19 March 2019

Nigeria: Why Nigerian Govt Cannot Fund Citizens Health Needs - Official

Nigeria must explore other sources outside the budget to effectively finance its health sector, the Director-General, Budget Office, Ben Akabueze, has said.

Mr Akabueze spoke on Tuesday at a workshop in Abuja organised by the Collaborative Africa Budget Reform Initiative (CABRI), under the theme: "Nigeria Value for Money in the Health Sector."

The workshop examined how the Nigerian health sector could be better financed to improve the quality of health services rendered to the populace. In attendance were participants from the ministries of finance, health and financing partners working in the health sector.

Mr Akabueze while delivering his presentation on 'Reprioritising Health in the National Budget', said the federal government is not able to allocate more funds to the sector than it is doing because the country is experiencing fiscal constraints.

He said it is unfair to look up to the federal government alone to address the issues in the health sector.

Mr Akabueze said the federal government has in the past few years increased its effort in financing the sector. This, he said is evident in the amount allocated to the sector in the 2018 and 2019 budgets as well as the accommodation of the Basic HealthCare Provision Funds in the 2018 Budget.

There has been a slight increase in budgetary allocation to the health sector, but Nigeria has not met the commitment made by African countries on funding of healthcare services for their citizens.

In the 2001 Abuja Declaration, countries under the African Union pledged to commit at least 15 per cent of their annual budgets to the health sector.

Since the declaration, the Nigerian federal government has not voted more than six per cent of its annual budget for the sector.

The highest allocation since the declaration was in 2012 when 5.95 per cent of the federal budget went to health.

Due to the inability of the government to increase its commitment to the sector, the Basic Health Care Provision Fund (BHCPF) was proposed as an alternative fund to cater for the health needs of Nigerians.

Every fiscal year, one per cent of the Consolidated Revenue Fund (CRF) is meant to be earmarked for the Basic Health Care Provision Fund (BHCPF).

Unfortunately, the BHCPF has not been performing since it was signed into law in 2014. For the first time, BHCPF was inserted in the 2018 Budget but the fund is yet to be fully released.

The BHCPF in the 2018 appropriate bill was N55 billion and in the proposed 2019 Budget, N51.22 billion.

Half of the fund is meant for the National Health Insurance Scheme, 45 per cent for the National Primary Health Care and the remaining five per cent for emergencies treatments among others.

In January, President Muhammadu Buhari launched the rollout of the BHCPF but Nigerians are yet to feel the impact of the scheme.

Mr Akabueze said the delay in the release of the BHCPF is due to the fact that the fund cannot be treated as a statutory transfer.

This is because there is no mandate or law that supports such.

He said though it was included in the 2018 and proposed 2019 budgets, the country's financial challenges made the government unable to fulfil its financial mandate.

He said this is the reason it is necessary to start thinking of alternative means of funding the health sector.

"This does not stop with the fact that the funds available to the federal government are limited as there are large non-discretionary expenditures and there are loans to be serviced. The government first takes care of the non-discretionary expenditures before considering how much remains in the government's treasury to be disbursed.

"Clearly, we have a significant fiscal constraint, we are having challenges with funds. That is why we are not allocating more money to the health sector. It is unfortunate, but the fact is that we are constrained. The budget is already in deficit. Until we can comfortably generate more income, it will hard to adequately release the funds," he said.

Mr Akabueze said the government can have more resources to fund the health sector if it increases the tax on sugary beverages, alcohol, tobacco and other related items that increase the disease burden in the country.

He also said one of the reasons why the allocation to the health sector seems to be underperforming is the staff strength of the agencies in the sector. He said the workforce is high, therefore cutting into its budgetary allocation.

Speaking in a similar vein, the Executive Secretary of CABRI, Neil Cole, said Nigeria needs to start making plans to involve the private sector in health financing and service provision.

He said Nigeria needs to answer the question how much it intends to invest in the health sector and what services it intends to achieve with the financing.

"I cannot give you a figure but you should figure it out on your own. The country needs to know how much the nation needs to spend in the health and the services to be rendered. It needs to know what to invest in immunisation coverage. It is not about Nigeria attaining the 15 per cent Abuja declaration pledge, but appropriate enough to achieve the expected desired services for the people," he said.

He also advised the private sector to invest in the health sector as their Corporate Social Responsibility to society.

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