COVID 19: Holding Govt Accountable on Budgetary Allocations for Health

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Minister of state for Health, Dr. Osagie Ehanire

Despite failure of the past years, when the 2020 budget was announced, Nigerians were optimistic the presidency’s promises to provide standard, quality, affordable and accessible healthcare to all, in order to achieve universal health coverage, as stipulated by the World Health Organisation (WHO) would come to fruition. In the wake of Covid-19, the global pandemic, Nigerian’s yearning for better and standard healthcare system through its health spend from 2015 till date is brought to the fore as the pandemic has exposed a weak health system. Adedayo Adejobi writes

With 2019 and 2020 appearing to be years of heightened disease outbreaks, from a different strain of the seasonal meningitis outbreak in Northern Nigeria to Lassa fever and then the unexpected emergence of monkey pox and Covid-19 in some states of the federation, the health system is in for the tough job of combating plagues .

The 2020 budget for health, President Muhammadu Buhari said his administration was interested in improving the lots of the health sector and this was a major reason for the increase in value-added tax (VAT) rate draft as communicated through the Finance Bill, from 5% to 7.5%.

“As such, the 2020 Appropriation Bill is based on this new VAT rate. The additional revenues will be used to fund health, education and infrastructure programmes. As the states and local governments are allocated 85% of all VAT revenues, we expect to see greater quality and efficiency in their spending in these areas as well,” Buhari said.

With United Nations’ member states agreeing to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals, which requires that all individuals and communities receive the health services they need without suffering financial hardship. The full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care till date have not been set in motion by Nigeria, talk less being achieved. Meanwhile, the Nigerian Economic Recovery and Growth Plan does not reflect the people’s needs, whilst the Abuja declaration which set a target of allocating at least 15 per cent of their annual budget to improve the health sector, has however, failed to elicit implementation in Nigeria.

Total Budget

Recurrent Allocation in 2015 stood at N2.607 trillion, while in 2016, N2.646 trillion was allocated; 2017, N2.988 trillion; 2018, N3.513 trillion; 2019, N4.070 trillion and 2020-N4.490 trillion. All these total N11.753 trillion.

For capital allocation, in 2015, it was N7,014trillion;in 2016, N1,587 trillion; in 2017, N2.178 trillion, in 2018, N2.873 trillion; 2019, N2.094 trillion and 2020, N2.470 trillion, summing up to N9.435 trillion.

Meanwhile, total allocation for 2015 was pegged at N4.493 trillion; in 2016, it was increased to N6.061 trillion,2017 spiked to N7.441 trillion, with 2018’s allocation at N9.120trillion; 2019 saw a decline to N8,920 trillion and 2020, N10.590 trillion, totaling N27.115 trilion

On Total Capital Releases, 2015 pegged at 3,869,414,286,16.24 whilst 2016 stood at 1,219,471,747,442.69, 2017- 1,297,486,2637,68.46, 2018 at 1,468,681,840,941.19 and 2019 6,670,333,387,73.5, totaling 5,039,614,619,542

Health Budget

Narrowing down to the Health Budget Recurrent Allocation in 2015 was 2,370,757,428,47, 2016 at 2,214,125,480,87, 2017 run at 2,528,543,966,62, 2018 was pegged 2,699,651,178,87, 2019 3,156,173,440,56 and 2020 3,810,957,117,15 totaling 1,678,020,861,254.

Capital Allocation for the year 2015 was 22,676,000,000, whilst 2016 was 28,650,342,987, 2017 reading 55,609,880,120, witnessing an upward trend saw 2018 peak 86,485,848,198. 2019 and 2020 saw a drastic decrease peaking 57,085,655,234 and 59,909,430,837 respectively, totaling 310,417,157,376.

Total Capital Releases for 2015 was 16,445,053,729, 2016 peaked 28,592,592,445.77, 2017 spiraled to 52,656,143,772.55, in 2018 and it nosedived to 44,499,584,274.72 and 15, 689,647,293.72. it is instructive to note that details of capital releases for 2020 capital expenditure is not available.

State House Clinic

There is no record of recurrent allocation, capital allocation, total allocation and total capital releases in the State House budget in 2015 allocations, but in 2016, N22.500 million was earmarked. 2017 through 2020 saw this same N33.173 million run through the budget, totaling N1.349billion.

No record of budgetary allocation for 2015, in 2016, Capital Allocation was given at 2,803,097,362, no record of allocation for 2017, but in 2018 it stood at a whopping 698,728,241 whilst 2019 stood at 467,125,881 and 2020 at 371,710,029 totaling 4,340,661,513.

Total Allocation for 2016 was 2,825,597,363, 2017 stood at 331,730,211, 2018 1 reached an all-time 1,030,458,453, decreasing in 2019 to 798,856,093 and 703,440,241 in 2020 totaling 5,690,082,361.

It is informative to note that in 2015 and 2017 there are no records of allocation. 2016,2018 and 2019 recorded 866,602,088, 349,364,120.5, 186,850,352.52 respectively totaling 1,402,816,561.02

Components of the budget that directly affect the health sector in Nigeria include the N44.5 billion earmarked for the Basic Health Care Provision Fund (BHCPF). The goal of the fund is to substantially increase revenue and improve Primary Health Care (PHC) as contained in the country’s National Health Act. For 2020, a total of N44.5 billion is expected to be allocated under the fund and this represents just about 8% of statutory transfers of which the national assembly received the biggest share of 22.5% (N125 billion) and the judiciary received N110 billion (about 20%) of the statutory transfers. It is also worthy to note that the allocation for 2020 was lower than allocated sum of N51.22 billion for 2019.

With the Chief of Staff, Malam Abba Kyari’s movement to Lagos for treatment of the Coronavirus, it indeed marked a clear tacit admission of the federal government’s failure in providing proper and effective healthcare, and most crucially its unpreparedness in tackling the pandemic outside Lagos. If Abuja wasn’t good enough to treat Abba Kyari, why treat others there? You could see that the federal government has been making empty noises.

Appalling is a recent tweet by the Federal Ministry of Health’s desperate plea to a United States Billionaire, Elon Musk, for 100 to 500 ventilators to tackle the Covid-19 pandemic which has brought the government under attack. Nigeria’s desperation in the midst of plenty and the government’s failure to invest adequately in the healthcare system by seeking medical treatment abroad, means Nigeria’s political elite who have left the healthcare system to deteriorate can no longer escape the coronavirus pandemic.

Across private and public hospitals in Nigeria, there are no more than 300 Ventilators at the moment. Meanwhile, there are budgetary allocations for health in billions with no state of the art facilities to show for the humongous budgetary allocations. Covid-19 has exposed Nigeria’s shame. What becomes more worrisome is the seeming hypocrisy of the government

Similarly, the President of the National Association of Resident Doctors, Dr. Aliyu Sokomba, said it seemed obvious that the Federal Government of Nigeria 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. 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 health sector.’’

Professor of Virology, Oyewale Tomori, in his rating of the health sector’s performance for 2019 said: “In the face of huge infrastructural gaps in, and inadequate budgetary allocation to the health sector (range between 3.90 percent and 4.75 percent of national budget from 2017 to 2020), it is difficult to rate Nigeria health sector performance any highly.

“I will avoid numerical scoring, but you can decide where we stand. Yes, we took some positive steps in the right direction, but these steps were insufficient, as the progress we made was too little, too late and too lopsided.”

Former President, Association of Resident Doctors, Lagos University Teaching Hospital (ARD- LUTH), Dr. Kayode Makinde, said: “The health sector performed below par in 2019, especially when compared with other countries. There were small wins here and there. For example, the allocation of one per cent from the consolidated revenue funds to service the provision of basic healthcare to Nigerians, which the government has not implemented.”

Maternal and Child health indices in Nigeria have remained consistently grim and it’s become clear that as a country, we could not expect to make any significant progress in development if we were unwilling to recognise the startling fact that pregnant women were dying in unprecedented, alarming numbers. Covid-19 has brought to sharp focus the commonality of this problem, the silent malnutrition tragedy facing Nigerian children and the need for urgency in addressing it.

With Covid -19 spreading across the country, coupled with the poverty, poor performance of the health system, the hand-to-mouth economy of the majorly poor and highly densely populated hinterlands, there is no better time and justification to challenge the government to finish the construction of the health centres across the country.

Nigeria cannot afford to deal with the enormity of escalation and possible causality figures of the outbreak at this time in its economic life, hence the need for a proactive completion of the health care centres across the country.

Admonishing the government on need for sufficient primary healthcare centres in the country, need to scale up and the unique essence of being vigorous and systematic in its response to activate medical machinery for identification of covid-19 cases should they break out, President The Association of Local Governments of Nigeria (ALGON), Hon. David Alabi, said, “The Primary Health Centres are inadequate in efficiency and proportion to the 200 million inhabitants !”

“My advice is simply for state governments to ensure that every designated ward in each local government and area council in Nigeria has a well-equipped and functional primary health centre. I am quite optimistic that the three tiers of governments provided we put “square pegs in square holes” can put a check on the spread and reduce the fatality index to a zero – tolerance status.’’

‘‘President Muhammadu Buhari (GCFR), Commander-in-Chief of the Armed Forces and State Governors deserve our commendation for their proactive and pragmatic strategy needs. In terms of medical information machinery, Nigeria was fortunate to have the D.G of NCDC as a member of the W.H.O that was in Republic of China to study the COVID-19 pandemic- causes and preventive measures! Today, the entire Health Institutions in Nigeria do have a deep understanding of the disease.’’

‘‘As the National President of the Association of Local Governments of Nigeria (ALGON), I have met with the National Executive Committee (N.E.C) and in abeyance and support to World Health Organisation, federal and state ministries of health multilateral approach to reducing the spread , ALGON has laid emphasis on continued advocacy, education, improved personal hygiene and regular clean hand-washing with soap, regular application of alcohol -based hand sanitisers and social distancing practice etc.. However, the National awareness and curtailing drive against COVID-19 should be a bottom-up approach rather than the up-bottom because of its vulnerability amongst the uninformed at the grassroots, simply because the local government administrations are the closest to the communities/ grassroots where the prevalence is high!’’

At a time the world is opening up discussions about how the practice of healthcare could innovate, Nigeria’s health system is struggling with the basic health issues, facilities, technology and processes. With the Covid -19 pandemic, our vulnerability as a nation has been thrown open.

The danger of neglecting healthcare has again been brought to the fore, our leaders must be held accountable.