"The health budget for 2024 is too small to ensure the nation's well-being."

"The health budget for 2024 is too small to ensure the nation's well-being."
Expectations were high when the African Union (AU) convened in Abuja in April 2001 and decided to dedicate at least 15% of their annual budget to advancing the health sector and achieving Universal Health Coverage (UHC).


The World Health Organization (WHO) also endorsed the Abuja Declaration, which was signed by African leaders.  However, when it comes to health indices, Nigeria is still in the woods 22 years after that pronouncement.


Nigeria now has one of the poorest health indices globally, particularly when it comes to maternal and child health. The nation is ranked 187th out of 191 members by the WHO. 


Nigeria is ranked higher than war-torn nations like the Democratic Republic of the Congo, Central African Republic, and Myanmar, among others. The ranking is based on performance indicators such as overall health level, population health distribution, responsiveness, and financial distribution.


One of the main suggestions for improving health has been raising the annual allotment to the health sector in the national budget to 15%, from an average of 5% since 2000. 


Unfortunately, the Federal Government has once again fallen short of allocating the necessary 15% of the planned budget for healthcare in 2024, even with a plethora of promises and pledges, as well as an additional N151 billion from the 2023 amount.


According to a breakdown of the 2024 Appropriations Bill, the health sector received N1.33 trillion, or 5% of the N27.5 trillion budget for 2024—less than 5.75 percent of what was allocated for 2023.


The Federal Ministry of Health and Social Welfare (FMoHSW) and its agencies have been allocated N1.07 trillion (recurrent and capital spending). Global Vaccine Alliance (Gavi)/immunization funds, including matching money for donor support programs, are allocated N137.21 billion. 


Additionally, N125.74 billion, or 1% of the Consolidated Revenue Fund (CRF), will be remitted to the Basic Healthcare Provision Fund (BHCPF). N500,000,000 was given to the Presidential Committee on Health Sector Reform.


The N1228,100,390,765 Appropriations Bill may be broken down further to reveal that N771,558,140,429 goes toward payroll, N21,756,304,848 goes toward overhead, and N434,785,945,488 goes toward capital expenses.


This suggests that just one-third of the funding would go toward capital investments and that more than two-thirds, or 65%, would go toward paying salaries.


A closer look at the budget reveals that, because of inflation and currency devaluation, the N1.33 trillion 2024 budget may end up "far less than" the N1.179 2023 budget.


Additionally, inflation and currency depreciation must have eaten into the BHCPF's gains, which increased by nearly 300 percent from N47.64 billion in the 2023 budget to N125.74 billion in the 2024 budget.


When the 2023 budget is compared to the previous ones, it is clear that the national health budget has increased from 4.7% in 2022 to 5.75% in 2023; the health budget has also increased from N278.31 billion in 2015 to N1.179 trillion in 2023; the BHCPF has decreased from N55.15 billion in 2018 to N47.64 billion in the 2023 budget; and family planning services have been scaled up from N20 million in 2022 to N20 million in 2023 in order to purchase commodities through counterpart funding.


In fact, the 2023 budget included almost N1 trillion for the first time ever in Nigerian health financing history.An additional examination of the 2023 revealed that the health sector received N1.179 trillion of the N20.5 trillion allotted for the fiscal year 2023.


The service-wide vote awarded N81.47 billion to the health sector as well. This comprises N4.4 billion for military retirees under the National Health Insurance Scheme (NHIS), N7.4 billion for counterpart money, including global fund and health refund to GAVI, and N69.57 billion for GAVI/immunization.


Compared to the N826.9 billion and N547 billion allotted to the health sector in 2022 and 2021, respectively, the 2023 budget demonstrated a notable growth.

 Nigeria's BHCPF and the service-wide vote (contingency budget) provided alternate funding, although the budgeted allotment to the health sector never went above 7%. Even at its 2012 peak of 6.2%, it was much below than the 15% pledged in the Abuja Declaration.   


Stakeholders are perplexed by President Bola Ahmed Tinubu's repeated breaches of his pledge to enhance budgetary allocation. Two months after taking office in July 2023, he had pledged to increase the budget from five or six percent to ten percent.


By 2024, Tinubu's administration will have increased the annual budgetary allotment to the health sector to 10%, with the promise of additional increases if they are used responsibly.


The main consequences, according to critics, of allocating only 5% of the projected budget for health in 2024 would be that the majority of Nigerians would still be unable to afford healthcare, and they would still have to pay for their own medical care. Additionally, the president and other political officials would still travel abroad for medical treatment.


Furthermore, medical professionals with training from Nigeria—physicians, nurses, pharmacists, and other health workers—would keep moving to more fertile areas where they could be guaranteed better pay and working conditions. 


In addition to the extremely poor release and egregious underutilization of funds, the critics demanded that a health budget implementation report be released on time in order to hold the National Assembly accountable. They also asked that the proposed estimates be closely examined in order to prevent duplication and the waste of limited resources.


The government's mishandling of the healthcare industry was evident in the N2.18 trillion 2023 supplemental budget that was approved in October and did not include a vote on the issue.


The Nigerian Association of Resident Doctors (NARD) and other stakeholders are appalled by this misdirected emphasis. Dr. Dele Abdullahi, the president of NARD, called the 2024 Appropriations Bill's budgetary allotment to health a mockery of the state of emergency that Prof. Muhammad Ali Pate, the Minister of Health and Social Welfare, declared in the field during the recently concluded National Council of Health (NCH) in Ekiti, Ekiti State. According to Abdullahi, it raises concerns about the Federal Government's commitment to guaranteeing that the healthcare system is adequately funded. 


"We will always stand at 15% as the African Union declared in Abuja in 2001. Then, we can assess the effectiveness of how these funds are used and determine if we will need more. A healthy workforce is an effective workforce, and access to quality healthcare is a fundamental right for every Nigerian," he stated.


"I think that ship has sailed as the National Council on Health already made that recommendation based on realities on the ground," Abdullahi continued. "I was confused about what they are proposing when I saw the budget proposal for health standing at a mere five percent of the current budget."


It's not about the five percent's arbitrary digits; rather, this quantity needs to be compared to earlier quantities made utilizing economic indexes from various historical periods. In actuality, the healthcare system has fewer resources to operate in a nation that claims that healthcare is failing, even though money may be higher. This is because economic realities and the price of commodities have increased as well.


Prof. Akin Osibogun, a public health physician and former Chief Medical Director (CMD) of Lagos University Teaching Hospital (LUTH) Idi-Araba, stated that the level of financing and inefficient resource utilization continue to be the primary obstacles to the provision of high-quality healthcare services in Nigeria, rather than the proportion of the budget devoted to health. 


According to Osibogun, the total health expenditure per capita in Nigeria is a pitiful $97, while it is approximately $4,000 in Europe and $8,500 in the US. He further stated that an overall study of worldwide statistics indicates that health outcomes improve with increased health spending per capita. 


"At the moment, our fund pooling systems are insufficient and feeble. Approximately 70% of our current health expenditures come from outside of our pocket (OOP). Global data generally indicate that a country's health outcome is worse the more prominent OOP is in its health finance scheme. 


Thirdly, Osibogun stated, "We are inefficient spenders even with our low level of health expenditure, with our health outcomes being worse than those of a country like Senegal spending less than half of what we are spending."


According to a Guardian investigation, NAFDAC and other important organizations tasked with overseeing drug and medical affairs in the nation have been rendered ineffective by inadequate funding, which has exacerbated the issue of phony and counterfeit medications.


President Tinubu recently unveiled Nigeria's Health Sector Renewal Investment Initiative and signed the Health Renewal Compact with federal, state, and development partners in Abuja. Contrary to the contents of the proposed Appropriation Bill 2024 for health, he stated that his administration is prioritizing and improving Nigeria's health sector through significant investments and the allocation of increased funds to the sector in the proposed 2024 budget. 


The occasion was a part of the celebration of Universal Health Coverage (UHC) Day, which falls on December 12 every year. President Tinubu announced that the BHCPF will be revamped to improve access to basic healthcare services as specified in the National Health Act (2014) in order to alleviate the high cost of healthcare. 


In order to enhance the country's primary health system, he continued, the BHCPF, which represents at least 1% of the Consolidated Revenue Fund, is anticipated to receive at least $2.5 billion in pooled and non-pooled financing between 2024 and 2026.

By 2027, there will be 17,618 Primary Healthcare Centers (PHCs) operating in all 36 states and the Federal Capital Territory (FCT), double the amount that was previously planned, according to Minister Pate. These PHCs would be connected to an extensive emergency care infrastructure.


According to projections, Nigeria will require at least N1.8 trillion annually to reach UHC, which would require enrolling 200 million people in a minimum health insurance program. 

According to a breakdown, if a monthly premium of N750 is paid for each Nigerian enrollee, it would come to N9,000 for a year—that's N1.8 trillion for 200 million people.


However, the amount exceeds the N1.33 trillion that the 2024 budget has set aside for construction and ongoing health spending. Critics argue that even while achieving universal health coverage (UHC) will cost Nigeria N1.8 trillion annually, the nation will save trillions of naira that would have been spent on treating chronic illnesses including diabetes, stroke, kidney damage, and cancer. 


Achieving UHC by 2030 is essential for realizing the fundamental human right to health and for keeping the promise of the 2030 Agenda for Sustainable Development, according to the 2023 UHC Global Monitoring Report. The Federal Government made promises, but the 2024 budget is deemed glaringly insufficient to enhance the health of Nigerians.

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