Towards ensuring judicious utilisation of health budgets
As legislature at both federal and state assemblies brace up to receive and process 2017 budget estimates from the executive, participants at a training workshop for senior civil servants in Kuru brainstorm on the need to allocate adequate funds for health while also urging proper utilisation of available resources. Sanya Adejokun reports.
Capital expenditure for the health sector decreased from N557 billion in 2015 to N28.7 billion in the 2016 budget. The recurrent expenditure for Health in 2016 is made up of personnel (N217.5 billion); overhead (N3.9 billion), giving a total of N221.4 billion which is less than the figure for 2015 that stood at N237.08 billion. In all, the N250,062,891,075, which is the total 2016 allocation as the health budget out of the total estimate of N6.08 trillion budget of the FG represents a meagre 3.66% of the budget. This is lower than the total 2015 health budget which had 5.78% of the total budget. The summary is that, over the years the FG has been committing only about 4-6% of its budget to health.
Stakeholders generally view consistent allocation to health over the years as inadequate to achieve the desired goal of ensuring the wellbeing of Nigerians.
The health budget for 2016 is far below the agreed 15 per cent “Abuja Declaration” reached upon in a meeting of heads of state of Organisation of African Unity (OAU) countries hosted by Nigeria in 2001. That declares that “we commit ourselves to take all necessary measures to ensure that all needed resources are made available from all sources and that they are efficiently utilised.
“In addition, we pledge to set a target of allocating 15 per cent of our annual budget to the improvement of the health sector.”
This was a pledge to prioritise the development of the health sector.
In a paper titled: An Overview of Federal Government of Nigeria’s 2016 Health Budget, Directorate of Research at National Institute of Policy and Strategic Studies, Kuru, Kyauta B. Tanyigna said comparison has been made with other countries of which about 33 per cent of them have allocated up to 10 per cent of their budget to health, other countries like Rwanda, Swaziland, Ethiopia, Malawi, the Central African Republic and Togo have since kept to the promise of the “Abuja Declaration” by allocating 15 per cent of their budgets to health.
The aim of the Abuja declaration was that in keeping to the promise, it will increase the amount of resources to be spent on health and if spent efficiently, could improve access to quality health services and save lives.
Participants at a Training Fellowship for Senior Public Servants in Health Policy and Financing jointly organised by National Institute for Policy and Strategic Studies (NIPPS) and Partnership for Advocacy in Child and Family Health (PACFAH) which held between October 4 and 7, 2016 in Kuru brainstormed on how health would be able to attract the needed attention in budgets of both federal and sub-national governments in 2017.
In the keynote address on Budgeting for Health in the Era of Economic Downturn and Recession: The Experience of Ghana delivered by Dr Lydia Dsane-Selby who stood in for Chief Executive of Ghana National Health Insurance Authority, it was revealed that contrary to the Nigerian situation where 70 percent of spending on health care needs is met from out-of-pocket, health insurance takes care of 70 percent in Ghana.
“We have been having discussions. We have heard from a lot of experts talk to us about the experience about how to identify alternative sources of funding beyond out of pocket expenditure to fund health in Nigeria,” she said.
While it was agreed that governments ought to allocate more funds to the health sector, there was the need to also ensure proper and efficient utilisation of what is available.
Acting Director General of NIPPS, Jonathan M. Juma, cited the example of a state in the north east with only one available MRI scanning machine servicing three or four states even though government officials in this and the other states ride dozens of SUVs. He urged participants not to push responsibilities to political leaders alone.
“Participants must be courageous when they get back to their stations and give priorities to items that will benefit the larger society. Rather than buy SUVs, it may be better to buy MRI scanning machines.”
National Team Leader of PACFaH, Dr Judith-Ann Walker noted that participants have shown “willingness to grapple with new ideas, I have observed willingness to engage with civil society organisations, but distance in the way we think about things.
“I have observed a system that is partially open to input from civil society in the way we meet needs of the people because budgets cannot only be developed in isolation in offices, they have to have a basis, common denominator. And that denominator should be from the people, from communities, from understanding felt needs.
“We brought them here to Kuru and we had these discussions. May be what we needed to do also was to go to communities to feel the real sense and the real pulse of how people are affected.”
Walker explained that after the NIPPS workshop, PACFaH, would also collaborate with National Institute of Legislative studies to organise retreats for the legislature.
“If we don’t treat health fairly, all out efforts at creating employment, building infrastructure, improving agriculture and other sectors will amount to nothing because health I at the bedrock, the foundation and right now in Nigeria, out of pocket expenditure on health is about 70 percent for households. It is not like that in other countries. In Ghana, it is 30 percent. We are paying for health but there could be a more efficient way of funding personal health needs.”
Ifueko Omoigui Okauru, Dr David Olayemi, Director Advocacy & Campaign of Save the Children, Asishana Okauru who is Director General of the Governors’ Forum all also spoke on the need for transparency and accountability in the management of available resources.
Olayemi said “I am actually looking beyond health. I don’t want it to look like budgeting for health. If the principles guiding budget processes do not change, health cannot be taken in isolation. It is about everything. The situation is even worse at the state level. Interestingly when we talk about budget processes, we focus on the federal level but doing so will continue to be erroneous.
“About 50 per cent of federation money goes to sub-national levels. Social services are supposed to reach the people from states and local governments. We must do a lot of analysis of how budgets are made and expended at the state level.”
On her part, Ifueko Okauru said Nigerians should look beyond government in funding the health sector.
“Funding the health sector must not be restricted to government sources alone. It has worked in other places and even here when you have individuals donated buildings to schools and hospitals. It is just to grow and expand the idea here too.
“Fundamentally, we as people must have a belief. If we don’t have that belief, everything we are saying here will amount to nothing. We must believe that there is no problem that cannot be solved.
“We must move from a complaint mode to that of influencing our own environment. We do not have to wait for others to do it for us,” she noted.