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Why 15% budget allocation to health is tall order, by FG

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• N246 budgeted for one month medical care of every Nigerian in 2021
• Concerns over no direct allocations for COVID-19, future pandemics
• FG allocates 4.526% of budget to sector compared to 12.5% by S’Africa

The Federal Government has provided explanation why it 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.

But a breakdown of the 2021 appropriation bill presented, penultimate week, to a joint session of the National Assembly by President Muhammadu Buhari showed that only 4.526 per cent (about N592.166 billion of the proposed N13.082 trillion) was allocated to health despite the ongoing COVID-19 challenge and the threat of another pandemic.

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A further breakdown of the proposed budget showed that only N2,960 was budgeted for the medical care of every Nigerian for one year (12 months) and N246.715 for one month and N8.2 for each day. That is N592,166,000,000 proposed for capital and recurrent expenditure in the 2021 appropriation bill divided by 200 million Nigerians to get 2,960.

Permanent Secretary, Federal Ministry of Health (FMoH), Abdulaziz Abdullahi, told The Guardian: “The 15 per cent budget for health is an aspiration and a set target that the country wishes to attain; however, many other factors militate against it. There are competing interests from different sectors such as education, agriculture, security, among others, and this means that the government must prioritise based on available resources.

“The dwindling resources are driven by increased insecurity in many parts of the country and the recent COVID-19 pandemic, which has virtually brought the economy of the world to a standstill. The fall in oil prices due to the pandemic has further reduced government revenue generation since oil is the major source of government revenue.”

Abdullahi said the situation led to the non-attainment of the targeted 15 per cent budget for the health sector, stressing that it would impact negatively on the Nigerian health system and universal health coverage even as the country continued to augment through other health financing sources such as loans and grants by international agencies, including United States’ President’s Emergency Preparedness Fund for AIDS Relief (PEPFAR), Global Fund, World Bank, among others.

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He also noted that underfunding the health system would bring about the lack of improvement, gradual loss, or decline in the health system’s gain over the years.

“This will increase the stock-outs of essential commodities and consumables across health facilities in the country. The attendant effect of all of these will be a further rise in the already high out-of-pocket health expenditure and catastrophic health expenditure, thereby further pushing several households into poverty. It will also impact health care delivery systems, including the infrastructure and the needed equipment.”

The permanent secretary said the COVID-19 pandemic had brought to the fore the inadequacies which were hitherto overlooked.

MEANWHILE, stakeholders in the health industry have lamented that the money allocated to health falls short of what is needed to meet the needs of the country’s health sector.

They expressed concern that despite the present and future threat of COVID-19 and other predicted epidemics, there were no direct allocations for COVID-19 and dedicated funds for financing future pandemics in the proposed 2021 budget

President, Nigerian Medical Association (NMA), Prof. Innocent Ujah, told The Guardian: “We need to study the proposed appropriation bill very well. But from what we can see, there is little improvement which falls short of the 15 per cent recommendation for national budgets on health.”

According to him, there is some distance to travel to ensure health care is affordable and accessible to all citizens for Universal Health Coverage (UHC) to be achieved.

“At the heart of the fragile health systems are the perennial failure of governments (federal, state, and local) to prioritise health and allocate adequate resources to it. Nigeria’s allocation to health in 2020 was a mere 4.16 per cent of the budget and it is predictable how much of the fund would be released for the care of the people,” Ujah said.

A virologist and Chairman Expert Review Committee on COVID-19, Prof. Oyewale Tomori, told The Guardian that time had come for stakeholders to stop expecting 15 per cent allocation for health, saying it was unsustainable.

“Let us focus this year on how the paltry allocation is spent. Who gets the lion’s share, who steals the rest and what crumbs the ordinary people get for their health in the end? Time we begin to focus more on what happens to these allocation when it gets to the ‘Ministries of Hell’ for the people and ‘Ministries of Wealth’ for some people.”

WHAT are the implications of the proposed budget on the quest for better health indices? A consultant public health expert and Executive Secretary, Enugu State Agency for the Control of AIDS (ENSACA), Dr. Chinedu Idoko, said: “The implication is likelihood of not achieving the anticipated pursuits of improved human, material and financial resources needed for the very necessary rehabilitation of the nation’s health care.”

Reacting to the non-mention of COVID-19 or funds for preventing future pandemic in the proposed 2021 budget, Idoko said that it is pertinent that for the country to make progress, the per capita spending on health should be shored up to, at least, the minimum expected standard of 15 per cent per capita, saying: “This way, the various facets of health care delivery will be able to access the minimum required for execution of critical elements of its functionality.”

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A further breakdown of the proposed 2021 budget showed there was a slight improvement in the percentage allocation of the 2021 appropriation bill to health from 4.14 per cent in 2020 to 4.526 per cent in 2021 proposal. In the 2020 budget of N10.33 trillion, the health sector received only 4.14 percent, that is, N427.03 billion out of the total budget.

However, the Federal Government increased the capital budget for health in the proposed 2021 appropriation bill from N46.478 billion in 2020 to N131.741 billion.

But there are fears that the little progress made in the development of Primary Health Care (PHC) and the National Health Insurance Scheme (NHIS) and ultimately Universal Health Coverage (UHC) might be reversed with the reduction of monies allocated for the Basic Health Care Provision Fund (BHCPF) from N44.498 billion in 2020 to N35.025 billion in 2021.

Unfortunately, the BHCF had been on a downward progression since the first allocation of N55.15 billion in 2018. In 2019 about N51.22 billion was earmarked and the lowest in 2020 with N44.498 billion.

ELSEWHERE, according to Deloitte commentary on South Africa Budget 2020/21, the country’s budgeted expenditure for 2020/21 is R1.95 trillion (2019/20 revised estimate: R1.84 trillion). The health allocation is (R229.7 billion – increased by three per cent).

A breakdown showed South Africa allocated 12.5 per cent of its yearly budget to health and its national budget is 4.2 times that of Nigeria’s N13.082 trillion at $110.4 billion (R1.84 trillion) that is N55.2 trillion. The allocation to health R229.7 billion ($13.78 billion) that is N6.89 trillion compared to N592.166 billion.

So this means South Africa’s budget for health is 11.6 times more than that of Nigeria and for a population of 67.7 million people compared to 200 million people in Nigeria.

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