Battles Low Budgetary Allocations Inspite of THISDAY’s Advocacy
Iyobosa Uwugiaren and Kingsley Nwezeh write that in spite of THISDAY’s advocacy, Minister of Health, Prof. Isaac Adewole, battled low budgetary allocations in the last four years
W ith consistent low budgetary allocation to Ministry of Health in the past four years, the Minister of Health, Professor Isaac Adewole, and the Minister of State, Dr Osagie Ehinare, have battled insufficiency of budgetary allocations, leaving funding gaps. But they have been persistent in the pursuit of policy initiatives and reforms.
THISDAY, the nation’s leading newspaper of record, as part of its corporate social responsibility efforts to help Nigeria focus on the challenges of financing its health sector and finding sustainable solutions to them, held several policy dialogues last year, with technical support from The World Bank.
The huge interest/concern by the participants, including some critical segments of the international community, could be seen in the finding of the Chief of Health, Nutrition and Population of The World Bank, Dr. Benjamin Loevinsohn, who said that Nigeria spends less on healthcare than almost any other country in the world, resulting in poor Nigerians paying out-of-pocket for their health. He noted that most poor Nigerians were unable to afford adequate healthcare.
But, in spite of the yearly low budgetary allocation, THISDAY’s findings revealed that the Ministry of Health boasts of some commendable achievements in terms of policy initiatives and reforms in the health sector in the past four years. As one of the most critical sectors in the country, the sector requires, at any given time, the full attention of government.
Since 2001 when Nigeria hosted African Union leaders, where a resolution to dedicate 15 percent of member-states’ annual budget to the health sector was reached, successive Nigerian health ministers have had no choice but to work with what is allocated to the ministry.
Since the Abuja Declaration, the highest percentage made in that direction was 5.95 percent in 2012. In President Mohammadu Buhari’s 2018 budget proposal, N340.45 billion representing 3.9 percent of the N8.6 trillion was allocated to the health ministry. As a professor of Gynaecology and former Vice Chancellor of University of Ibadan, Professor Isaac Adewole, and the Minister of State for Health, Dr Osagie Ehinare, have been strong on implementation of policy initiatives.
Although some of the policies preceded the Buhari Administration, they saw to its logical conclusion. Development partners notably, the World Bank, the World Health Organisation, Department for International Development, Bill and Melinda Gates Foundation among others, have made significant contributions in a bid to mitigate disease burdens and meet universal health care projections and targets.
Professor Adewole said recently that apart from the money added in the 2018 budget, the ministry had received about $22 million to fund the Basic Healthcare Provision Fund (BHCPF).
“The Department for International Development (DFID) is also putting 50 million pounds over the next five years” he added
As part of the National Health Act and a fundamental funding provision under the Act, the Basic Healthcare Provision Fund (BHCPF), provides one percent of the consolidated revenue for health funding. For the first time since the passage of the National Health Act in 2014, N55 billion was earmarked by the National Assembly as stipulated by the Act in 2018 budget. Six states are to benefit from the initial roll out. They include Osun, Abia, Niger, Yobe, Borno and Edo.
The federal government recently flagged off the enrolment of clients under the Basic Health Care Provision Fund (BHCPF) in Oshogbo, Osun State. The event which was held at the Primary Health Care Centre, Isale-Agbara, Osogbo, is a key component of the National Health Act, which aims at extending Primary Healthcare (PHC) to all Nigerians by substantially increasing the level of financial resources to PHC services.
Speaking at the Launch, the Minister of Health said that the BHCPF programme, also known as Huwe was a signature programme of President Muhammadu Buhari's Administration.
With prolonged leadership crisis at the National Health Insurance Scheme and the poor national coverage of the NHIS scheme -- since inception, and the passage of the National Health Insurance Amendment Bill by the National Assembly, it is expected that challenges facing the scheme would now be laid to rest.
This came as a result of a combined efforts of the ministers, Senator Lanre Tejuosho and Hon. Muhammad Usman, who heads the Senate and House Committees on Health. Though yet to be assented to by the President, the Bill is believed to have significantly resolved some lingering issues. Some health sector players, however, insist that there were still some grey areas.
On the Universal Health Coverage, Professor Adewole, believes that more funding from government would engender quality healthcare with a view to achieving the coverage.
“For us to accelerate progress on Universal Health Coverage (UHC) Federal and State Governments would need to invest more significantly in health.
"Because of limited government and pooled health financing, health spending was dominated by out-ofpocket (OOP) expenditures. As a result, OOP spending accounts for about 75% of total health expenditure – among the highest in the world – and 25% of households spend more than 10% of their household consumption on health, sign that more people were prone to poverty traps if they fall ill.
“According to the latest National Health Accounts, 67%, 26%, and 7% of government health spending took place at the Federal, State, and Local levels respectively in 2016, as a result, PHCs frequently lack basic amenities, equipment, and drugs which are severely undermining service delivery and efforts to improve health outcomes”, he said at a recent event.
In spite of efforts at funding the health sector, disease burdens remain high. Nigeria still accounts for a significant percentage of the global malaria burden. According to the World Malaria Report, Nigeria still accounts for 25% of the global malaria burden. Nigeria also accounts for 19% of deaths from malaria.
"Though funding for malaria control has remained relatively stable since 2010, we need to improve on the level of our investment to achieve a reduction of at least 40% in malaria case incidence and mortality rates globally by 2020', Adewole said in a recent interview.
The figures are not very far in relation to other diseases such as HIV/AIDS, tuberculosis et cetera in terms of disease burden, funding and distance from eradication.
According to the 2017 Global TB Report, Nigeria is among the 14 high burden countries for TB, TB/HIV and MDR-TB. The country is also ranked 7th among the 30 high TB burden countries and 1st in Africa. Nigeria was among the 10 countries that account for 64 percent of the global gap in TB case finding in 2017. India, Indonesia and Nigeria account for almost half of the total gap. The National Strategic Plan, NSP, on tuberculosis, said recently that Nigeria requires $336m to address TB challenges by 2020. But, a breakdown of the funding for the disease in Nigeria so far, shows that $31m (9%) has been provided domestically, and $90m (27%) has been raised through international donors; leaving a $215m (64%) funding gap.
With low budgetary allocation, the performance of the ministers would only be viewed from the funds available and the judicious application; but critics are quick to argue that development partners make significant contributions to the funding of health programmes in Nigeria, pointing to the state of teaching hospitals and federal medical centres, as signs of poor management. Overall, it is an above average performance.