A graph illustrating the high cost of healthcare.
Poor funding of the health sector leaves negative impacts on Nigeria’s rising population, with the country accounting for 20% of global maternal deaths, the world’s highest under-5 deaths, third highest global HIV infections and heaviest TB burden in Africa.
Numerous abandoned health projects litter the country, denying Nigerians access to affordable health services.
Understaffed, ill-equipped and dilapidated, others, quasi-operational health facilities are unable to cater for the growing population. Much of this has been blamed on the poor funding of the country’s health sector, as public expenditure on the sector has constantly fallen below the benchmark of 15% of the national budget set by the African Union.
However, most Nigerians cannot afford the services of private hospitals and medical centres.
In 2001, leaders of African countries at a summit in Abuja, Nigeria’s capital, pledged to allocate at least 15% of their annual budgets to the health sector, with the aim of improving healthcare in the region. This came to be known as the Abuja Declaration.
Despite being a party to this declaration, Nigeria has failed to honour it.
Out of the N14.77 trillion federal government’s budget for 2022, only N724.9 billion, 4.9% was allocated to the health sector. A breakdown of the allocation showed that only N3,587 was earmarked for the medical care of each of Nigeria’s 202 million citizens throughout 2022, that is, N298 monthly, N68 weekly and N9 daily, not enough for antimalarial drugs in a country with dangerous malaria statistics.
Former president, Olusegun Obasanjo, had described health funding in Nigeria as “one of the worst in the world”. Ironically, even Mr. Obasanjo, who hosted the summit where the Abuja Declaration was made, never attained the benchmark until he left office in 2007. His highest allocation to the sector was 5.6% of the budget in 2006.
The highest allocation Mr. Obasanjo’s successor, Umar Yar’Adua, made to the health sector was 5.26%, N144.6 billion from N2.74 trillion, in 2008.
The next president, Goodluck Jonathan, allocated N282.7 billion, 6.08%, N4.64 trillion, in 2012, the highest by percentage since the AU health pledge.
So far, the highest allocation to the health sector by former President Muhammadu Buhari is 4.75%, N423.9 billion from N8.91 trillion, in 2019.
Nigeria has had a cumulative budget of ₦114.42 trillion since 2001, but only ₦5.39 trillion of this, representing 4.71% went to the health sector.
Yet, a larger chunk of health budgets is gulped by recurrent expenditure, mostly payment of salaries and running costs. In the last 22 years, only in 2001 did allocation to capital projects, ₦25.06 billion naira, exceed recurrent expenditure, ₦14.21 billion naira, of the Federal Ministry of Health.
The government has blamed its failure to meet the 15% benchmark on paucity of funds and competing needs in other sectors of the economy.
The former Permanent Secretary of the Federal Ministry of Health, Abdulaziz Abdullahi, said though desirable, the 15% budget benchmark remains a tall dream.
“The 15% budget for health is an aspiration and a set target that the country wishes to attain. However, many other factors militate against it. There are competing interests from different sectors such as education, agriculture, security, among others, and this means that the government must prioritise based on available resources”, he said.
“The dwindling resources are driven by increased insecurity in many parts of the country and the recent COVID-19 pandemic, which virtually brought the economy of the world to a standstill. The fall in oil prices due to the pandemic has further reduced government revenue since oil is the major source of government revenue”.
While Mr. Abdullahi partly blamed the COVID-19 outbreak for the non-attainment of the 15% healthcare benchmark, findings outlined earlier in this report revealed that the health sector was being underfunded long before the pandemic.
The former permanent secretary, however, revealed that the country will continue to rely on loans and grants from external sources, including the US government, Global Fund, World Bank and other international donor agencies, to augment the financing of its health sector.
Donor funding fell significantly after Nigeria was re-classified as a “Lower Middle Income” country. Since 2003, Nigeria has received almost $3 billion from Global Fund, while contributing $38.7 million to the fund as a global health partner. Recently, the fund disbursed 25% of the $1.1 billion allocated to address key health issues in the country, in addition to the €50 million Nigeria received from the European Union, EU, in 2020.
Many health analysts have previously argued that it is a misplaced priority for the government to place issues such as petrol subsidies or under-recoveries ahead of strengthening the health system where substantial funding is required to bridge huge infrastructural deficits and depleting stock of skilled medical professionals in the country.
It is expected that the amount spent on petrol subsidy alone, which is more than the combined budget for health and education, can be applied to critical sectors like healthcare.
AljazirahNigeria urges the Federal Government under whose purview the health sector lies to be ardent in redeploying the resources that accrued from the removal of fuel subsidy to reinvest in other critical sectors such as education, healthcare, security, and infrastructure. “This will not only improve the standard of living for citizens but also enhance economic growth, making citizens to afford the toll on their healthcare needs.
