Saturday, 9 January 2016

Health budget: 2016 appropriation still below WHO recommendation

Stakeholders in the health sector were shocked at the paltry N221.7 billion appropriated to the industry which is far below the N900 billion they had envisaged. Experts had expected a total health budget to be higher than previous years considering the numerous challenges facing the sector.

Though the 2016 budget of N6.08 trillion is big on capital spending -N1.8 trillion, compared with N557 billion appropriated for capital spending under President Goodluck Jonathan last year, capital spending on health is still uncertain, including how to go on with the new-fangled zero-base budgeting.

For instance, cost of immunising Nigeria’s children. Vaccines and the services that surround immunisation next year will cost $1.4 billion, according to official estimates.
At N197 to a dollar, that’s N275.8 billion. In context, $1.4 billion is one-sixth the worth shaved off Aliko Dangote’s fortune since February by a combination of naira slump and falling stock prices, according to Forbes.

University College Hospital, Ibadan
Getting the vaccines could be some headache for the National Primary Health Care Development Agency, which coordinates immunisation nationwide.
NPHCDA said it has “secured” a $148 million from GAVI – the Global Alliance for Vaccines Initiative, which helps procure and move vaccines around the world. A counterpart $166 million from federal government is uncertain, and so is the rest of the money.

Watchers of Nigeria’s health sector have therefore expressed fears that Nigeria’s health service delivery could get worse in 2016 due to insignificant allocation, which they said would be worsened following the withdrawal of international donor agencies support in an area like HIV/AIDS.
According to them, paucity of budget has become a common feature of the country’s health budget which many of them expected will vary especially with the ‘Change’ agenda of President Mohammadu Buhari.

However, to their chagrin, Buhari on Tuesday said N221.7 billion would be spent on health sector in 2016 as part of the initiative to improve the health care delivery to Nigerians. Buhari said this while presenting the 2016 budget to the joint National Assembly session in Abuja. The numbers have been crunched and the budget is in, but it is set to leave health stakeholders in jaw-dropping shock.
Health was only mentioned once in President Muhammadu Buhari’s entire budget speech before the National Assembly on Tuesday – and that in connection with recurrent expenditure. Now analysts are left in the cold.

Analysts have therefore expressing disappointment, further recalled that N262 billion (1.7Billion USD) was allocated to health in Nigeria’s 2014 budget; of which 82 per cent was on recurrent expenditure. The N262 billion allocated to health was about six per cent of the total budget and second only to defense, education and finance (finance includes debt servicing). It was slightly less than the N279 allocated to Health in 2013.

The 2013 budget allocation to the healthcare sector, on a per capita basis, was N1, 680 as against a World Health Organisation (WHO) recommendation that governments spend a minimum of N6, 908 per head, on providing healthcare services to their citizens. The gap of N5, 224 per head at the Federation level was too wide to be filled by autonomous spending fr0m state governments, according to findings.

The 2013 budgetary allocation to healthcare delivery was made even worse by the fact that 77 percent or N77 of every N100 allocated to the Ministry, was spent on paying personnel employed in the sector, leaving just N20 of every N100 spend, for capital expenditure incurred by over 50 Federal Medical Centres and Teaching hospitals across the federation and just N3 of every N100 budgeted for healthcare to cover overheads incurred.

With this structure of allocation, analysts observed that it was not surprising that these medical centres found it difficult to maintain existing facilities or acquire modern medical equipment. This explained the high tendency for political office holders and affluent Nigerians to travel abroad to take care of their healthcare needs, leaving Nigerians who cannot afford to travel abroad to use the poorly equipped and resourced hospitals in Nigeria.

Nigeria also has one of the lowest healthcare spends per head, even when compared with country peers in Africa. “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.”

Nigeria’s healthcare spend per head, which the 2012 World Health Statistics report puts at US$67, is even more insignificant, when compared with that of developed countries. The United States healthcare spend per head stands at $7000, that of Switzerland is US$6000 while the average healthcare spend per head among countries of the Organisation for Co-Operation and Development (OECD) is put at US$3,600.

A fallout of the low government spend on healthcare, is that Nigerians are forced to pay for healthcare delivery directly from their incomes at the point of getting healthcare services. This is classified as out of pocket expenses by the WHO, a major indicator of the state of healthcare delivery in a country.

The report showed that out of pocket expenses in Nigeria, which accounts for 65 per cent of the total healthcare expenses in the country, is one of the highest in Africa. For example, out of pocket expense in Ghana is 29 per cent, in South Africa it is just 17 per cent, while it is just 10 percent in Angola. The danger of high out of pocket expenses is that it could lead to financial ruin, or in some tragic circumstances death, where the patient is unable to afford the immediate cost of healthcare.

Nigeria, the report further showed, already has one of the worst healthcare statistics in Africa. An average of 143 children of every 1,000 births die before their fifth birthday in Nigeria, figures from the 2012 World Health Statistics show. Newswatch Times investigation shows that the only place worse than Nigeria for a child to be born is Angola, among comparative countries. The African average is 119 for children dying before their fifth birthday. In Kenya, the average is 85, in Senegal 75, in Ghana 74 and in South Africa 57.

Nigeria also has one of the worse life expectancy rates for adult survivors of early childhood death. The average Nigerian had a life expectancy of just 54 years in 2009, just about the average in Africa, but well below 62 years for Senegal and 60 years for Ghana.


This story was published in Newswatch Times on December 31, 2015.

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