December 7, 2023

Eze Onyekpere

This discourse reviews the federal health budget proposal for the financial year 2023. This review is done against the background of the Abuja Declaration of African Heads of State, Nigeria’s poor health indicators, and the challenge implicit in the inextricable link between the right to health and the right to life. It ends with some key recommendations.

The total sum allocated to the Ministry of Health out of the overall expenditure of N20.507tn is N1.097tn inclusive of the N47.649bn provided for the Basic Health Care Provision Fund. This is 5.35 per cent of the proposed budget expenditure. This is just about one-third of the 15 per cent Abuja Declaration commitment. However, there are other provisions related to health in the budget vis, provisions for the National Health Insurance Scheme fund of MDAs (N105.797bn), NHIS for military retirees (N4.481bn), NHIS for Corps members (N5bn) and GAVI/Immunisation counterpart funding (N69.570bn). When the foregoing is added to the allocation of the Ministry of Health, it comes up to N1.282tn which is 6.25 per cent of the proposed expenditure. This is still less than 50 per cent of the Abuja Declaration commitment.

Considering the fluctuating value of the naira, it is imperative to convert the allocations over the years to a more stable currency. Using the official rate of the Central Bank of Nigeria, the health votes have been undulating since 2015. In the years 2015, 2016, 2017, 2018 and 2019, it was $1.367bn, $1.269bn, $997.3m, $1.168bn and $1.221bn respectively. In 2020, 2021, 2022 and the 2023 proposal, it was $1.093bn, $1.332bn, $1.723bn and $2.647bn respectively. Evidently, the proposal for 2023 is the highest figure. The right to health is a forward-ever, backward-never right which demands continuous improvements in the pursuit of the highest attainable state of physical and mental health. From the benefits of scientific progress and emerging knowledge, the goal-post keeps shifting in the positive direction and implies a demand for improvements in financing.

If the votes that were not captured in the proposal of the Ministry of Health are removed, recurrent expenditure got 57.3 per cent of the votes while capital expenditure got 36.8 per cent of the health allocation. As usual, the recurrent vote is 98.1 per cent personnel, while only a paltry 1.9 per cent goes to overheads. This recurrent mix cannot facilitate functional health institutions that focus on effective service delivery when the overhead costs are simply not provided for.

There are concerns around the 1 per cent Consolidated Revenue Fund for Basic Health Care Provision Fund in the 2023 FGN budget proposal. The N47,649,312,042 provided for the BHCPF was included in the vote of the Ministry of Health instead of the statutory transfer as stipulated in the National Health Act. This poses a challenge because section 28 of the Fiscal Responsibility Act stipulates as follows regarding the duties of the finance minister on budgetary matters: “Where, by the end of three months, after the enactment of the appropriation Act, the minister determines that the targeted revenues may be insufficient to the fund the heads of the expenditure in the Appropriation Act, the minister shall, within the next 30 days of such determination, take appropriate measures to restrict further commitments and financial operations according to the criteria set in the Fiscal Risk Appendix- such provisions shall not apply to statutory or constitutional expenditure.”

The above implies that if there is a paucity of resources for budget implementation, the vote provided for BHCPF would be subject to budget cuts alongside other budget lines that are not statutory transfers. This is very likely to happen considering the huge deficit financing of the 2023 budget. Therefore, the Federal Government should ensure that the BHCPF is captured appropriately under statutory transfers so that it can get the priority it deserves in the event there is a paucity of funds. It is even expected that funding for the BHCPF should be ring-fenced to the extent that it should not lapse at the end of the year (including undisbursed parts of the vote) but be carried over to the next. If Nigeria’s health indicators are frightening, why return money to the treasury or keep back budgeted funds in any year?

Surprisingly, the take-off grant in the Special Intervention Fund for the Vulnerable Group Fund provided in section 25 of the National Health Insurance Authority Act was missing from the health budget proposals. It is also not provided in the Service Wide Votes. The implication is that the Federal Government is not ready to kick-start the fund considering that the BHCPF, which is one the sources of its funding, is merely recycling existing resources already created by the National Health Act. It is not new, or more money for health. The imperative of this special intervention fund is the leveraging power it can bring to bear on the VGF. The activation of the Fund and indeed the compulsory health insurance regime of the National Health Insurance Authority are expected to pool trillions of naira every year in new funds to the health sector. The minimum the government can do at this time of lean resources is to activate this new source of funding, which can reduce the pressure on unavailable public finances.

The Minister of Finance has given hints on the 2022 Finance Bill. The expectation is that the bill should be used to right the wrongs meted out to the health sector over the years. Any tax, such as the sugar tax or aggravated excise duties on tobacco or any other tax justified and premised on the health of the population, should be dedicated to the health sector. It is unconscionable to use the health of the population to raise a tax and then put the money at the disposal of the bottomless pit of the general treasury where the proceeds of such tax can be frittered away on frivolous, inappropriate, wasteful, and sometimes illegal, and illegitimate expenditure. The executive and legislature should simply do the right thing.

In conclusion, the 2023 federal budget must ensure more money for health while tightening the loopholes to ensure greater value for health from all budgeted and programmed funds. It must also target equitable allocations and expenditure of public health resources so that even the vulnerable and the poorest of the poor are not left behind.

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