Nigeria has again failed to meet the commitment it made alongside other African countries 19 years ago on health funding, with the budget proposed by President Muhammadu Buhari last week allotting less than 10 per cent to the sector.
The budget for 2021 proposes N547 billion for healthcare, about seven per cent of the budget's total of N13.08 trillion.
The amount comprises N380.21 billion for recurrent expenditure and N132 billion for capital projects. There is also N35.03 billion Basic Health Provision Fund, which includes funds for managing emergencies and infectious diseases such as the COVID-19.
On average, the amount translates to about N2, 735 per Nigerian, given the country's population of about 200 million people.
The budget covers the salaries of health workers and logistics involved in the day to day running of the health ministry and tertiary health facilities.
It also covers funds for the purchase of personal protective equipment for health workers fighting COVID-19, interventions against diseases such as Malaria, Tuberculosis, Meningitis, HIV/AIDS.
There are also construction and rehabilitation of primary health facilities, purchase and maintenance of cancer machines, and a pool of funds for health insurance packages.
The seven per cent allocation to healthcare, however, falls below the 15 per cent agreed by African countries in 2001.
It was the realisation of the deficiencies in their health systems that made African governments commit in April 2001 to dedicate at least 15 per cent of their annual budgets to the health sector in what is now known as the 'Abuja Declaration'.
Nineteen years later, only about seven countries -- Rwanda, Botswana, Niger, Zambia, Malawi and Burkina Faso, Togo -- have met the Abuja target. In 60 per cent of the countries, the health sector share of total government expenditure is below 10 per cent, according to the World Health Organisation.
A 2011 WHO report said a decade after the declaration, 27 nations increased their health expenditure. Nigeria's highest-ever public budget share for its health was seven per cent. That figure fell to less than 4 per cent in 2019. It means, in a way, the seven per cent proposed for 2021 is an improvement over the 2019 and 2020 figures.
When donor funds dwindle
The 2021 budget proposal came on the back of the recent COVID-19 pandemic which has infected almost 60, 000 persons in Nigeria, killing over a thousand.
The pandemic has exposed the dire situation of health care systems in Nigeria and Africa.
While President Buhari's latest proposal contains an improvement in health funding, it is still way off the continental mark. The WHO said in April that 43 African countries had just 2,000 ventilators and 5,000 intensive care beds. At least 10 countries had no ventilators at all.
Nigeria has relied significantly on foreign donors for the funding of its health programmes.
Before COVID-19, many of Nigeria's key health interventions -- including on polio eradication, vaccination programs, malaria, tuberculosis, HIV/AIDS, and maternal and child health -- remained almost entirely dependent on foreign donors.
The economic downturn caused by the pandemic this year affected donor funds.
Amid the crisis of shortage of external funds, health advocates said they were expecting a robust health funding in the 2021 estimate to salvage Nigeria's health system.
Some analysts have blamed the funding deficit on the country's myriads of other problems, such as in the security sector.
The 2021 budget for the Ministry of Defence was put at N840.56 billion against N878.4 billion budgeted for 2020 with N121 billion earmarked for capital projects.
The ministry of education budget, including the N70.05 billion meant for the Universal Basic Education Commission (UBEC), is put at N615.15 billion.
Ifeanyi Ezeh, a researcher and public health advocate, said while defense and education need keen attention, health should also be prioritised.
"If the government can finance its defense budget without foreign support, it could do the same for health," he said.