As required by the 2014 National Health Act, the government should allocate at least 1% of its Consolidated Revenue Fund (CRF) to the Basic Healthcare Provision Fund. This is geared towards the financial management of primary healthcare in Nigeria with the aim of providing a basic minimum package of health services to low-income and vulnerable Nigerians, particularly in underserved communities. However, in the 2020 budget, the Fund was reduced by over ₦44.4 billion.
Worse still, according to a performance report released by ONE Campaign, since 2001, Nigeria has consistently committed less than 7% of the total annual national annual budget to health, leaving a major gap in the financial resources required to drive the health system. In fact, according to data from the World Bank, the current health expenditure in Nigeria is a paltry 3.89% of our total Gross Domestic Product (GDP). But this cannot continue. A lot is at stake, as a lot of people die because the government is not spending enough on the health sector.
To increase budgetary allocation for healthcare and achieve quality health outcomes for vulnerable and poor Nigerians, we need to advocate for innovative and sustainable health financing mechanisms. And we must continue to demand for the full implementation of the BHCPF. As well as pro-health fiscal policies like the 2021 Finance Act’s Sugar-Sweetened Beverages (SSB). While this said tax that imposed a 6.75% excise duty of ₦10 ($0.02) per litre on all non-alcoholic, carbonated, and sweetened beverages is below the recommended 20% by WHO, it is still a way to start from and go. Experts even say pro-health taxes do not only improve the health of Nigerians, but also alternatively expand the country’s weak tax base and boost revenue generation.
From the foregoing, I believe we can achieve sustainable healthcare financing with multidimensional approaches germane to rallying the support of relevant government institutions, stakeholders and private-sector investors. But this starts with citizens and activists demanding strong political will from our leaders at all governance levels to boost spending on the health sector.
As a developing and low-income country, the existing Basic Healthcare Provision Fund and Sugar-Sweetened Beverages (SSB) tax are key to ensuring that the Nigerian government finances and builds a comprehensive, PHC-oriented health system to achieve universal health coverage. With advocacy efforts, policymakers at high levels will be committed to open, fair and inclusive processes for health financing to advance their full implementation and ultimately increase the allocation for health.
Advocacy will also facilitate citizens to engage in the implementation framework and as well hold the government accountable. This will be done by tracking and monitoring how funds from the BHCPF and pro-health taxes are invested and spent for their intended use by the concerned health authorities and government agencies for primary healthcare development and preventive health systems at sub-national levels. Particularly to the benefits of residents’ prevention and treatment of Non-Communicable Diseases (NCDs) that have a negative toll on our national productivity and whose treatment costs disproportionately affect poorer people in underserved communities.
For example, Ekiti State has disbursed over ₦80 million to 122 PHCs across wards in 16 local government areas to ensure operational funds are available for their facilities. Other states have also made tangible progress, while some are still far behind in the implementation of health financing programs. Activists and citizens have a duty to advocate that sub-national governments make its investment in healthcare a top political priority — starting with their 25% contribution of the funding to implement BHCPF through an earmarking of their state annual budget. Also, advocacy comes in here to ensure there is transparency on how Officers-in-Charge of BHCPF-accredited PHCs in wards across states are utilizing the programme and enrolling residents for its services to reduce out-of-pocket costs for healthcare.
Indeed, we are at an inflection point as Nigerian voters go to the polls in 2023 to elect new governments at all levels. Consequently, it’s high time our candidates prioritized high-impact agenda and issue-based manifestos that would keep health at the center of governance and legislation. By and large, the predisposition of our new political leaders, government officials and legislators to the health sector will have far greater significance on how healthcare will be sustainably financed. More than anything, the upcoming 2023 General Elections offers a reopened door of opportunity for us to ensure plans to fund our health system are at the forefront of the political agenda.
Ayomide Agbaje, a ONE Champion in Nigeria, writes from Ekiti
