By Stanley Achonu
This week, health commissioners from the 36 states will convene in Abuja to discuss “Financing Primary Health Care in Nigeria” at the PHC Financing Forum under the auspices of the Nigerian State Health Leadership Collaborative. The work of the State Commissioners and their partners is cut out for them – commit to improving budgetary allocation to health at the sub-national level and ensure value for money in utilizing available resources.
Improving primary health funding is critical because Nigeria’s current primary health care system does not adequately meet the needs of its population. Nigeria has one of the highest rates of out-of-pocket spending (75%) and one of the lowest rates of health insurance coverage (4%). The numbers are troubling given that approximately 40% of Nigerians live in poverty and in social conditions that contribute to poor health.
In most developing nations, primary health care fills these gaps. It is generally associated with positive health outcomes because it addresses most of a person’s health needs and targets the most vulnerable. Moreover, it is not just disease-specific but also people-centered regarding physical, mental, and social well-being, making it an influential factor in lifting people out of poverty.
Conversations about improving health care funding in Nigeria and Africa are not new. When heads of state of African Union countries met in Abuja in 2001, they set a target of allocating at least 15 percent of their annual budget to improve the health sector. Sadly, two decades after the Abuja Declaration, Nigeria is barely scratching the surface, grossly leaving healthcare underfunded with terrible health indicators described as some of the worst in Africa.
Perhaps the strained health sector and the lack of improvement over the years explain why many Nigerians and the rest of the world were concerned about Africa when the COVID-19 pandemic hit in 2020. The lack of solid health systems capable of delivering the level of preparedness required to combat emergencies like COVID was evident when several state governments in Nigeria started building Emergency Operations Centers (EOC) during the heat of the pandemic.
This precarious situation had many stakeholders believing that COVID-19 could be the final impetus needed by federal and state governments to prioritize health care, improve healthcare financing, and promote better health outcomes. But unfortunately, Nigeria appears to have learned little from the pandemic, with no significant improvement in prioritizing and adequately funding the health sector over the past two years.
A report on state budgetary allocation for health by ONE Campaign shows several state governments in Nigeria drastically reduced their health budgets between 2020 and 2022. For example, Ebonyi and Plateau states slashed their budget for health by more than 60% over the last two years. Worse still, Nigeria’s (federal and state) health allocation as a percentage of the total budget decreased from 11.2 percent in 2020 to 8.6 percent in 2022, taking the country further away from the continental Abuja Declaration benchmark of 15 percent. The persistent under-allocation of resources to the health sector has resulted in a funding gap of N1.36 trillion between 2020 and 2022 alone, which is likely to grow if State Governments do not prioritize healthcare.
In the face of a massive decline in health funding, some states have remained committed to improving their health care budgets. For instance, Kaduna and Sokoto state consistently met the Abuja declaration target of 15% since the pandemic hit. In Yobe, Bayelsa, and Imo states, the budget for the health sector has more than doubled since 2020. Kano State Government also announced plans to increase its 2023 allocation to the health sector. These actions are commendable. One can only hope for the same drive and political will from all other states beginning from the 2023 fiscal year and that budget allocation is matched with actual fund release.
The need to improve primary health care funding and ensure judicious use of resources to drive the necessary change is now paramount. By committing to improved health care financing, we are promoting our citizen’s health and the nation’s economic well-being. Therefore, the Abuja forum must go beyond a talk shop and deliver concrete steps to secure new funding sources and demonstrate better resource management.
The Health commissioners must recommit themselves to the following: increase their allocation to the health sector to at least 15 percent of the total budget to meet the Abuja Declaration; ensure timely release of counterpart funding for the Basic Health Care Provision Fund (BHCPF) and other donor-supported programs; ensure a proper mix of financing for health infrastructure and health programs; ensure appropriate, efficient, and transparent use of health funding to deliver value; and invest in training and retraining of all staff cadre in the primary health centres.
The Nigerian constitution gives state and local governments the responsibility to deliver primary health care to Nigerians. I urge the commissioners to take this responsibility seriously for the sake of millions of vulnerable Nigerians in extreme poverty. The best time to begin adequate health care funding and strengthening was 20 years ago after the Abuja Declaration; the next best time is now.
Stanley Achonu is the Nigeria Country Director of The ONE Campaign and writes from Abuja.