April 25, 2020

HEALTHCARE FUNDING: COVID-19 exposes govts’ failures


Illustrative, Medical staff

FG allocates 4.5% of budget to health in 12 years
FG, states allocated 6% of budget to health in 2019
Malaria claims 73,680 Nigerians in 4 months
Nigeria loses 216,000 children, 22,310 pregnant women this year

By Clifford Ndujihe, Politics Editor

IF the Federal Government and state governments had not been paying lip service to healthcare funding, Nigeria would have been at a vantage position to combat the prevailing COVID-19 pandemic sweeping across the world.

In the last 12 years, the Federal Government allocated N3.346 trillion (4.48 per cent) of its N74.70 trillion budgets to Health. In 2019, the Federal Government, 36 state governments and the Federal Capital Territory, Abuja allocated N1.119 trillion (6.17 per cent) of their collective N18.134 trillion budgets to Health, according to Saturday Vanguard checks.

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These are far cries from the World Health Organisation, WHO’s recommendation of 13 per cent or the Abuja 2001 Declaration by the African Union of 15 per cent. Medical facilities at the federal level would have been better if the Federal Government had spent N11.21 trillion (15 per cent of N74.70 trillion) on healthcare in the last 12 years.

Matters are made worse by incomplete release of the budgetary funds and the bulk of funds released go for recurrent expenditure (salaries and emoluments) instead of capital projects.

Aisha Buhari’s lamentation

In October 2017, First Lady, Aisha Buhari re-echoed lamentations of healthcare givers and stakeholders over the poor state of affairs in the sector.

She publicly upbraided the Chief Medical Director of the State House Medical Centre, Dr. Husain Munir, for the poor state of the health facility established to take care of the President, Vice-President, their families as well as members of staff of the Presidential Villa, Abuja.

Then her husband, President Muhammadu Buhari had been abroad for medication for about six months.

Speaking at the opening of a two-day stakeholders’ meeting on Reproductive, Maternal, Newborn Child, Adolescent Health and Nutrition held at the Banquet Hall of the Presidential Villa, she said: “If somebody like Mr. President can spend several months outside Nigeria, then you wonder what will happen to a man in the street.

“Few weeks ago, I was sick as well. They advised me to take the first flight out to London; I refused to go. I said I must be treated in Nigeria because there is a budget for an assigned clinic to take care of us. If the budget is N100m, we need to know how the budget is spent.

“Along the line, I insisted they call Aso Clinic to find out if the X-ray machine is working. They said it was not working. They didn’t know I was the one that was supposed to be in that hospital at that very time.

“I had to go to a hospital that was established by foreigners 100 percent. What does that mean? So, I think it is high time we did the right thing. If something like this can happen to me, there is no need for me to ask the governors’ wives what is happening in their states. This is Abuja and this is the highest seat of government, and this is the Presidential Villa.’’

More than two years after the First Lady’s lamentations, little or nothing was done to improve on the sector. The Federal and State governments budgetary allocations to health remained miserly while Nigeria’s health indices continued to rend the heart.

HEALTHCARE FUNDING: COVID-19 exposes govts’ failures

Poor health indices

Currently, Nigeria accounts for 20 to 23 per cent of global deaths from maternal mortality (women who die due to complications from pregnancy or childbirth). The World Health Organisation puts the figure at 20 per cent while the Lead Consultant of the National Safety Data, MSD, Mary-Ann Etiebet, said it is 23 per cent.

This means that of the 97,000 women who died from pregnancy and childbirth complications between January and April 23, 2020, according to Worldometer, Nigeria accounted for 19,400 to 22,310 of the deaths.

Also, Nigeria is not faring well in the war against malaria. The WHO, in its 2019 Malaria Report said that the world’s largest black nation contributes 25 per cent of global malaria cases and 24 percent of deaths. This indicates that as of April 23, 2020, Nigeria has lost 73,680 people to malaria.

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At press time, Worldometer real-time statistics showed that 307,000 people had died from malaria in 2020.
In like manner, Nigeria is a major contributor to deaths of children under five years. Former Health Minister, Professor Isaac Adewole, said recently that ‘’every single day, Nigeria loses about 2,300 under-five year old and 145 women of child-bearing age, making the country the second largest contributor to under-five and maternal mortality rates in the world.’’
Indeed, according to the UNICEF, Nigeria accounts for nine per cent of global child mortality.

Worldometer records at press time showed that 2.4 million children under-five years had died in 2020. In essence, 216,000 of the dead children were Nigerians.

The Minister of Health, Dr Osagie Ehanire, last February said that cancer kills 72,000 people in Nigeria annually.
Speaking at a briefing held in Abuja to commemorate the 2020 World Cancer Day, Ehanire added that an estimated 102,000 new cases of cancer are also detected in the country every year. “According to the Nigeria National Cancer Prevention and Control Plan (2018-2022), cancer is responsible for 72,000 deaths in Nigeria every year with an estimated 102,000 new cases of cancer annually,” he said.

Poor health infrastructure shocks Mustapha

Secretary to the Government of the Federation, SGF, Boss Mustapha, recently, underscored how badly things were in the sector upon taking his headship of the Presidential Task Force, PTF on COVID-19.

The worried SGF said: “I can tell you for sure, I never knew that our entire healthcare infrastructure was in the state in which it is until I was appointed to do this work.”

Indeed, when the pandemic hit Nigeria late February, the country had only five laboratories that were capable of testing patients for COVID-19. Almost two months after, the country has struggled to add seven more laboratories. At press time most states do not have test laboratories and scores do not have isolation centres.

It is not surprising that Nigeria has been able to carry out 10000 COVID-19 tests far less compared to countries like Ghana (68,591 tests), Morocco (21,947), Egypt (55,000), South Africa (143,570) and Pakistan (124,549).

How govt’s short-changed healthcare

In the last 12 years, Federal budgetary allocation to health has remained abysmal and less than six per cent (see table).
In 2016, President Muhammadu Buhari’s first full year in office, out of the N6 trillion budget, N250 billion was voted for the health sector, representing 4.13 percent of the total budget.

Given that the budget was prepared using an estimated exchange rate of N199 to $1, it meant that the dollar equivalent of the health budget stood at $1.25 million.

2017 witnessed a budget proposal of N7.4 trillion, with the health sector getting N308 billion, or 4.13 percent. This time, the exchange rate was estimated at N305 to $1, meaning that the dollar equivalent of the health budget for 2017 was approximately $1.01 million.

So while it appeared that budget allocation to the health sector grew from N250 to N308, it was actually a reduction when represented in dollar.

In 2019, apart from Kwara (17.8 per cent), none of the 37 governments allocated up to 15 per cent of its budget to health. Those that did more than 10 per cent were Yobe, Katsina, Sokoto, Benue, Borno, Imo, Jigawa, and Osun.

When late Malam Abba Kyari, the Immediate past Chief of Staff to President Buhari tested positive for COVID-19, the nations capital had inadequate medical facilities to treat him. He was flown to Lagos where he died a few days later.

Now, a host of very important persons who tested positive for coronavirus in Abuja have shunned the isolation centres and opted for their homes to the chagrin of the authorities.

COVID-19, a blessing indisguise – Cardinal Okogie

Looking at the scenario, respected Catholic Priest, Anthony Cardinal Okogie, said the COVID-19 outbreak has exposed Nigeria’s poor leadership and government.

Okogie lamented how President Muhammadu Buhari administration was spending billions on cars for lawmakers and ignoring the health sector.

He said in a statement that the ravaging global pandemic “has been a dangerous yet revelatory moment in Nigeria. It is dangerous because this deadly pandemic has infected over a million and killed thousands of citizens of our planet. No one seems to know when and how it will end.

“But COVID-19 is also revelatory, a blessing in disguise because it has exposed Nigeria as a country where quality of leadership is of low grade. What we have known but denied for so long is now shown to us as an incontrovertible fact: that the quality of leadership in our country must improve.”