15% budget to health; Nigeria's dilemma

Both the press releases by MamaYe Campaign and Civil Society Legislative Advocacy Centre (CISLAC) have emphasised the need for the Nigerian government to keep to its promise of allocating at least 15% of its budgetary allocation to health sector. Nigeria had played the chief host to over 50 African heads of States in a special summit of the African Union on HIV/AIDS, Tuberculosis and Malaria tagged ‘The Abuja + 12 Meeting’ held in Abuja on Monday 15 and Tuesday 16 July 2013 in Abuja. The meeting reviewed progress made 12 years ago to increase the proportion of health spending to 15% as well  in reversing the trend of infectious diseases. In 2001, Nigeria had promised to spend 15% of its total annual budget on health. In 2013, only 5.6% of the budget is being spent, and that number has been decreasing every year since 2011. There is a moral dilemma for our country. We hosted a meeting to review progress and we are among the countries that are far from meeting their commitment. In an 8th July presidential statement about the upcoming Abuja +12 summit, President Goodluck Jonathan had this to say “ It is imperative for Nigeria in line with the above statement to explain to its citizens what significant result we have recorded in line with the Abuja declaration.” If Ghana in 2013 could allocate 12.5% of its budget to health, then what stops Nigeria from doing same? The summit of African Union on HIV and AIDS, Tuberculosis and Malaria (ATM) in May 2006 had observed that one of the 12 priorities for the Abuja Plan of Action on HIV and AIDS, Tuberculosis and other Related Infectious Diseases included Resource Mobilization and funding.It also observed that with respect to the proportion of national budgets allocated to health, 33% of countries have allocated at least 10% of their national budget to health while one country has attained the target of 15%, which is Tanzania.Another report by World Health Organisation (WHO) in 2010 titled ‘The Abuja Declaration: 10 years on’, observed that only three countries are on track with respect to the health MDGs whereas 27 countries have no or insufficient progress.Twenty-six countries have increased the proportion of total government expenditures allocated to health since 2001. Eleven countries including Nigeria have reduced their relative contributions of government expenditures on health during the period.The Global AIDS Response Country Progress Report Nigeria GARPR 2012 has also observed that donor investment in the HIV response has continued to outstrip government’s investment even though spending on HIV by government increased from 7.6% in 2008 to 25% in 2010.Some of the challenges observed with respect to funding of HIV/AIDS which will impact on the Abuja declaration was observed in the 2009 National HIV/AIDS Policy Review Report that “the national response faces significant funding gaps, funding at all levels is predominantly donor driven and donor dependent.States’ political and resource commitment to HIV/AIDS remain extremely weak and in many cases have deteriorated as budget funds are seldom released and there is little or no allocation by LACAs.Governments at all levels have displayed reluctance to implement the one percent budget allocation to HIV/AIDS approved by the federal executive council. The report has also observed that there was monumental wastage of resources and capacity building at all levels of HIV/AIDS programme implementation due to staff attrition and bureaucracy.Private sector potential remains untapped. There was also the challenge of poor programme implementation, lack of transparency and accountability by stakeholders across board, which undermines the drive for diversified resources.The aforementioned is a rider for Nigeria to begin to factor why we are far from achieving 15% budget allocation to health.Another significant action when taken that will help Nigeria jerk its budgetary allocation to health is for the national health bill to be passed in to an act.Its serves as a veritable tool to address funding gap in the health sector and ensures improved quality of care which is in line with Nigeria’s commitment to the United Nation Secretary General’s Strategy on women’s and children’s health.It will also catalyse improved financial resources from the proposed 2% of the Consolidated Federal Revenue Capital that will be channeled to primary health care and national health insurance.The bill was passed by both the 2 chambers of the national assembly sometime back but suffered a hitch when it was the turn of President Jonathan to sign it into law.The experience was the same during former President Obasanjo and late President Yaradua, in the sense that it received commitment from the legislative arms but lackluster attitudes from the executive. The past experience has prompted the question whether the bill is an executive bill or a private bill sponsored by some concerned individuals.If the bill is an executive bill, why will the President refused to assent to it?  It is pertinent to answer the above question, as we need to critically examine why the executive arm never assented to the bill so that we know where our advocacy efforts will be concentrated. It is important to examine the barriers and channel our energy and resources to redress the situation.  Does the bill have champions such as Ministers of Finances and that of health that could publically and behind the scene rally for its support, passage and assent by Mr. President? The world is watching Nigeria to take the right step in allocating 15% of its budget to health sector and the time to act is now. Written by Aminu Magashi Garba (North Coordinator and Evidence Advisor on the MamaYe Campaign)