Nigeria’s myriad health sector challenges are seen not likely to abate soon on poor budgetary allocations and government’s lack of political will to implement the one percent intervention fund provision in National Health Act (NHA, 2014), BusinessDay findings show.
The Federal Government said it intends to drive health care delivery from the grass root where majority of the citizens dwell, on massive health infrastructure deployments at the rural areas to deal with primary health care challenges.
Ibrahim Wada, Founder, Vice Chairman of Nisa-Garki Group and Chief Consultant Gynaecologist of NISA Hospital, Abuja, observes that for Nigeria to address its huge challenge in the health sector there is need for more public private partnerships, like obtainable in other developed nations.
Government’s inability to implement its own laws that mandate it to allocate 1 percent, of its Consolidated Revenue Fund (CRF), to drive health sector is seen as a major setback, as well as demonstration of government’s lack of seriousness to fund health care programs.
“He who doesn’t plan, plan to fail’ that is why there are so many issues in our health sector, manpower, Power issues, maintenance issues, funding issues, you name it,” Wada told BusinessDay in an exclusive interview.
Section 11 (1) of the health Act created an intervention fund, to be known as Basic Health Care Provision Fund, to be financed from, Federal Government Annual Grant of not less than one per cent of its Consolidated Revenue Fund, grants by international donor partners; and as well as funds from any other source.
Section 3 of the Act which stipulates how the money is to be expended, provides that 50 percent of the fund shall be used for the provision of basic minimum package of health services to citizens, in eligible primary/or secondary health care facilities through the National Health Insurance Scheme (NHIS, while also providing that 20 percent be dedicated to the provision of essential drugs, vaccines and consumables for eligible primary health care facilities.
The Act also specified that 15 percent of the money be used for the provision and maintenance of facilities, equipment and transport for eligible primary healthcare facilities.
10 per cent of the fund is also supposed to be used for the development of Human Resources for Primary Health Care, while the balance 5 percent of the fund shall be used for Emergency Medical Treatment to be administered by a Committee appointed by the National Council on Health.
“Where we are the situation is redeemable, government resources are going down and as government resources are going down then we must open the tap to other resources,” Wada adds.
Ben Anyaene, Health expert and former board Chairman of Health Reforms Foundation of Nigeria (HERFON) sees the non- implementation of the policy as a major drawback for the health sector.
His said, “Government has responsibilities to care for the basic issues, especially the communicable diseases. These are things they should capture at the primary health care levels and treat. I feel sorry for my country.”
“Rwanda is already doing 15 percent arising from the meeting of African Heads of States and government which took place in Abuja, Nigeria. Rwanda’s health program is now a reference point for other African countries.
The country’s population is not up to that of Lagos State in Nigeria. They are sending people from there to come and train people in Nigeria on health issues.”
BusinessDay findings indicate that since the law was passed in 2014, no administration has moved closed to implementing the 1 percent provision. For Anyaene, “It is a shame that the Federal Ministry of Health, have not been able to include it in the annual budget”
“It means that we are not paying enough attention to health issues. It is either they do not understand the importance of health economics, government and job creation or we are pushing what cannot work. It is painful.
“What are the provisions in the budget for Primary Health Care concerning nutrition, mother and child, malaria, family planning? That is the starting block. 50% of that should help to push for some kind of insurance, minimum basic package for all Nigerians. This minimum basic package has not been implemented.
“The issue is the capital component of the budget. What is it being used for? Is it to build more hospitals or to purchase more vehicles, or pay for traveling? They are talking about malaria eradication, is it by word of mouth? How much are you budgeting for it? The same thing goes for nutrition, HIV Aids etc. These are the things ravaging us. If foreign donors withdraw their support for HIV interventions in Nigeria now, so many things will collapse. The same applies to immunization, nutrition, etc. So, what is it that we are doing? The one percent is not even enough. The one percent is for the primary health care issues, for vaccines, human resources development.”
Although the proposed 2018 budget increased by N1.1 trillion, 15.74 percent over last year’s budget, government did not incorporate the provision into the budget.
The 2018 budget is the third since President Muhammadu Buhari assumed powers in May, 2015. Within the three years, however, total budget in three years had grown from N4.49 trillion in 2015 to N8.61 trillion, a 92% increase.
A critical assessment of the health sector allocation for three years, however show that although there has been a progressive increase on N340.9bn; N308.5bn and N250.1bn allocated for the 2018, 2017 and 2016 fiscal years respectively, the health component has declined steadily from 5.63% of total budget in 2014, to 5.78% in 2015.
Research in health sector provisions show that while in 2016 Nigeria made a budgetary provision of N221.4bn (88.54%) for recurrent expenditure, the capital budget was N28.7bn (11.46%). In 2017 however, while recurrent was N252.9bn (81.97%) provision for capital expenditures rose to N55.6bn (18.03%).
This is just as the proposed 2018 recurrent budget is put at N269.3bn (79.02%) and Capital N71.5bn (20.98%).Health experts described the increase as “insignificant” given the huge challenges in the health sector, calling for government intervention.
They cited allocations to the National Primary Health Care Development Agency (NPHCDA), which they see to be very poor considering the challenges in the areas that affects majority of poor Nigerians.
In the 2018 budget NPHCDA got N23.9bn with recurrent expenditure pegged at N2.1bn (8.95%) and capital expenditure at N21.8bn (91.05%).
For the 2017 budget, NPHCDA was allocated N19.2bn, with N2.1bn (11.14%) set aside for capital expenditure as against N17.1bn (88.86%), for recurrent.
The 2016 budget of NPHCDA did not fare better with total budgetary allocation of N17.7bn and capital expenditure gulping only N2.1bn (11.56%), while the recurrent expenditure was put at N15.7bn (88.44%).
Tunde Segun, the Country Director of Mamaye Evidence for Acton program, while speaking to BusinessDay exclusively on the implications of the absence of the 1percent consolidated revenue fund to the Health sector, decried the non- implementation of the provisions in the Act.
“The federal government itself is not implementing its own law because when the National Health Acts was passed into law, it was provided that at least 1% of the consolidated revenue fund would be given to the health sector and the national health Acts has been further sub divided to how that money would be utilized and for the federal government to be flouting their own law, obviously this is not a good image for the administration that has shown that they have a strong anti-corruption stance.”
“If you have a law for the health sector and you are not fulfilling it, then you can be taken to court for not implementing your own law. We have Universal Basic Education Commission, which is getting its own 2% , how come health cannot even get 1%,” Segun stated observing health as a “basic right of every citizen.”
Ejike Orji, a former Country Director of IPAS, described the development government’s inability to fund NHA after all these years as “sad”
“We feel that hope is still not completely lost and we are hoping by the time the budget gets to the National Assembly that it would be corrected,” he however notes that the Federal Government is still very far from the 15% agreement with African Union. “If the NHA is properly funded, a lot of the challenges that the health sector is facing would be addressed,” he concluded.