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Less than five percent of the N13.5 trillion combined budgets of the federal and state governments will be spent on public health this year.

Less than five percent of the N13.5 trillion combined budgets of the federal and state governments will be spent on public health this year.

This is despite the poor infrastructure in the sector and the avowal by the government to discourage medical tourism, Daily Trust investigations have shown.

Official data analysed by Daily Trust shows that the two tiers of governments have budgeted a total of N591.8 billion for health, representing 4.3 percent of their total spending this year,

Although the figure represents a slight increase over last year’s, it is well below the 15 percent benchmark set by the African Union (AU) during the Abuja Declaration in 2001.

Last year, only four percent (N499.3 billion) of the N12.2 trillion total budgets of the two tiers of government was spent on public health.

Partnership for Advocacy in Child and Family Health (PACFaH), a health policy advocacy project led by Nigerian NGOs in its report on the State of the Nigeria Health – 2017 decried the low budget allocation to health.

The advocacy group which holds government to account to fulfil health policy and funding commitments, said “the 2017 proposed health budget is at 4.17 percent, a whopping 73 percent gap from the 15 percent benchmark.”

PACFaH said these figures are too insignificant considering the public health challenges facing the country in areas of children malnutrition, routine immunization, maternal and infant mortality and family health, among others.

“It is quite disheartening that other African countries with very low influx of revenue like Ethiopia and South Africa budget as much as 12 to 15 percent,” the report said.

“Nigeria should and can have a much higher allocation than these countries,” Dr Aminu Magashi of Community Health and Research Initiative, has said.

A public health consultant, Dr John Onyeokoro told Daily Trust that “the intervention fund of about N46 billion was not included in the budget due to lack of consensus among the key actors in the health sector at federal and state levels.”

Poor infrastructure

In April 2001, heads of state of AU countries met and pledged to set a target of allocating at least 15 percent of their annual budget to improve the health sector.

National Health Act 2014 provides that one percent of the Consolidated Revenue of the Federation should be set aside for health funding.

A report by the Africa Health Budget Network said because the government spends so little, the burden of paying for healthcare falls disproportionately on households.

In Nigeria, “69 percent of all health spending in the country was spent by households up-front, without insurance, in 2013,” the report said.

Nigerians are spending about $1billion annually on outbound medical tourism to India, Egypt, Dubai and United Kingdom, among others.

Nigerian public officials and their families always seek medication attention abroad, leaving behind poorly-funded public health sector characterised by incessant strikes by health workers, dilapidated infrastructure, and obsolete equipment, among other problems.

In April last year, President Muhammadu Buhari said the federal government will not provide funds to any government official to travel abroad for medical treatment unless the case cannot be handled in Nigeria.
Inadequate funding

The central government’s budget for the year is N7.29 trillion; and the recurrent expenditure will gulp N2.98 trillion.

The 33 states have a combined budget of N6.22 trillion and they are spending N2.60 trillion (42 percent) on salaries and overheads.

The federal government has earmarked N304 billion (4.17 percent) of its total expenditure of N7.3 trillion on health. Last year it voted N250.06 billion or 4.13 percent out of N6.1trillion. The sum of N51 billion of the N304 health budget is for capital projects.

The 28 states will spend N287.6 billion (4.63 percent) on health this year, a slight increase from the N249.27 billion (4.1 percent) 30 of them spent last year. The states have a combined budget of N6.2 trillion this year compared to last year’s N6.1trillion.

Health budget figures for Kebbi, Benue, Adamawa, Ondo, Ekiti, Ebonyi, Imo and Cross River are not available.

The 15 northern states are spending N155.2 billion (6.52 percent) on health out of the N2.38 trillion total budgets of the region. In 2016, the north spent N135.96 billion on health out of their total budget of N2.5 trillion.

The southern states are spending N132.4 billion (3.45 percent) on health out of the region’s N3.83 trillion total budgets for the year. Seven southern states spent N113.31 billion on health out of the region’s approved budget of N3.5 trillion last year.
Zone - by - zone figures
The northwest’s spending on health dropped from N60.02 billion last year to N46.2 billion this year. Its total expenditure this year is N1.01 trillion, slightly lower than 2016’s N1.12 trillion.

The southwest zone has budgeted N75.4 billion of its total budgets of N1.4 trillion on health this year, compared to last year’s N80 billion. The zone’s total budget last year was N1.4 trillion.

The northeast health budget rose to N57.8 billion against previous year’s N51.46 billion. Its total budget this year is N593 billion, lower than the N676 billion it spent in 2016.

The north central zone’s budget for health is N51.2 billion, almost double of the N24.48 billion it spent on the sector last year. The zone’s 2017 expenditure is N781.5 billion slightly higher than last year’s N684 billion.

The south-south region total budget for health is N51.1 billion, a hundred percent rise from the N25.41 billion it spent last year. The oil rich zone budget last year was N1.6 trillion, while it earmarked N1.77 trillion this year.

The southeast’s states of Anambra, Enugu and Abia have budgeted N5.9 billion for health out of the combined zonal expenditure of N581.2 billion for the year. The three states of Anambra, Enugu and Ebonyi spent only N7.9 billion for health. The zone’s combined budget last year was N490 billion

Top spenders

The states with biggest expenditure for health this year are Lagos (N51.4bn), Rivers (N27bn), Kwara (N26.1bn), Bauchi (N23.4bn), Borno (N19.5bn), Ogun (N15.1bn), Kaduna (N10.5bn), Kano (N10bn) and Kogi (N11.6bn).

States with above N5 billion votes for health are Oyo (N8bn), Sokoto (N7.7bn), Yobe (N7.4bn), Nasarawa (N7.2bn), Jigawa and Katsina (N6.5bn each), Delta (N6.3bn), Edo (N6.2bn), Bayelsa (N5.9bn), Akwa Ibom (N5.7bn), and Zamfara (N5bn).
Low spenders
States with least expenditure for health are: Abia (N685m), Osun (N894m), Niger (N2bn), Enugu (N2.5bn), Gombe (N2.6bn), Anambra (N2.7bn), Plateau (N4.3bn), and Taraba (N4.9bn).

Budget value

The project director of PSN-PACFaH, Remi Adeseun said 2017 federal health estimate “is cumulatively lower than that of 2016 due to the skyrocketed foreign exchange value of a naira to dollar.”

He said exchange rate “is important because most of our health services are reliant on importation.”

He said with official exchange rate now N305/US1, compared to last year’s N197/US1, the proposed 2017 health budget ($0.997m) is less than last year ($1.269m), by 21 percent.

Foreign donors

Dr Onyeokoro said federal government “refunds to GAVI and Global Fund, totalling about N6 billion, further diminishes the real value of the budget.”

Onyeokoro said another challenge of the sector, aside from poor funding, is poor accountability. “Worse still, there is no strategic attempt to include or capture all the monies from different international donor sources in our budgetary framework.

“If this was done, the recent cases of mismanagement of Global Fund and GAVI funds, an embarrassing scenario, would have been averted,” the consultant said.

He said countries like Rwanda that have attained the “Abuja declaration” did so by capturing all sources of fund inflow to the health sector.

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