent.

The Africa Practice, a strategic advisory firm, operating at the nexus of industry and government, in a document, supported by Bill and Melinda Gates Foundation, titled “2023 Budget Proposal: Focus on the health sector”, said that based on precedence, the budget is likely to be further revised upwards as it is deliberated on at the National Assembly. The author of the report, Agwu Ojowu, said: “In line with the administration’s set schedule, the budget is to be enacted by December 31.”

According to the PACFaH@Scale document, as health sector remains one of the key areas of priority of the government as contained in the country’s National Development Plan 2021-2025, this report is a glance review of the proposed expenditure for the health sector in the proposed 2023 Federal Government budget to gaps and/or areas of improvement for policy engagement and to achieve UHC.

The document noted: “In August 2022, the Federal Ministry for Finance Budget Nation Planning issued a Budget call circular where Ministries Departments and Agencies (MDAs) were directed to give prominence to human capital development, specifically Health, Education and Social Protection in resource allocation. The Ministry recognized health care improvement as one of the key government priority areas. The analysis of the proposed budget estimates revealed that the sum of N1.17 trillion was allocated to the health sector against the sum of N826.9 billion (presenting a 42.59 per cent Increase) in the 2022 amended budget. While the capital health budget was increased by 94.83 per cent, the recurrent health budget was also increased by 25.54 per cent. There is a provision for retained independent revenue, which could also help the sector to carry out some activities. There is also the sum of N2.5 billion – a project tied to Aid & Grant for the procurement of the ‘Procurement and Installation of Magnetic Resonance Imaging (MRI) Machine’ at the Federal Teaching Hospital, Abakaliki. As apart from development, the health sector has the sum of N81.47 billion under the Service Wide Vote (namely N47.6bn for GAVI/Immunisation; N7.4 billion for Counterpart Funding Including Global Fund/ Health/ Refund and N4.4 billion for GAVI; and NHIS (Military Retirees).

“It could be seen that the health budget increased from N278.31 billion in 2015 to N1.179 trillion (representing a 323.68 per cent increase) in 2023. The service wide vote for health increased from N18.55 billion to N81.47 billion (representing a 339.19 per cent increase). The health recurrent budget was also increased from N237.31 billion in 2015 to N580.82 in 2023, representing N144.75 per cent. The health capital budget increased from N22.68 billion in 2015 to N404.08 billion in 2023, representing a 1,681.65 per cent increase. The huge increase in the health budget shows some level of policy commitment over the eight years period.

“However, the BHCPF was reduced from N55.15 billion in 2018 to N47.64 billion in the proposed 2023 budget estimates. This was a 13.61 per cent reduction. Thus, the funding increased by 6.92 per cent compared to the N44.56 billion allocation in the 2022 amended health budget. Given the current finding commitment to the sector, the health per capita increased to N5,409 using the World’s population Review 2022 estimated population of 218 million for Nigeria. The health capital will be N5,724 if the National Population (NPC) 206 million 2020 population estimates are adopted.

“Interestingly, while the routine immunisation budget was also increased from N64.6billion in 2022 to 2022 to N86 billion in the proposed 2023 budget estimates, the Federal Government of Nigeria has reintroduced the family planning budget line into the budget estimates. A new line ‘scale up of implementation of the national family planning programme, services and procurement of family planning commodities through counterpart -funding for 2023’ with the sum of N20 million was created.

“It could be seen that the sum of N137 billion was allocated to the health capital budget in 2021. N90 billion was released and cash backed and only N54 billion was utilised from the release. The amount released constitutes 66 per cent of the total allocated fund. The N54 billion utilised only constituted constitute 60 per cent of the released fund and 39 per cent of the total allocated fund. Therefore, as of second quarter (Q2) 2022, only N32.79 billion was released and cash backed (representing 15.81 per cent of the total allocation) from the N207.39 billion allocated as the health capital budget in 2022. Out of this released sum, only N4.65 billion. The sum utilised constitutes 14.18 per cent of the total released sums and only 2.24 per cent of the total health capital allocation for the year. It is more worrisome given the guideline and instruction from the 2023 budget call circular clearly stating that the ‘Implementation of the 2022 Capital Expenditure budget is expected to close by December 31, 2022, as indicated in the 2022 Appropriation Act implementation Guidelines (HMFBNP/BOF/2022/AAIG/02/2022), in furtherance of the FG’s commitment to maintain a predictable January – December fiscal period.’ This means that the FG has only about three to release all funds allocated to the sector for effectiveness and to achieve the key target and goals of the sector as contained in the National Development Plan 2021-2025.”