Despite being Africa’s biggest economy and the continent’s most populous nation, Nigeria’s health budgets have over the years remain some of the lowest on the continent. In 2001, Nigeria hosted a special summit of the then Organisation of African Unity (OAU) where it alongside other member states pledged to commit, at least, 15% of its annual national budget to public health.
Sixteen years later, Nigeria is yet to meet the major obligation of the Abuja Declaration and has yet to implement the major requirement of its National Health Act which came into law in 2014 and provides for the establishment of a Basic Health Care Provision Fund that will be financed by 1% of the Consolidated Revenue Fund (CRF) of the Nigerian federation.
Remi Adeseun, a pharmacist, is head of legislative advocacy for the Partnership for Advocacy in Child and Family Health (PACFaH); a coalition of Nigerian civic organizations advocating for public health sector reform.
In a chat with African Newspage, he speaks about Nigeria’s proposed 2017 budget for the public health sector calling on the National Assembly to help Nigeria fulfill the obligations of both the Abuja Declaration and the National Health Act
As an advocate for increase in budgetary allocation to the public health sector and ensuring judicious utilization of the funds, what do you make of Nigeria’s proposed 2017 budget for the health sector?
My perspective to examining issues is looking at them from all sides because nothing is perfect such that it doesn’t have its downsides and nothing is so bad such that it doesn’t have its upside. On the upside of the proposed 2017 health budget of Nigeria, there is a remarkable increase in terms of the health budget’s capital expenditure.
If you may recall, the capital expenditure of the health budget in 2016 was just N28 billion whereas in 2017, the proposed capital expenditure for the health sector is N51 billion, which amounts to almost 80% increase. This is a very positive development considering the fact that the capital aspect of budgets are what is utilized for the procurement of goods and services necessary for the delivery of healthcare services to the people.
So, that was a very good development but the challenge is that there is the Abuja Declaration which provides for what proportion of the Nigerian government’s budgetary expenditure should go to the public health sector and that proportion is 15%, as agreed by the Heads of State of the member states of the African Union during a meeting held here in Abuja back in 2001.
“This is because in 2016 when the Central Bank of Nigeria (CBN) pegged the exchange rate at N197 per 1USD, the health budget of N250 billion was equivalent to $1.269m. Today, even with the CBN’s exchange rate of N305 per 1USD, the proposed 2017 health budget of N304 billion is just equivalent to $0.997m, which makes it 21% lower than that of 2016, in real terms
Now, the issue is that the allocation for public health in the proposed over N7 trillion budget expenditures for 2017 is N304 billion which is equivalent to just 4.17% of the total national budget. Essentially, the percentage allocation is almost the same as that of 2016, which was N250 billion and which was equivalent to 4.13% of the total national budget expenditure.
But if you look at the current exchange rate of Naira in relation to the United States Dollar, you will realize that in reality, the 2017 health budget is even less than that of 2016. This is because in 2016 when the Central Bank of Nigeria (CBN) pegged the exchange rate at N197 per 1USD, the health budget of N250 billion was equivalent to $1.269m. Today, even with the CBN’s exchange rate of N305 per 1USD, the proposed 2017 health budget of N304 billion is just equivalent to $0.997m, which makes it 21% lower than that of 2016, in real terms.
So, it is obvious that the Nigerian government is still not living up to its responsibilities when many other African countries are already doing so. Members of the National Assembly (Senators and Representatives) were recently in South Africa where they saw that the country with the lowest allocation to the public health sector among the member states of the Southern African Development Community (SADC) is South Africa itself which commits up to 14% of its annual budget expenditures to the health sector.
Other countries of the region like Botswana and Swaziland are committing up to 16% and 17% of their annual budgets to the public health sector. This clearly shows that the 15% benchmark is achievable because even within Nigeria, Bauchi state has already achieved it; last year the state committed 15% of its annual budget to public health and this year it has even gone beyond the benchmark by budgeting 16%. They say: ‘Where there’s will, there’s a way, so the government simply has to have the will to make adequate provision for the public health sector.
Like you said, the Abuja Declaration demands that national governments in Africa commit at least, 15% of their annual budget expenditures to public health but don’t you think it is unrealistic to expect the Nigerian government to at once scale up its health budget to 15%. Why don’t you advocate for gradual increase in the public health budget until the target is achieved?
I think this is a very reasonable argument which is why PACFaH as a coalition together with other health sector reform coalitions held a joint legislative advocacy meeting with the members of the National Assembly, predominantly members of the House of Representatives in Uyo last year. Part of the resolutions of that meeting is to adopt a gradual increase in budgetary allocation to the country’s health sector.
“But the most important thing is to be able to chart a course by, for example, determining that in the next 4 years we will reach 12% and that by 8 years we will achieve the 15%, unfortunately, there is no any such a plan yet and so no effort is being made towards that
But the most important thing is to be able to chart a course by, for example, determining that in the next 4 years we will reach 12% and that by 8 years we will achieve the 15%, unfortunately, there is no any such a plan yet and so no effort is being made towards that. Therefore, what has been happening over the years is either decline or at best stagnation in percentage allocation to the public health sector.
Public health is not being given priority attention, which is why we are demanding that the federal government don’t just sign agreements without having the will to implement the obligations contained in such agreements; there is need for the Nigeria to take responsibility for implementing laws and treaties it has signed on to.
Your coalition (PACFaH) is also demanding for the allocation of 1% of the Consolidated Revenue Fund (CRF) of the federation to the public health sector. Why is that necessary?
You will recall that I mentioned that the capital budget for the Nigerian health sector has increased from 28 billion in 2016 to 51 billion in 2017, according to the proposed health budget. Now, the thinking in government circles is that the increment is sufficient enough to make up for the requirement of the National Health Act of 2014.
“the National Health Act says not less than 1% of the Consolidated Revenue Fund (CRF) of the federation should be allocated to public health. So, just like the allocations to the National Judicial Council, Universal Basic Education Commission, and the Independent National Electoral Commission, this is also a statutory allocation – and not a discretionary one!
However, the Act says not less than 1% of the Consolidated Revenue Fund (CRF) of the federation should be allocated to public health. So, just like the allocations to the National Judicial Council, Universal Basic Education Commission, and the Independent National Electoral Commission, this is also a statutory allocation – and not a discretionary one!
Therefore, by not implementing the Act the federal government is but breaching a law of the National Assembly which if it were in other climes, somebody will have to answer why and thus whoever is responsible for ensuring the implementation of the Act will have to be punished in accordance with the law. The challenge is that the government is seeing implementation of the Act as something discretionary: it is purely a statutory matter.
This is why we have been calling the attention of the federal government to it and we are happy that the 2017 budget is still just a proposal. The owners of the budget and the 2014 National Health Act are essentially the elected members of the National Assembly who also have the power to ensure that the 1% of CRF has been allocated to the public health sector in the 2017 national budget. We are optimistic about their ability to do so and calling on the Nigerian media to help bring the issue to the legislators’ attention.
Probably the reason why governments in Africa including Nigeria are not very keen about allocating more resources to public health has to do with lack of understanding of the nexus between quality of healthcare services and sustainable economic development. How are the two related?
Before now, many people including us in the civil society perceived healthcare services as just a social service, providing healthcare is indeed a social service – but it is also a catalyst for national economic growth and sustainable development. Thus, the saying that ‘A healthy nation is a wealth nation’ is not just a proverb; rather, it is economically proven that every dollar invested in the health of the people leads to increase in productivity in the range of 20% to 30% returns.
” So, one pharmaceutical company has a total turnover that is more than the annual budget of Nigeria which shows that if we invest in the full value chain of health, of which the pharmaceutical industry is a component, we stand to gain beyond the productivity we can gain in having a healthy workforce
For example, if you have kids that are always falling sick of pneumonia, diarrhea or malnutrition; someone is taking time off their productive work to take them to hospital. So, investing in public health is a major economic decision and not just a social one. Moreover, we unfortunately don’t look at health from the perspective of its full value chain; health include the pharmaceutical industry which in developed countries like US, UK, and Switzerland are part of the highest grossing contributors to national economy.
The total annual turnover of Novartis, the Swiss multinational pharmaceutical company, is in the range of $20 to $30 billion while Nigeria’s annual national budget is just around $12 billion. So, one pharmaceutical company has a total turnover that is more than the annual budget of Nigeria which shows that if we invest in the full value chain of health, of which the pharmaceutical industry is a component, we stand to gain beyond the productivity we can gain in having a healthy workforce.