Nigeria: Still Toying Around with Health

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Odimegwu Onwumere is concerned that Nigeria only marginally improved the 2017 budget for the health sector from 3.65 per cent in 2016 to 4.15 per cent, but is still a far cry from the 15 per cent recommended by WHO and African Heads of State 
 
“The House of Representatives has faulted the allocation of 304 billion naira to the health sector in the 2017 budget,” said the media on January 30, 2017.
 
This suggests that the country’s health sector may be heading towards financial challenges this year due to unseemliness in the besmirched proportion of money allocated to the sector in the 2017 budget.
 
Given the financial downturn that the country is facing, the assurance to achieve exhilaration in the child health, nutrition and family planning could be a tall dream as N500 equals a dollar, whereas the budget was asked for N197/1USD.
 
There would be no gainsaying the fact that the N304 billion 2017 budget that was allocated to the Ministry of Health was a child’s play. The country merely touched the health budget of 2017 from the fraction of 3.65 per cent it was in 2016 to 4.15 per cent, as against what the World Health Organisation (WHO) and African Heads of State declared in a meeting at Abuja in 2001, where there was an accord that every country should apportion 15 per cent for healthcare in its yearly budgetary expenditure. The Partnership for Advocacy in Child and Family Health (PACFAH) in teamwork with the Health Reform Foundation of Nigeria (HERFON), grieved in a seminar that Kaduna, Nassarawa and Oyo states were aloof in taking issues pertaining to family planning programme in the health segment of their 2017 budgets seriously, as a study conducted by HERFON revealed.
 
Other states like Bauchi, Kano, Niger and Lagos in their respective 2017 budgets for health were stained. In Lagos for instance, analysts said, “Although the entire budget increased by N150 billion when compared to the 2016 budget of N662.6 billion, the health budget reduced from N64 billion which represents 9.76 per cent of the total budget in 2016, to N57.29 billion, representing 7.05 per cent in 2017.”  From all angle, how the health sector was being treated in the country has raised eyebrows in different quarters.
 
On December 20, 2016, the Pharmaceutical Society of Nigeria (PSN) threw its weight against the allotment for healthcare by President Muhammadu Buhari-led government in the 2017 budget. What the presidency of Buhari has done may be termed as retrogression in the sense that countries like China had 12.6 per cent for that purpose, while Turkey had 10.7 per cent in the year 2015, while United States had 20.7 per cent and Germany had 19.4 per cent, and Iran had 17.5 per cent for their healthcare systems. It was only in 2012 that health spectators believed was the best Nigeria has done in Health allocation of 5.95 per cent.  
 
However, Bauchi State had mapped out 16 per cent of her 2017 budget for health, above the 15 per cent that was the hope of the WHO for countries and above Nigeria’s 4.15 per cent. Today, critics are appraising Governor Abdullahi Abubakar of the state for this singular act, saying that he meant well in the 2017 budget of N145 billion tagged ‘Budget of Sustainable Development’ which has a planned periodic disbursement of N58 billion equal to 40 per cent of the overall budget and capital outlay of N86 billion 60 per cent of the total budget.
 
Kaduna might have gone lower than expected with her N10.49b for health from the total budget figure of N214.9 billion encompassing of N83.46 billion periodic spending and N131.45 billion in capital expenditure. This money for the health sector in Kaduna, in earnest, may not take care of what Governor Nasir el-Rufai of Kaduna State charcterised as “an Emergency Nutrition Intervention Programme to reduce malnutrition and hunger amongst our poorest citizens and children.” Likewise, the N10 billion that was allocated to the Health Ministry by the Kano State Governor, Abdullahi Ganduje from the N209.8 billion 2017 budget proposal could not be enough.
 
Taking a look on what the governor spent on malaria alone before September 2016, one would say that his budget dubbed ‘Budget of Sustainable Self Reliance’ is the obverse. Evidence was that on September 22, 2016, Ganduje made it public that his government had acquired drugs and diagnostic equipment at the value of N59m to combat malaria in the state. And if every part of health in that state gulp such an amount, it then means that the N10 billion was an amount meant for the wallet.
 
It could be said that Niger State’s N108b budget for 2017, the health sector had nothing to boast about no matter the opinion of yesmen saying that the Niger State Governor, Abubakar Sani Bello was head bent on tackling health issues in the state. Again, looking at the total budget in the state, there will not be a better word to say that the sum was miserly.
 
Coming to Nasarawa State, the lawmakers even pushed for a bigger health allotment in the state’s 2017 budget. Sadly, they once kept the health budget in 2017 under the carpet. There were reports suggesting that “Partnership for Advocacy in Child and Family Health into how Nasarawa financed its health sector between 2012 and 2014 showed less than half of allocation appropriated for health in each year was actually paid out to ministries, departments and agencies. Only N2.4 billion out of N5.4b was released in 2012; N4.2b out of N8.2b was released in 2013 and N4.3b out of N11.8b was released in 2014.”
 
Imagine. The effects of the clumsiness in Nigeria’s health budget were that in 2016 alone, resident doctors of 25 teaching hospitals across the country, embarked on strike because of financial irregularities from the government to reach their needs. In a country where there is no functional cancer treatment centre, many medical doctors have left the country in search of a better living in other climes.
 
There were reports suggesting that only 21, 000 of Nigerian medical doctors registered with the Medical and Dental Council are working in the country from 80,000 the number was. The highlight of this was that the doctors were leaving the country given that doctors working for government in other countries like South Africa merit about N300,000 individually in a month, whereas those in Nigeria gain about N170,000 individually, per month, and often owed for months.
 
The House of Representatives Committee on the Diaspora was thrown aback in the surge of migrating Nigerian doctors and raised eyebrow, saying that in the United States of America, Nigerians consist about 77 per cent of dark-skin doctors working in that country. In some arguments, it’s understood that no matter the 4.15 per cent the national health sector was raised to in this year’s budget, the 3.65 per cent it was in 2016 was far better, because of the financial collapse that has engulfed the country, where the currency continues to depreciate than has ever been heard of in the country’s history.
 
PACFAH once captured this view thus, “The total sum of N304 billion has been proposed for the Federal Ministry of Health, amounting to 83 per cent for recurrent expenditures (salaries and overheads) and 17 per cent for capital expenditure (health infrastructures and services).
 
“This 2017 proposed Ministry of Health budget is 4.17 per cent of the national budget, a poor improvement on the 2016 budget of 4.13 per cent. With about 80 about improvement in terms of capital expenditure of the 2017 proposed budget compared to that of 2016, the reality is that this proposed health budget is cumulatively lower than that of 2016 due to the skyrocketed foreign exchange value of a naira to dollar.”
 
Dissecting that, the N304 billion was budgeted when the Central Bank of Nigeria doweled the trade rate at N197/1USD.  “Mid-year of 2016 and for the 2017 proposed budget, the exchange rate is at N305/1USD. As a result, while 2016 health budget was $1.269m, the proposed 2017 health budget is less by 21 per cent at $0.997m. This is important because most of our health services are reliant on importation,” the source bemoaned.