Between poor budgetary allocations and dysfunctional health sector

With rising incidences of COVID-19 cases in Nigeria, raising questions about the preparedness of the country and, indeed, the respective states, to tackle the pandemic, not a few have expressed concerns about the neglect the nation’s health sector has suffered over time in terms of government’s spending. The COVID-19 outbreak brought to fore the age-long debate, more so as the elite who are in the habit of jetting out in search of better healthcare overseas are all now holed up in the country with what the ‘forsaken’ health sector has to offer.

The need for Nigeria to invest more in the health sector has become more of a refrain. Over the years, however, successive governments have fallen short of the globally accepted budgetary allocation for the sector. Even since 1999 when Nigeria returned to democracy and was supposedly expected to have well-thought government policies to improve the lives of the people, the sector has remained largely under-funded.

This explains why the healthcare system has remained dysfunctional and ineffective in responding to the needs of the citizenry, with consequent poor health outcomes and indices. It is also the reason the medical tourism fad has now overtaken the country.

To underscore the scenario, co-chair of the Bill and Melinda Gates Foundation, Bill Gates, sometime in 2018, while enumerating some of the indicators of government’s failure to prioritise health, told the now-defunct National Economic Council that Nigeria was “one of the most dangerous countries in the world to give birth” and had the “fourth worst maternal mortality rate in the world, only ahead of Sierra Leone, Central African Republic, and Chad.”

Gates, who noted that it was also one reason Nigeria had one of the lowest life expectancy rate at 53 years, stressed that it was important the Federal Government’s economic recovery and growth plan reflect the people’s needs — investment in infrastructure and competitiveness must go hand in hand with investments in people to anchor the economy over the long term.

Gate’s call echoed a global concern that led to a decisive action by the United Nations and the African Union, among others. In April, 2001, heads of state of African Union countries met in Abuja and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector. But the resolution, now popular as the Abuja Declaration, has never been implemented in Nigeria.

Also, the National Health Act, which was signed into law in 2014, stipulates that 1 per cent of consolidated revenue fund be used to finance the Act. But nothing has been done in that regard.

Over the years, the country’s budgets for health have never exceeded six per cent. A breakdown of the health budget of Nigeria, with an estimated population of 200 million, also shows that government’s contribution to health spending of each citizen is approximately N2000.

In 2010, Nigeria allocated a meager 3.58 per cent to the health sector. In 2011, it was 5.58 per cent. In 2012, it was 5.95. In 2013, the sector got 5.66 per cent. In 2014, health received 5.63 per cent, 2015 had 5.78 per cent, 2016 got 4.14 per cent while in 2017, the N377.4billion allocated to the health sector was a meagre 5.17 per cent of the nation’s budget.

In 2018, for instance, the nation’s health budget stood at N340.46bn, which was 3.95 per cent of its N8.6tn proposed national spending. In 2020, of the total N9.45tn budget, N427.3bn was allocated to health, which is about 4.5 per cent.

The Vice President of the Commonwealth Medical Association, Dr Osahon Enabulele once described the health budgets as “scandalous and sad,” with Enabulele saying that even in the United Kingdom and countries that made significant investments in external military invasion, a lot is budgeted for health. The UK, in 2018, budgeted £129bn for health, which translated to 15 per cent of its national allocation of £842bn.

Enabulele said, “It remains very scandalous that Nigeria that hosted the 2001 African Heads of Government meeting has yet to meet even up to half of that declaration. It remains scandalous that, even in this current dispensation, we have not been able to move up to five per cent of the national budget in terms of budgetary allocation to health.”

Dr. Aliyu Sokomba, in a reaction, also said the government was not interested in the health sector, describing the health budget as “too meagre” and “very insignificant.”

“That is why they seek healthcare outside this country,” Sokomba said. “They know that all the fundamentals of a functional health system are lacking in this country, so the health system cannot function. What is more amazing is how Nigerians have come to terms with this reality that they are doomed and they do not have a functional government to cater to the sector.”