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ACCOUNTABILITY IN THE HEALTH SECTOR
HENRY EWUNONU argues that the fraud in the health sector, particularly at the local councils, is unconscionable
World Health Day is marked annually on April 7. The theme of the 2025 celebration was “Healthy Beginnings, Hopeful Futures,” with a special focus on maternal and newborn health. The day was used to make a clarion call using a whole-of-society approach to drastically reduce preventable maternal and newborn mortality and bring to the forefront the long-term well-being of women as a global agenda. It is in this light that the revelation by the ICPC last week that diversion of funds for healthcare and infrastructure accounts for over 60% of cases of corruption investigated by the Agency at the Local Government level becomes very disturbing.
The report is very saddening because “money answereth all things”. There have been a concerning and now transgenerational angst against the low budgetary provision for health in Nigeria contrary to the 15% Abuja declaration of 2001, the poor budgetary performance in terms of delayed approvals and minimalistic release of the appropriated sums and weakness of the sector that makes the country vulnerable in the face of health emergencies.
This, therefore, calls for serious interrogation. Why should anyone divert funds meant to provide health security for our citizens? Should such slush funds not be categorised by people of conscience as ‘blood money’?
Employing a root cause analysis approach to try to understand this shameful heist on the people’s life support, the following pillars are manifestly exposed. These include the abysmal poverty or yawning abyss of governance at the local government level occasioned by the shaky foundations on which they are founded and instability of the administration, which makes them vulnerable to dissolution by any state government, even without a reason – cogent or unfounded. Poor capacity for utilization of appropriated and released funds has also been identified as a bane of the health sector, which paradoxically defies any logical explanation. How can a sector that is crying against the little provision starve itself by failing to utilize what is provided, leading to the return of appropriated funds yearly? Others include the indifferent posture of the citizens who look away from their responsibility as citizens who ought to hold governments at all levels accountable and prevent arbitrariness and abuse of power.
These make local government councils a no man’s land of sorts, apart from being in the pockets of the state governments. One should therefore be concerned given the enormity of roles prescribed by the Constitution of the Federal Republic of Nigeria 1999 as amended, the National Health Act 2014 and National Health Policy, which include governance and administration of Primary Health care the entry point in the health system and bedrock of healthcare delivery in our nation.
For knowledge purposes, the Constitution in section 7 and the Fourth schedule expressly assigns provisions and health services to the local government authority. If such a critical sector should be assigned to this poorly multi-dimensionally resourced tier of government, little wonder then that the nation’s health sector has been anything but disappointing, measured by a very simple index or criterion which benchmarks availability, accessibility, affordability, efficiency, effectiveness and cultural/religious acceptability.
“Should we continue in sin that grace may abound?” God forbid.
Nigerians, especially those who cannot afford private healthcare, should rise up to demand accountability from the LGCs. One worrisome observation is that there exist functionaries of this level of government, including Ward Councillors, who ought to protect the people against mistreatment and stealing of resources provided to care for them; instead have become hawks that devour what was entrusted to their care.
The Media and CSOs amplifying the voice of the vulnerable and weak should demand for practical implementation of the July 11 2024, Supreme Court judgement as it regards the autonomy of the LGCs. The ruling party should demonstrate unequivocally its readiness for implementing that judgement by providing leadership, monitoring and evaluation and periodic reporting on the level of progress.
Health-related professional associations have remained indifferent for far too long. That silence appears conspiratorial now. They can’t, on one hand, be complaining of an undue high workload at the Secondary and tertiary levels of care while being uninvolved in what will restore functionality and effectiveness of the primary healthcare level. Healthcare professional associations should demand the restoration of an effective Medical Officer of Health position at the LGAs, who should be saddled with the overall managerial responsibility of administering healthcare at that level of government. They, along with other CSOs, should be involved in budget oversight activities, including tracking of appropriated funds. They should deploy resources for ‘following the money’, identify funding gaps, propose effective financing options and ensure probity and accountability. They should witch-hunt wrongdoers to the extent that the law permits by calling out non-performers and those with itchy fingers who steal the coffers blind. Everyone, including religious organisations, should decry the frivolities and irrelevancies seen in budgets these days. Whereas awareness creation and public enlightenment are important for disease prevention, those very ambiguous terms have been used to do the unthinkable in siphoning the available meagre funds needed for service provisioning. It appears that the amount of funds used for public awareness programs for HIV/AIDS in Nigeria may even be bigger than the amount used for diagnosis and treatment, without commensurate returns evidenced by statistics. It’s said that such budgetary subheads are just “jobs for the boys” as there’s no framework for accountability or impact assessment save for photo reports in the media. This sort of subhead painfully still appears in the national and state budgets. In the face of donor assistance withdrawal by the USA and other nations, Nigeria should rethink health appropriation so that our little can matter for so much. Every dark hole or leaky crack must be patched and sealed. As the African proverb says, those who cannot help but only swallow large boluses should cut down as the soup has finished.
Ewunonu is
a medical doctor & health reforms advocate,
