The budget is an indication of what the priority of the government is. A poor allocation to health is an indication of how the government prioritises the health of its people.
The 15% allocation to health as set by the Abuja declaration requires that the national government allocates 15% of its budget to the health sector. But, as can be seen in the graph analysing federal allocation to the health sector from 2010 to 2016, the Federal Government is not setting example for the States to follow.
It is not encouraging that since 2010 when the government budgeted 3.7% to health, we’ve not progressed in the last 7 years. At this point we are referring to allocations, not even fund releases. Oftentimes, releases are less than what has been appropriated. Furthermore, 80% of the appropriated budget is on recurrent expenditure. We are only left with 20% for capital expenditure. Taking that into consideration, what will be left for over 60% of Nigerians who live below one dollar ($1) a day and whose hope for health care services is at the primary level?
The primary health care is poorly funded. The 3-tier system that we are practicing is even a challenge to the management of the health system. In other countries where they apply a unitary system, once a policy is established at the federal level, it takes effect at other levels of governance. Tying primary health care structures to local governments that are underfunded means that health care system at the primary level, which is the hope of the people at the grass root, is affected.
With increase in inflation rate, which went up to 17% in 2016 from 13% in 2010, the purchasing power of our budget is further reduced, thus affecting the actual allocation to the health sector. The drastic drop in purchasing power is an indication that the health sector requires more funding to meet up with health care services that have become more expensive because of our current economic situation.
The Federal Government needs to give more resources to primary health care revitalisation as part of fulfilling its policy thrust for the health sector. This can be situated in the National Health Act, which makes provision for 1% of the consolidated revenue fund to be made available for basic health care.
There is need to be less dependent on donor financing for health care. We need to seriously consider domestic financing such as higher taxes on luxury products, to support our health care system.
Economic Value of Good Health Financing
A healthy nation is a wealthy nation. Only a nation with a healthy workforce will have optimum productivity, as sick people can only spend to recover instead of spending to boost the economy. When children are not vaccinated, you are building a population that will be susceptible to pockets of diseases, and even outbreaks, leading to a vulnerable population.
As a political, economic and administrative tool, the budget guides planning and implementation, and drives investments and benefits. It is also a way for the government to fulfill its campaign promises to strengthen the health system.
The government of Nigeria needs to critically consider the political and economic values of spending adequately on health. It is time we helped the underserved population who cannot afford health care services beyond the provisions at the primary health care centres. This administration is showing commitment to revitalising primary health care, but with inadequate budgeting to health, we may not achieve plausible and sustainable outcome.
Maternal and Newborn Health
An adequate health budget is a close step towards achieving improvement on maternal and newborn health care services at the primary level. At MamaYe, we are working hard to change the narrative about maternal and newborn health from “every year, Nigeria loses about 240,000 newborns and 40,000 women to maternal related deaths” to “...this year, Nigeria has saved 240,000 newborns and 40,000 women from maternal related deaths”. We are also encouraging everybody to take actions that would help save the lives of pregnant women and newborns through advocacy to policy makers and numerous activities involving organisations, communities and the individuals that we call the Super Activists. One of our advocacy efforts resulted in Bauchi State allocating at least 15% of its budget to health in 2016 and 2017.
The government needs to implement the Abuja Declaration to complement these actions in order to improve maternal and newborn health in Nigeria.
Written with contributions from Esther Agbon, Budget Advisor, MamaYe Nigeria.