GIVING THE HEALTH SECTOR A BOOST
It is the duty of the government to make healthcare services available and affordable to those who truly need them. Denying citizens healthcare services to the point of abrogation is as good as denying them their right to life. Nigeria’s statistics for maternal mortality ratio, infant mortality ratio and life expectancy are very scary. The pattern of financing healthcare in Nigeria will determine if and when Nigeria will attain universal health coverage.
The government must spend more on healthcare services. In line with the Abuja Declaration of 2001, the federal government is encouraged to allocate at least 15% of its annual budget to health. The annual appropriations to the Federal Ministry of Health in the 2014, 2015, 2016 and 2017 budgets are 5.63%, 5.78%, 4.13% and 4.17% respectively of the overall budgets. The total allocation of 356,450,966,085 to the Federal Ministry of Health in the 2018 budget is commendable but can also be improved upon. If the Abuja Declaration benchmark of 15% can- not be met because of other competing needs, the federal government should allocate about 7.5% of its annual budget representing half of the Abuja Declaration benchmark to its commitment towards meeting acceptable health standards.
Upon attaining 7.5% budgetary allocation to healthcare, the fed- eral government can then progressively increase the budgeted amount up until a time when we will be able to meet the benchmark of the 2001 Abuja Declaration. Beyond increasing the budgetary allocation to healthcare, there is need to also ensure that the bulk of the allocation goes to capital expenditure. In the 2018 budget of the Federal Ministry of Health, 24.26% of the allocation went to capital expenditure while 75.74% of the allocation went to recurrent expenditure. This has also been the trend in previous years. Going forward, it will be in the best interest of the nation to increase the percentage allocation to capital expenditure.
In order to make more money available for the health sector, the National Health Insurance Scheme Act should be amended to make health insurance compulsory and universal. New funding sources like a minimal surcharge on imports, a special sin tax on alcohol and tobacco, and minimal tariff on telecommunication services could be explored to fund healthcare services. The federal government should also consider the establishment of a Health Bank of Nigeria.
The Health Bank of Nigeria will provide long term loans at single digit interest rates to healthcare infrastructure, human resources and healthcare institutions. Regional and international development partners should be encouraged to support the man- date of the Health Bank of Nigeria. The Central Bank of Nigeria should provide long term bailout funds for the health sector. In line with the provisions of the 2014 National Health Act, the recent decision of the federal government to allocate one per cent of the consolidated revenue fund amounting to 55.150 billion to basic healthcare provision fund is commendable.
However, all hands must be on deck to ensure that the appropriated 55.150 billion is fully released, cash-backed and judiciously utilised. Going forward, the dedicated amount of the consolidated revenue fund for basic healthcare should be domiciled in the statutory transfers of the annual budget rather than the service-wide votes of the annual budget where it is currently domiciled in the 2018 budget.
All ongoing efforts towards local vaccine production and sustainable immunisation financing should be strengthened. Bi-annual funding for the procurement of vaccines should be encouraged in order to reduce delays due to procurement bottlenecks, partial releases, cash-backing and utilisation of funds. Ongoing efforts geared towards nationwide revitalisation of Primary Healthcare Centres must seek the support of state and local government areas. Worthy of note is the fact that the federal government pays more attention on the construction of primary healthcare centres than it does on provision of resources for the daily administration and management of the primary healthcare centres. This implies that any effort of the federal government towards construction of primary healthcare centres that does not get the collaboration, commitment and support of the states and local governments will likely lead to fully constructed but non-operational primary healthcare centres.
What is the utility provided by a fully constructed primary healthcare centre that is under lock and key? The National Primary Healthcare Development Agency should develop a smart tool for functionality assessment to determine the degree of funding each primary healthcare centre will receive.
Also, the National Assembly is encouraged to elevate primary healthcare to justiciable fundamental human rights as enshrined in chapter four of the 1999 constitution. This will go a long way to promote transparency and accountability in the sector