Discontent over Health Budget Cuts

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Prof. Adewole

Despite Nigeria’s pledge to improve healthcare spending in order to scale up service delivery in the health sector, the 2016 budgetary allocation fell short of even the minimum standards. The budget cuts have led to public outcry across a broad spectrum of stakeholders within the health sector, Paul Obi writes

Nigeria’s commitment to healthcare funding over a decade now has failed to attain World Health Organisation’s (WHO) recommended standard. The trend has remained a source of concern among stakeholders in the health sector. Over the years, government’s pledge to redress the imbalance has rather fell below expectations, even as the country’s indexes on healthcare service delivery plummeted. It has therefore been a whole hog in meeting funding target for the health sector.

Additionally, Nigeria’s abysmally Universal Health Coverage (UHC) and poor health insurance cover continue to impede on prospects for effective and efficient healthcare services. And because of the increasing cases of ‘out of pocket’ spending on health by citizens, focus on how government can increase funding on the sector has become a front burner issue. Stakeholders reasoned that government’s commitment to improving health system must be seen in its annual budgetary allocation to the sector, which will be indicative of the level of seriousness on the part of government.

Thus, the 2016 federal health budget and the allocation therein fall short of those expectations, thereby, raising doubts about government sincerity to healthcare funding. It is in this light that stakeholders recently cried foul about this prevailing budget shortfall in the health sector.

According to the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), Nigeria with the second highest burden of HIV/AIDS after South Africa, and with about 3.5 million people living with the virus, ought to have done more in the allocation to this health budget. While taking a swipe at both the executive and National Assembly on the tokenistic allocation to the HIV/AIDS programmes, NEPWHAN National Coordinator, Victor Omoshehin explained that “under the past government, the national response was allocated about N10 billion as a domestic fund to finance treatment, prevention, care and support services in Taraba and Abia States and increase access to free HIV testing in more than 20 states in Nigeria.

“If the government of change will not increase the domestic funding for HIV, then Nigeria cannot own up to the responsibility of achieving the Vision 90:90:90 by 2030 and we cannot end AIDS by 2030,” he said. “The US government and the Global Fund are responsible for about 95 per cent of our national HIV/AIDS prevention, treatment and care programme. Presently, the US government has scaled down its services to only three Local Government Areas in Nigeria, leaving a huge gap of supporting scale-up of services in the remaining 737 LGAs,” Omoshehin said.

NEPWHAN National Coordinator contended that considering poor allocation for HIV/AIDS response, “the President should not assent to the bill because the peoples’ concern has not been addressed. President Muhammadu Buhari should not sign this budget that the National Assembly has made provision of N3.6 billion to buy exotic cars while they just allocate N1.5 billion to care for people living with HIV.
“We cannot continue to depend on funds from partners. We are Nigerians and not Americans. We pay our taxes to the Federal and state governments of Nigeria. So Nigeria government should take responsibility of the people living with HIV in the country. Provision for HIV/AIDS national response in the 2016 budget is too low to achieve any realistic targets; the more reason why Nigeria remains the second largest destination of HIV/AIDS in the world for the past 10 years.”

The 2016 appropriation included only N1.5 billion for HIV/AIDS response programmes in the federation. THISDAY checks revealed that the National Agency for Control of HIV/AIDS (NACA) had earmarked about N18.9 billion for the 2016 fiscal year, the proposal was rather trimmed down by the two chambers of the National Assembly to N1.5 billion, which will only cater for Abia and Taraba States.

The cut also came at a time where the United States government, The Global Fund and other foreign donors have intimated the Nigerian government of their withdrawal from funding Nigeria’s HIV/AIDS projects across the 36 states of the federation. Similarly, NEPWHAN observed that the withdrawal by foreign donors has been prompted by the rebasement of the Nigerian economy during former President Goodluck Jonathan’s administration, where the country became Africa’s biggest economy. This was subsequently followed by the declaration of Nigeria by the World Bank as a Middle Income Country (MIC). A status which automatically removed the country from Low Income Country (LIC), depriving Nigeria the prospects of benefiting from enormous foreign aids, such as foreign funding of HIV/AIDS programmes.

To this end, NEPWHAN urged the Presidency and the National Assembly “not to play politics with the lives of vulnerable and poor patients who depend on these allocations to have access to continuous live saving drugs. Nigeria should rather take ownership of HIV response as there is obvious dwindling of resources from donor agencies. They called on the National Assembly “to help revamp the national HIV/AIDS response and the health sector by ensuring that the HIV/AIDS budget is reviewed before the final signing by the president as the lives and hopes of 3.5 million Nigerians remain in danger.”

Speaking further, Omoshehin explained that should the National Assembly fail to heed to its demands, NEPWHAN will have to adopt some drastic measures to protest against the low funding of HIV/AIDS programmes in the country. He warned that NEPWHAN “are going to storm the National Assembly, we will demonstrate, because with this budget, people living with HIV will no longer have access to treatment, care and support services, and a lot of people will die. And all we are going to do, we can definitely go to National Hospitals or any hospital in Abuja and get the corpse of people who are affected with HIV, who have died and then we take this corpse to National Assembly if that is what they want.”

Aside NEPWHAN, stakeholders on primary healthcare service also queried the purported exclusion of funds for immunisation and vaccine programmes.

Chairman of the National Immunisation Financing Task Team (NIFT), Dr. Ben Anyene, told journalists in Abuja during a forum that stakeholders in the health sector are worried over “report of exclusion of funds for vaccines in the recently passed 2016 federal budget. “If true, we demand that adequate funds for vaccines and immunisation in general, be included in the 2016 Appropriation Act before assent, we should rather increase budgetary allocation and appropriation for immunisation not discard it,” he added.

On the imperative of immunisation financing, Anyene explained that since the year 2000 that Nigeria and other countries received tremendous financial assistance from GAVI through various windows. He maintained that “following the rebasing of the economy, Nigeria’s Gross National Income (GNI) rose to $2950 in 2014 and surpassed the eligibility threshold of $1580 for GAVI support. “With Nigeria’s transition out of the GAVI support, this has further placed the country’s immunisation programme at a critical stage where urgent action is needed to ensure sustainable financing for vaccines, devices, cold chain infrastructure and other related aspects of the programme.”

Anyene further stressed that plans are underway by government to set up a National Immunisation Trust Fund to cater for the existing gaps in financing programmes. “The trust fund when established is expected to serve as an independent body that will advocate, coordinate and mobilise funds for routine and supplemental immunisations in the country for 2016 and beyond.
“The fund is expected to draw contributions from government, organised private sector, partners and willing Nigerians, the funds will still be inadequate when added to the traditional budgetary appropriations,” Anyene observed.

To say the least, with the present budgetary allocation to HIV/AIDS response, President Buhari’s United Nations commitment to end the HIV/AIDS virus appears to be in jeopardy. Buhari had during the 70th UN General Assembly in New York, US, pledged to lead the fight against the virus, and to end AIDS by 2030 through commitment to fund and expand the scope of prevention and treatment of the disease. At the epoch gathering in New York, Buhari told the gathering made up of UNAIDS Executive Director, world leaders and experts that Nigeria is keen in “working together to make HIV and AIDS history by 2030.”

Conversely, the 2016 budget allocation to HIV/AIDS response will not be enough to address key components of the programme geared towards testing, prevention, treatments and care. The budget will delay Nigeria’s commitment to kick start the Vision 90:90:90 aimed at eradicating the virus by 2030.

Beside the crisis that will befall HIV/AIDS programmes in the country, Nigeria is expected to give a final push towards ending polio and other vaccine preventable diseases. That will also face another critical risk going by the present 2016 appropriation. The budget failed to take into account current critical health programmes Nigeria is grappling with. A poor performance on immunization against polo will upturn Nigeria’s positive result to a sorry state likely to attract intense global condemnation.

As the Presidency and National Assembly fine-tune means to restructure the controversial budget, time is not yet completely lost on injecting some flesh on the health budget. It is expected that policy makers would consider the current health challenges Nigeria faces. Provision of adequate funds is the best bet to cater for such challenges. To do otherwise, will spell doom for the country in many respects.