Health sector’s Amoeba budget – Lekan Sote

Nearly everyone, who experiences the inadequate healthcare delivery system of Nigeria, thinks that practically all the governments of Nigeria, from the Federal to the sub-national levels, woefully fail to adequately fund the sector.

Nigerians were worried at the sundry trips that former President Muhammadu Buhari made to fix even something as insignificant as an ear ache. When he stayed in Britain for more than 100 days and Vice President Yemi Osinbajo had to step in as Acting President, many were convinced that Nigeria’s healthcare delivery system was irredeemable.

Also, not a few threw mocking jabs at current President Bola Tinubu, who they speculated went on his own medical tourism, first before the presidential primaries of his All Progressives Congress, which he won, and after the presidential election, which he also won.

Critics report the following as percentage of Federal Government spending on healthcare delivery in recent years: 2019, 4.75 per cent; 2020, 3.83 per cent; 2021, 4.18 per cent; 2022, 4.76 per cent; and the current year 2023, 5.75 per cent.

Those who are clever with figures say that this budgetary allocation provides only N9,000 of healthcare for each Nigerian in the yet unfolding 2023 budget. Just one diagnostic test can wipe off the entire amount, especially if you are dealing with a major health crisis.

In a document titled, “Situation of Women and Children in Nigeria,” the United Nations Children Emergency Fund reported that there is 576 child mortality per 100,000 live births in Nigeria. Former Nigerian Minister of Health, Dr. Osagie Ehanire, once tried to explain the cause of the high maternal and infant mortalities in Nigeria.

He admitted that “the area where you have this maternal mortality is the rural areas, where they have zero access to healthcare and… many people are actually excluded from the healthcare service delivery (facilities).”

Other reports indicate that Nigeria loses 140 pregnant women everyday, just as yet another report indicates that, out of 195 countries, Nigeria occupies the shameful number 163 position of the Global Health Security Index.

Before he left office as Minister of Health, Dr. Ehanire had been planning to increase the number of functional Primary Healthcare Centres in Nigeria, with the requisite number of qualified medical personnel, equipment and consumables.

Out of the 30,000 Public Healthcare Centres across the country, it is reported that only a mere 6,000, or five per cent, are operational. Experts argue that the 1 per cent of the Consolidated Revenue Fund of the Federation that is dedicated to Primary Healthcare Centres is inadequate.

In any case, the major portion of the inadequate budgetary funds allocated to the healthcare sector is spent on overheads and very little is spent on infrastructure, equipment and consumables. You may have observed that patients sometimes have to buy even the gloves that the medical personnel who attend to them will wear.

The problems of the healthcare sector recently got to a head and the workers embarked on an industrial action for the umpteenth time. Members of Joint Health Sector Unions and Assembly of Healthcare Professionals however, suspended the strike for 21 days after President Tinubu assured them that he would invest in the healthcare sector.

To show the health sector unions that he appreciated them, President Tinubu told them that he thought that healthcare has a direct link with the economy, industrial productivity and national security. That probably made their day.

But whilst some argue that the Federal Government’s budgetary allocations to healthcare delivery system is inadequate, others point out that a wholistic overview of allocations in all the budgets of the Federal Government, State governments and Local Government Authorities–should reveal a huge investment in healthcare delivery system of Nigeria.

Those who make this argument suggest that the indeterminate classification of monies spent on healthcare delivery throughout Nigeria has assumed amoebic proportions; small in some parts, and huge in yet others. Amoeba is an organism with the capability to alter its shape.

Nigeria’s spending on its health sector is undefined and imprecise, but real. While critics argue that government isn’t spending much on healthcare delivery, observers are pointing to government spending on healthcare through other sectors.

Those kinds of expenditure should have dual classification; and recognised as medical as well as educational expenditure. The problem may also simply be that there is no coordinated approach to budgeting for the country’s healthcare delivery system. Everything is done in a haphazard manner.

For instance, money spent on facilities, consumables, staff remuneration and overheads in the medical schools of the educational sector must be classified as government spending on healthcare delivery.

Even so, industry players complain that there is not enough funding for medical schools in Nigeria. In 2015, Prof Folasade Ogunsola, a medical doctor, who is currently the Vice Chancellor of University of Lagos, spoke on behalf of Association of Colleges of Medicine of Nigeria, of which she was chairman.

She implored the Federal Government to raise its funding of (at least) Federal Colleges of Medicine to enable them fulfill the purposes of training and healthcare delivery for which they were established.

The free meals that the Ministry of Humanitarian Affairs, Disaster Management and Social Development claimed to have provided for kids, while the Covid-19 pandemic lasted, should also be regarded as part of Nigeria’s healthcare delivery spend.

Unfortunately, despite the (practically discarded) feeding scheme in schools that was introduced by the President Buhari government, Nigeria has the dubious record as the nation with the highest rate of malnutrition in the world!

Multilateral organisations too have been making contributions to Nigeria’s healthcare funding. The United Kingdom has been kind with a grant of £2 million to “optimise the performance, quality and impact of (Nigeria’s) health workforce.”

According to the United Kingdom’s High Commissioner to Nigeria, the grant is provided because, “a skilled, well-motivated and adequate workforce is critical for Nigeria to #EndPreventableDeaths and build resilience against global (premature death) trends.”

Though, some cynics have interpreted this “benevolence,” or do-gooder gesture,  as some form of conscience payment for the brain drain of Nigeria’s medical personnel to Britain. One cynic, wrote, “This is the tax (or compensation) for all (Nigerian) medical personnel working in the UK.”

Surely, when you consider this relatively dismal allocations to healthcare in Nigeria’s Federal budgets against the 15 per cent that signatories of the 2001 Abuja Declaration that African nations agreed should be spent on medical expenditure, it is clearly below expectation.

It is however, worthy to note that death rate in Nigeria in the last 50 years has nearly halfed: It dropped form 22.5 per 1000 in 1973 to 13.8 in 2021. It further dropped to 12.4 in 2022. So, by whatever tricks, the health of Nigerians is getting better.

In spite of the argument that maybe a huge amount is spent on Nigeria’s healthcare delivery system by all the tiers of government no one seems feel the impact. Maybe there is a need for a well defined, agreed, orchestrated and coordinated approach to spending on the healthcare sector by all the tiers of government in Nigeria.

And the National Economic Council, made up of all State Governors and chairmanned by the Vice President, may be the appropriate place to start. And it is encouraging that President Tinubu appears willing to work with the council.

Twitter@lekansote1, lekansote.com

About Post Author