Nearly a decade of monitoring, tracking and analysing government’s commitments in the health sector shows that despite increases in the overall national budget, the health budget has declined more recently from 5.58 percent in 2011 to 4.17 percent in 2017. This is indeed a far cry from the commitment of 15 percent of the entire budget made at the Abuja Declaration of 2001. The proposed 2017 health budget is
understood to be in the region of N54.1 trillion, a negligible improvement from the 2006 approved health budget, which was N250.6 billion and 4.13 percent of the total national budget. The economic reality is that Nigeria has been spending less on health as the years have gone by.
Compared to the proposed 2017 health budget, an analysis of the 2016 budget shows that the funds earmarked for recurrent expenditure was at N67.8 billion; 63.3 percent of the total health budget. The 2017 recurrent expenditure is N252.8 billion at 83.1 percent. The capital expenditure for 2006 was N39.1 billion, at 36.6 percent of the total budget. In 2017, government allocated N51.3 billion to this, making 16.9 percent of the total budget. In real terms, therefore, we can assume that the because of the inflation rates and the prevailing weak currency, capital allocations in the sector is neither increasing nor improving.
The federal government, in approving the National Health Act, directly indicated the willingness and commitment to improve on the overall state of the health of the nation. Stakeholders believe that the proposed 2017 budget may not deliver on these promises if the implementation of the Act is ignored and the required one percent of the gross national revenue is not made available to the health sector. This invariably includes the non-implementation of the nutrition programme; the National Strategic Plan of Action for Nutrition (NSPAN), which seems completely ignored in the 2017 budgetary appropriation for health.
With the current proposed budget, the nutrition division of the Federal Ministry of Health would have little or no funds to work with in addressing issues of malnutrition and to scale up such nutrition interventions as increasing the uptake of Vitamin A supplements; provision of deworming tablets and undertaking activities to reduce the rate of stunting; anemia in women; and exclusive breastfeeding of infants, as well as scaling up the treatment of severe wasting.
In 2012, in an effort to rally the international community around improving nutrition, the 176 members of the World Health Assembly endorsed the first ever global nutrition targets, focusing on six areas; stunting, anemia, low birth weight, childhood overweight, breastfeeding and wasting. These targets aim to boost investments in cost-effective interventions, spearhead better implementation practices, and catalyse progress towards decreasing malnutrition.
Health is wealth and it is mandatory for government to respond more to the health needs of the citizens by ensuring investments in nutrition and health. The civil society forum will continuously monitor interventions in this regard to ensure that the necessary interventions are made to save more lives in Nigeria.
Nigeria needs about N 255,360 billion ($912 million) over the next three years to invest in high impact nutrition specific interventions as it carries one of the highest rates of stunting in the world and the lowest rates of breastfeeding. Although the estimates of what it would take to achieve the global nutrition targets are based on ambitious scale up assumptions, rapid scale up of nutrition interventions can be achieved and can lead to a swift decline in malnutrition. The benefit of achieving these targets would be enormous as an annual investment of $371.3 million will save 123,379 lives of children under five years, avert 889,657 cases of stunting in Nigeria and give returns of up to 25 times greater than the initial investment (for every 100,000 naira spent, we generate 2.5 million in economic returns).
Stakeholders in the nutrition sector have expressed clearly their dissatisfaction with the proposed 2017 budget.
“The health budget clearly shows that nutrition is not prioritised and will not be if we don’t say anything now”.
“The future of Nigeria is at stake, our women and children are at risk as key health interventions are not available”.
Whilst the 2017 health budget may not resolve all the issues facing the health sector because of its inadequacy and many competing development objectives, the main challenge for policymakers is to decide which actions should be prioritised. One way to do this is to compare cost benefits across interventions and programmes. There is strong evidence that shows very high economic returns for investing in nutrition. Not only are investments in nutrition one of the best values for money in relation to development actions, they also lay the groundwork for the success of investment in other sectors. Fortunately, there is an increasing awareness of the positive impact of nutrition on health and development. Increasing the dialogue between governments at all levels, particularly with the civil society who are in the forefront of health and human development advocacy, will help to bridge the gaps in budget decision making. The current steps made by both the government and CSOs to work together in the budgeting process is a step in the right direction. However, government needs to engage more in the budget implementation and accountability analysis to meet the health needs of the citizens of Nigeria.
Health is wealth and it is mandatory for government to respond more to the health needs of the citizens by ensuring investments in nutrition and health. The civil society forum will continuously monitor interventions in this regard to ensure that the necessary interventions are made to save more lives in Nigeria.
Jayne Arinze-Egemonye is Monitoring and Evaluation Officer, Partnership for Advocacy in Child and Family Health (PACFaH)/Civil Society Scaling Up Nutrition in Nigeria (CS-SUNN).
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