As experts fault underfunding of health sector

The Budget Office of the Federation has released data showing how the country has grossly underfunded the health sector in the past 10 years and how it has consistently short-changed the future of its citizens through abysmal release of budgetary allocations despite having one of the worst health indices in the world and constant disease outbreaks.

Nigeria’s allocations to the health sector over the years have been below the recommended 15 per cent benchmark stipulated in the 2001 Abuja Declaration, which Nigeria was a signatory to

Titled “10-year capital funding gap in Nigeria’s health sector“, the data showed a wide gap between capital appropriation and the actual release/utilisation from 2016 to 2025.
According to the data obtained by The Guardian, which specifically captured capital allocations and actual releases for 10 years, which was about N218.0 bn appropriated for capital projects in 2025, only N36 million was actually released to the sector.
It further showed that in 2024, 2024 the sum of N434.8bn was allocated to the sector, while only N65.4bn, representing 15.06% of the allocation, was released.

Further breakdown of the budgetary allocations and releases revealed that in 2023, N134 billion was allocated, with N40.4bn released representing 30%, 2022 had N134.7bn allocated, and N87.3bn released 45%, 2021 had N194bn allocated, with N93.8bn representing 70% of the total capital budget released. 2020
N46.5bn with N23.2bn released.

In addition, N46.5bn was allocated for capital projects in 2019, while N25.5bn was released.
2018 had N71.1bn with N42.6bn release, N51.3bn in 2017 with N33.3bn released and N28.7bn in 2016 with only
N15.2bn released.
Minister of Health and Social Welfare. Prof Ali Pate, on Monday, during the Ministry’s 2026 budget defence before the House of Representatives Committee on Healthcare Service, revealed that only N36 million out of the N218 billion appropriated for its 2025 capital expenditure was released.

He told lawmakers that the implementation of the 2025 capital budget was stalled by circumstances beyond the Ministry’s control, adding that the meagre release made it practically impossible for the Ministry to execute its capital projects for the year.

Pate explained that though the entire personnel allocation for 2025 was released and fully utilised, the capital component suffered severe funding constraints, largely due to the bottom-up cash planning system operated by the Office of the Accountant-General of the Federation.

The minister stated that the situation was compounded by delays in the release of Nigeria’s counterpart contributions, which prevented the Ministry from accessing certain counterpart and donor-supported funds tied to capital projects.

Meanwhile, criticisms have continued to trail the proposed N2.48 Trillion health sector budget for 2026 as experts insist that the government cannot execute any serious capital project or meet up with the financial obligations for programmes that it had already engaged in with such a budget, especially the recent pact with the US government, Global Fund co-financing and the Gavi co-financing commitments.
They argued that despite the cuts in Official Development Assistance (ODA) for health, which makes increased domestic funding more imperative now than ever before, the amount proposed in the 2026 health budget is even lower than what was allocated to the sector in 2025.
Experts, therefore, urged the government to increase the health budget to at least six per cent of the total national budget.

In an interview with The Guardian, the Executive Secretary, Country Coordinating Mechanism (CCM) of the Global Fund, Tajudeen Ibrahim decried the federal government’s inability to prioritise the health sector in it annual budget adding that the Federal Ministry of Health could not execute any capital project in 2024, and was able to access only 25 percent of the immunization funding in 2024.
“What he was able to achieve in terms of access was about 25% of the immunisation money for the 2024 budget, which was extended up to 2025 December. So, he was only able to assess 25% of that allocation. What should happen to the other 75% population that should be immunized?.
Comparing the 2025 health budget with the 2026 proposed budget, he said, “What was approved in 2025 is more than what was proposed for 2026. The overall country budget for this year is over N58 trillion. In 2025, it was about N48 trillion. So, if you compare what was approved last year with the total budget and compare this year’s budget with the total budget, you get a percentage. So, it’s lower in the midst of all the commitments that we’ve already made, the government-to-government commitment, that’s US government-to-government of Nigeria commitment, where we’re supposed to take certain responsibility”.

“The Global Fund co-financing is there, Gavi co-financing is there. If this budget is approved, we cannot meet those responsibilities. I am not talking about other capital projects that have been initiated, except that they are saying all this should be funded from loan. If we do not have enough budget to meet our budget declaration, HIV, TB, malaria, communicable diseases will become less prioritised by the government, and there is automatically going to be a big problem”.
Ibrahim stated that the minimum health budget for this year should be at least 6%, which was the projection we had.
According to him, if the government fails to meet this 6%, it will automatically miss the U.S. $2 billion funding and will not be able to attract other funding.
“If we are unable to provide the government counterpart funding, we will also not be able to access the Global Fund. 50% of the Global Fund money as a country and that 50% is tied to activities, interventions, and this will be a threat not only to routine immunisation but health delivery in totality”.

Ibrahim further highlighted the effect the budget will have on the government’s target to deepen health insurance to cover more Nigerians and also improve service delivery at the Primary Health Care centres.
He said, “‘What we aim to achieve is to ensure that 40 million Nigerians are enrolled into the health insurance by the year 2027, we cannot meet that target, also the PHC revitalization, we are talking of directing people to primary care, so that when you have quality primary care, the chances that we will be having high cost of treatment will be reduced because you take care of primary preventive health conditions so that they will not degenerate to where you will be requiring high cost of treatment. These are some of the challenges about this budget”.
Ibrahim observed that there is a weak collaboration between the public and private sectors; otherwise, that would have been another avenue to address some of this.

High cost of living, high cost of care, and the fact that the government is committed to the 2021 Abuja Declaration, which requires African governments to set aside 15 per cent of their national budget for health.
He said, “Most countries are increasing their budgets. If you look at some states in Nigeria, like Kaduna State, they are already budgeting above the 15 per cent Abuja Declaration for health. So, Kaduna is the only state in Nigeria today that have 100% coverage of its health facility in terms of essential commodity supply, and if we don’t have it across all the states, we cannot achieve results”.

He emphasised the need for the civil society media and other stakeholders to engage the minister of finance, the budget office and the National Assembly to ensure that the health budget is increased to meet at least the 6 per cent minimum projection “.
On his part, a renowned Virologist and the President of the West African Network of the National Academies of Sciences (WANNAS), Prof Oyewole Tomori noted that Nigeria’s perennial low health sector allocation is a starvation diet to an already malnourished child stressing that the nation’s health indices reflect the 1960s health status characterised by poor health service delivery, regular outbreaks of diseases some of which the world has forgotten.

He criticised the proposed 2026 budgetary allocation for the health sector, describing it as a continuation of chronic disease of underfunding of the health sector.
Tomori lamented that despite the importance of health to economic growth and development, the government remains deaf and blind to pleas to adequately fund the health sector.
He said, “Those who say the health sector is not a direct revenue-yielding sector, only need to remember that one disease outbreak is all that is needed to decimate and destroy years of economic growth and development- remember COVID-19”.

Tomori noted that Nigeria has just forgotten about the Abuja 15% allocation of the national budget to the health sector,l
He said, “The 2026 health sector allocation represents about 4.3% of the proposed N58.18 trillion national budget. In 2025, the health sector was allocated 5.8% of the total ₦47.9 trillion. In real naira terms, the 2026 allocation is less than the 2025 allocation. This is when the naira buys less and less by the day, and foreign assistance and aid shock absorber pad is cracking, hardening. dwindling and may eventually disappear”.