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Furore over Buhari’s 2020 health budget proposal

Less than N300 allocated for each Nigerian; Stakeholders predict doom in healthcare sector   

Last week, President Muhammadu Buhari, proposed a capital expenditure of N46 billion for the Ministry of Health in the 2020 appropriation budget submitted to the joint session of the National Assembly in Abuja. The proposal is N4 billion and N10 billion short of the 2019 and 2018 capital expenditures respectively. The President also proposed N44.5 billion for the Basic Health Provision Fund, BHCPF – a fundamental healthcare funding provided by the National Health Act, first introduced into the National budget in 2018.  An examination of the 2020 budgetary proposal shows that health is 11th on the hierarchy, trailing a number of less fancied Ministries.

From an aggregate expenditure of N10.33 trillion for the 2020 budget, the allocation to health is a paltry 0.4 percent which is a far cry from the 2001 Abuja Declaration target of 15 per cent. 

For decades, health watchers have decried  the abysmal budgetary allocation, bedevilled by late release or non-release and poor implementation which have led to  Nigeria having one of the worst maternal, infant and Under-5 health statistics in the world. Good Health Weekly team, Sola Ogundipe, Chioma Obinna and Gabriel Olawale spoke to major stakeholders in the health sector.  Thy bare their minds on their fears, worries, disappointments and  expectations. Excerpts:

In the views of the Publicity Secretary, Association of Medical Laboratory Scientists, AMLSN,  Dr. Casmir Ifeanyi said:

“The proposed allocation for health in the 2020 budget is inadequate. What we need to look at is the Abuja AU declaration for funding to health sector, That N46 billion does not represent that. We also need to avert our mind to what percent of N10.3 trillion that the N46 billion represents and if you look at it, you will see that 10 percent of 10 trillion is 1 trillion, that simply means that 46 billion is less than 10 percent of 10 trillion, and therefore it can rightly be said that in fact 0.4 percent of 10 trillion, that is very abysmal. That is nothing near to AU declaration which was done in Abuja to encourage countries to make 16 percent of their budget available to health sector, if out of N10 trillion we are only appropriating N46 billion, for a population said to be over 200 million people, that is shameful, and  speaks volumes as to how Nigerians’ health is being valued particularly by the present government.

Buhari, APC
President Buhari

Nigeria needs huge investment to achieve health for all -Dr Ola Brown(Opens in a new browser tab)

This is the government that promises to put an end to medical tourism, unfortunately the head of government continue to engage in medical tourism, now in the budget we cannot find provision to support the end to medical tourism.

In the build up to this budget, Nigerians were told, even though it was done secretly, that about 20 federal health institutions had been in concession for PPP, nobody is discussing that, I think that is the reason why they are making paltry allocation in the 2020 budget, having concluded a deal through the ICRC to filter away health services at the tertiary health institution, where over 20, and they call it pilot study into the hand of private people, if you take away the health of our people and hand it over to capitalist I see danger, I see doom, I am worried about access, the whole campaign about access to health, availability of health service, universal coverage begins to border me, if you divide N46 billion, with 200 million, that simply means that our government is allocating just a little over N200 for the health of every Nigerian walking the street.

That is very discouraging, it is terrible that we have come down. Almost N300 billion is provided for work, what we expect is a similar provision for health sector and education, these are critical areas but not up to health sector.

It is after health sector that you can talk about infrastructure and education, you have to be alive to do other things. I here appeal to the National Assembly, led by Dr. Ahmed Lawal, and Gbajabiamila, to do the needful. They have been perceived as people’s assembly, we want to urge them to prevail on the Executive to revisit this paltry allocation to health sector and make it up so that we can revive the sector and curtail medical tourism.

Nigerians also need to resist the concession of our health system into private hands, that PPP template in health sector. It is robbing Peter to pay Paul.”

It is a huge misnomer— Adeniran, Chairman PSN Lagos State

In her submission, Chairman, Lagos State Pharmaceutical Society of Nigeria, PSN,  Pharm. Bola Adeniran said: The N46 billion capital budget for the health sector is a huge misnomer as it represents less than 1 percent of the N10.3 trillion budget. Some of the realities are that for the 5th time running, the Federal government has not factored the 1 percent Consolidated Fund which should energise the procurement of drugs at PHC level and social health insurance which are twin drivers for Universal Health Coverage.

As usual the Federal government has not made provision for Research & Development in the research institutes notably National Institute of Pharmaceutical Research & Development, NIPRD, and Nigerian Institute of Medical Research, NIMR.

Government has, from a superficial perspective, not budgeted enough to take care of personnel costs especially specialist allowances and funds for adjustment of CONHESS scale as was done with CONMESS since 2014 for  health workers.  These are issues that usually lead to avoidable strike actions in our volatile sector.  We do hope that government is not calculating dividends of its ill-conceived concession arrangements in 22 Federal Health Institutions, FHIs, as there are reflections of income generation in the 2020 budget estimates from privitisation.

On the flipside, Federal government ineptitude continues to encourage unprecedented corruption in most of the FHIs and agencies in healthcare. Government must therefore do more than it is doing to rescue dwindling fortunes in the health sector.

There is need for greater prioritisation of health —Dr Faduyile, NMA President

The details are not yet out but looking at the disclosed ones, especially when the fiscal space is contrasting. For instance, Basic Health Provision Fund, BHCPF, trajectory in 2018 was N55.1bn, in 2019- N51bn and now in 2020- N44.8bn.  So, the 1 percent BHCPF is reducing.

But the NMA appreciates the government for domiciling the BHCPF rightly where it is prescribed to be by the National Health Act – Statutory transfers as against the service wide votes in previous years.

For Capital allocation, in 2018 it was N71.11bn, 2019, it was N46bn and now 2020 it is now 48bn.  This proposed capital expenditure cannot do much to achieve the rehabilitation of certain tertiary hospitals as earmarked by the federal government in the effort to mitigate medical tourism.  No information yet on proposed total government expenditure on health for the 2020 fiscal year.

There are outstanding issues in salaries and emoluments for medical and other health care workers. The NMA prays that they are captured in the 2020 Appropriation to forestall industrial upheavals in the already ailing health sector.

Summarily, there’s a need for greater prioritisation of health in the national expenditure profile to accelerate the nation’s aspiration towards UHC.

My worry is how the budget will be utilised —Ohuabunwa, President,  PSN

On his part, President, PSN, Pharm. Sam Ohuabunwa said: The real issue is not the size of the budget to health. First, will it be cash-backed and second will the budget be efficiently utilised? When you combine the direct allocation to the Health Ministry and the statutory transfer to the health fund provided by the National Health Law, we have a fairly tidy sum.

My worry is how the budget will be utilised to address the key issues affecting Nigeria’s health care. How much will go to providing primary care and improving access to quality medicines. How much will be used on taking care of the civil servants?

How much will actually go into preventive healthcare, ameliorating infectious diseases and non- communicable diseases. That is the real question, not just the size of the budget. Can we get value for money?

Budget  grossly inadequate for 200 million people —Ajiboye, National President,  AGPNP

Corroborating their views, National President, Association of General Private Nurses Practitioners, AGPNP, Balogun Ajiboye, said: “It is the general belief that health is wealth and an unhealthy society cannot achieve maximum productivity level. Therefore, for any nation to develop, healthcare must be funded adequately. If Universal Health Coverage is about giving all Nigerians affordable, accessible and available healthcare services, regardless of their economic status, sex, religion, location and tribe, ensuring healthy lives and promoting the wellbeing at all ages is what the sustainable development is all about,  N44.5 billion for BHCPF and N46 billion for health totalling N86.4 billion out of N10.33 trillion budget is grossly inadequate for the health care of 200 million unhealthy population like Nigeria.

Also, if we want to base this proposal on precedence, it is not impossible that 60 percent of the capital project will not be released or probably released in December, and which might likely go for Christmas bonus for the boys.

However, if government can develop political will to do things rightly through the following: utilise nurses and midwives appropriately by allowing them to perform their functions in accordance with the law and their training, create enabling environment for the private health sector, after all, over 65 percent of the citizens’ access healthcare through private facilities, make health insurance mandatory and allow it to accommodate all stakeholders in the industry, reduce politicisation of health by putting round pegs in round holes, create health bank for easy access to fund to healthcare practitioners and health  businesses.  If all these could be done promptly, this small budget can create giant and positive effects on citizen health care.

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