The disclosure by the Minister of Health and Social Welfare, Professor Mohammed Ali Pate, before the House of Representatives Committee on Healthcare Services, during the 2026 budget defence that only ?36 million out of an approved ?218 billion capital budget for the ministry in 2025 was actually released for capital expenditure is not just troubling but symptomatic of a deeper fiscal governance crisis.

The health capital budget is practically non-existent with the paltry 0.02 per cent released. Capital expenditure is not a luxury line item, it is the backbone of delivery. Capital budgets are designed to build, equip and modernise. In the health sector, they fund hospital construction, diagnostic equipment, laboratory upgrades, the rehabilitation of primary healthcare centres, among others.

When capital releases dry up, infrastructure decays, expansion stalls, service delivery deteriorates and the quality of care inevitably declines. What makes the situation more disturbing is the imbalance: the recurrent costs (salaries and running costs) were released while the capital funding was starved.

This entrenches a structural flaw in Nigeria’s public finance architecture, while investment in long term projects is sacrificed. Paying salaries without investing in facilities and equipment leaves the health workers demoralised, thus fuelling brain drain.

For a country already burdened by high maternal and infant mortality rates, persistent infectious diseases and prevalence of non-communicable diseases, such underfunding carries severe consequences. The health system risks deeper deterioration at a time when resilience and expansion are urgently needed.

Also, the non-release of funds blocks access to external assistance, as many international health programmes require counterpart financing, thereby compounding the sector’s fiscal paralysis. Beyond infrastructure, the broader consequences are severe.

Underfunded facilities fuel outbound medical tourism, drain foreign exchange, and deepen inequality as only the affluent can afford quality care. Apart from cash flow constraints, Prof. Pate also complains of systemic bottlenecks, including issues surrounding the aforementioned counterpart funding arrangements.

While fiscal pressures are real, they cannot justify a 99 per cent non-performance rate in critical sectors. If revenue inflows are insufficient, then budget projections should reflect that reality from the outset. Governance demands honesty in planning and discipline in execution.

Moving forward, we urge the executive and legislative arms to come up with realistic budgeting that will align appropriations with credible revenue forecasts. We must stop budgeting for consumption while growth suffers. That is bad governance!

The health and critical sectors must be protected from disproportionate cash rationing. Most importantly, there should be a political will to treat healthcare as a national security and development priority. We must take the people’s health more seriously.

Nigeria has repeatedly pledged commitment to achieving universal health coverage. But ambition without execution is hollow.  If the country is serious about reform, restoring credibility to its budget process, especially in the health sector, must be non-negotiable.