Since 2001 when heads of state of African Union countries at a conference in Abuja, the Nigerian capital, pledged ‘to set a target of allocating at least 15% of annual budgets to the improvement of the health sector’, Nigeria’s budgeting for health has consistently fallen short of that target.
The 2015 budget for instance was 5.6% of the budget when government set 278.8 billion Naira for health in a budget of nearly 4.6 trillion Naira. The 6.7 trillion Naira 2016 budget presented by President Muhammadu Buhari which has been roundly commended as a people-friendly budget in which for the first time the education is getting a lion share, budgeting for health nose-dived, with the 221.7 billion Naira accounting for 3.6% of the total budget.
By World Health Organisation standards, this is grossly inadequate to provide basic health care for the populace and evidently insufficient to reduce out-of pocket payment for health services, which about 60% of Nigerians currently spend.
Undoubtedly, the real challenge stems from how to fund the many commitments of government made over the years. In 2012 at the London summit, governments pledged to increase funding for family planning from 3 million United States dollars to an additional 8.35 million US dollars. In 2014, the National Health Act signed into law mandated the Nigerian government to set aside at least 1% additional funds from the consolidated revenue fund for the health sector. Not much success was recorded in terms of implementation.
There are also concerns about the funding of Nigeria’s immunisation programme, which this year, will cost nearly 1.4 billion US dollars. according to estimates by the National Primary Health Care Development Agency which coordinates the immunisation programme nationwide.
Already, the nation has a 148 million dollars Global Alliance for Vaccines Initiative-GAVI fund, to help procure and move vaccines around the world. Nonetheless, with the current budget proposal, it is yet uncertain how Nigeria will bridge the 166 million dollars gap in counterpart funding.
For a fact, such funding gaps are not peculiar to Nigeria. Several countries around the world are equally challenged with funding deficiencies for critical sector targets and this has been exacerbated by the global recession, with developed nations and international donor agencies unable to meet their grant pledges. This gap informed the launching by the UN Secretary General of the Global Financing Facility-GFF, at the Third International Conference on Financing for Development in July 2015.
Nigeria is one of 63 countries to benefit from the country-driven financing partnership that brings together, under national government leadership, stakeholders in reproductive, maternal, newborn, child and adolescent health, to provide smart, scaled and sustainable financing to accelerate efforts to end preventable maternal, newborn, child and adolescent deaths by 2030.
To achieve this objective, it is imperative for all the tiers of government and the private sector to take responsibility for the health of their populace by proffering new strategies to finance health services for citizens. One veritable source of funding for Nigeria is the National Health Insurance Scheme-NHIS, which currently covers less than 5% of the population and is financed only by the federal government.
Introduced in 2005 to guarantee accessibility to healthcare for Nigerians, the NHIS provides insurance cover for civil and public servants who constitute just 3 percent of the entire population. Under the scheme, of the total contribution of 15%, the employer is expected to contribute 10% and the employee 5% to cover contributors’ health needs. However, nine years after it was introduced, only a few employees are paying their contributions to the scheme. This substantially reduces the amount of money in the system to be pooled. Furthermore, only two of the country’s 36 states have adopted the scheme.
Another revenue source is to expand the Social Health Insurance scheme, otherwise called Community Health Insurance scheme, to garner resources at the community level to provide health care for Nigerians in rural communities.
Perhaps the most important window for increasing the budget of the health sector is in the zero-based budgeting policy stipulated for the 2016 budget. In addition to eliminating wasteful expenditure, stakeholders now have an opportunity to present a strong advocacy for more funds to finance the plethora of health programmes, hitherto left unfunded.
How far Nigeria goes in delivering quality health care for its citizens will depend largely on the ability of stakeholders to argue their case and on the National Assembly’s commitment to fast-tracking much-needed financing to the health sector, for a more sustainable health care delivery in the country.