Nigeria’s Grossly Inadequate 2017 Health Budget

While the United States of America will spend about $7 million per prisoner in Guantanamo Bay in 2017, Nigeria will spend N1,688 on the health of each citizen in the year. An unrealistic figure it hoped would magically tackle the numerous health issues in the country. Martins Ifijeh reports

Ever wondered why Nigeria is yet to find solutions to most of the health challenges in the country, like the incessant outbreaks of Lassa fever, high maternal and child deaths, poor primary health facilities, lack of functioning cancer machines, malnutrition, poor health emergency responses, among others? Wonder no further. The Nigerian government does not allocate enough funds for health interventions. It is not their priority.

This again has been shown in the 2017 national budget of N7.298 trillion presented to the National Assembly by President Muhammadu Buhari for approval, where only a meagre 4.17 per cent was allocated to the health sector, which is arguably one of the most critical sectors that drive other sectors of a country. Only a healthy people can plan for security, development or economic advancement.

On specifics, the Federal Government, if the appropriation bill is passed, will spend N304 billion on the health of over 180 million Nigerians, amounting to N1,688 per citizen for the whole year. Meanwhile, a prisoner in Guantanamo Bay in the United States will expend at least $7 million in the same year.

Also, on healthcare alone, the United States this year will spend at least $7,000 per citizen, which is about N3.5 million using a forex rate of N495 to a dollar. Switzerland will this year spend $6000, which is about N3 million. This, when compared to Nigeria’s N1,688 per head for a whole year, suggests why the country still grapple with poor health indices and the poor mortality rates for a country that prides itself as the giant of Africa.

No wonder various statistics show that Nigeria has one of the worst health records in the world. The country’s average mortality rate is put at 52 years, whereas in some less economically strong nations, even in Africa, their mortality rates rank way better than Nigeria’s.

For instance, while the number of deaths of infants under one year per 1000 live births in Nigeria is about 72.7, according to a 2015 report from World Fact Book, that of Rwanda is 58 deaths per 1000 children under five. That of Malawi is 42 deaths per 1000. Gabon is 46, Togo is 45, Kenya is 39, while Libya is just 11.

According to the Group Medical Director, Reddington Hospital, Dr. Tunde Lalude, during a presentation in Lagos recently, he said the budget alone for National Insurance Scheme in the United Kingdom for a year was more than Nigeria’s entire annual budget, thereby underscoring the importance the UK government attaches to the health of its citizens; a direct contrast to what obtains in Nigeria, whose population almost triples that of UK.

But the World Health Organisation (WHO) says for Nigeria to be seen to prioritise healthcare, it must at the least spend a minimum of N6,908 per Nigerian in a year, which when multiplied by 180 million people will amount to N1.2 trillion.

Meaning if N1.2 trillion is budgeted and spent on healthcare for a year, as against the current N304 billion being allocated to healthcare for 2017, it will go a long way in solving significant health issues in the country.

The WHO’s analysis therefore shows that with only about 25 per cent of the supposed allocation only given to healthcare for 2017 in Nigeria, it means on the average, about 75 per cent of healthcare services for each Nigerian will be funded from out-of-pocket, with majority of Nigerians obviously unable to afford it.

It is in efforts to close the huge health funding gap by governments to its citizens, especially in developing and underdeveloped countries, that the WHO in its wisdom recommended that countries should allocate at least 13 per cent of their annual budget to the health sector for effective funding. All member countries, including Nigeria signed towards the recommendation.

Also, an Abuja Declaration, signed in 2001 by all member countries of the African Union, including Nigeria, who in fact was the host of the high powered meeting, recommended that for the continent to be at par with other nations of the world in terms of healthcare provision, 15 per cent of their annual budget, at the least, be allocated to the health sector.

Thankfully, some countries have started raising their health budgetary allocation towards fully keying into the WHO recommendation of 13 per cent or the Abuja Declaration by the African Union of 15 per cent.

For example, Rwanda reportedly devoted 18 per cent of its total 2016 budget to healthcare. Botswana budgeted 17.8 per cent to health; Malawi, 17.1. per cent, Zambia, 16.4 per cent and Burkina Faso, 15.8 per cent. But Nigeria still lags behind in this regard, which has had direct consequences on the funding capacity of the Health Ministry, thereby making the fight against poor healthcare somewhat unrealistic.

This puts Nigeria as one of the nations of the world with the least healthcare spending per head when compared with other countries, especially in Africa. For instance, it has been reported that South Africa spends about seven times more per head on healthcare than Nigeria does, while Angola spends about three times more per head than Nigeria.

These indices perhaps explain why experts believe the recent allocated amount for the health sector was done in bad faith, hence the need for it to be revisited, while other funding options are looked into, especially with the gradual withdrawal of some donor organisations, due to Nigeria’s recent status as the ‘strongest’ economy in the continent.

Stakeholders under the platform of Partnership for Advocacy in Child and Family Health (PACFAH), the Pharmaceutical Society of Nigeria (PSN), and several others have called on President Buhari and the Minister of Health, Prof. Isaac Adewole to review the allocation to health if they must make successes in the health sector this year.

PACFAH, is of the opinion that the proposed health budget was cumulatively lower than that of 2016 due to foreign exchange challenges in the value of Naira to Dollar.

The President, PSN, Pharm. Ahmed Yakasai says in 2015, the United States allocated 20.7 per cent of its annual budget for health, Germany 19.4 per cent, Iran 17.5 per cent, China 12.6 per cent, and Turkey 10.7 per cent.

A former Director, Federal Ministry of Health, who preferred to remain anonymous, said one of the major challenges the ministry had during her time was the poor budgetary allocation to the sector, hence the need for the government to up its game so that needless deaths can be prevented through adequate funding.

She decried a situation in which majority of the amount for health was used for paying health personnel, whereas the public health issues needing tackling were given just a little fraction of the entire amount. “The bulk of the allocation should go to preventive and promotive care,” she added.

She called for expansion of financial options, as well as strengthening the contribution of private sector in the provision of healthcare in the country. She believed Public Private Partnership was a strategic way of gaining financial leverage at all operational levels of healthcare.

She advised well-meaning Nigerians and organisations to donate towards healthcare. “With these systems in place, out-of-pocket expenditure will gradually face out, as it would reduce the financial burden of most Nigerians, who are known to live on less than $2 per day.”