The 2011 federal budget which put health at number four position behind defense, education and police has again brought to the fore the fact that the health of the Nigerian people is not a national priority.
Health as they say is wealth. A country with a largely unhealthy population cannot progress economically, increase her Gross Domestic Product per capita nor experience economic development which is measured primarily by economic growth besides the vision 20:2020aimed at putting Nigeria on the world economic map may be another vision that will not be achieved.
Governments at all levels are not making proper investment in the health of the Nigerian people because it is not considered a priority. But daily, Nigerians young and old die of different preventable diseases such as HIV/AIDS, tuberculosis, malaria, vaccine preventable disease of childhood, diarrheal, acute respiratory infections, maternal and neonatal conditions due to inadequate investment in preventive services. The direct and indirect cost of illness have also continued to pauperize most of the citizens and this affect economic growth as well as development but in spite of the country’s poor economic indices, health is ranked fourth among federal government’s priorities for the year. The sooner governments begin to improve investment on health of the people, the better. African countries like Liberia, Malawi, Burkina Faso, Djibouti, Botswana and Rwanda that are poor than Nigeria have met the target of the Abuja Declaration of 2001 in which all African Health Ministers agreed upon a 15 per cent budgetary allocation to health.
It is a shame that donor agencies seem to be more concerned about strengthening the Nigerian health system and improving the health status of Nigerian people more than governments with several billions of dollars in aid coming to Nigeria for the health sector sometimes exceeding government’s investment in health. But instead of making the most of these donor funds, we cannot effectively account for them. Little wonder the Minister of Health, Professor Christian Onyebuchi Chukwu made the avowal at a conference in New York to probe the use of donor funds into the country.
The money allocated to the health sector out of the total budget is just like putting water in a basket because no result can be achieved except there is increased investment so that the mission, vision and policy objectives of the Ministry of Health will not continue to be rhetorical statements. As a result of constantly earmarking over 70 per cent of health budget for recurrent expenditure and less than 30 per cent for capital expenditure, there is no money to fund programs and parastatals such as the National Primary Healthcare Development Agency (NPHCDA), hence, the use of extra-budgetary means to fund them. There is also little money left for the operation of health services which is meant to be delivered to the people, the reason why the services provided are of low quality and citizens could not utilize such services due to shortage of drugs among others. Equipment are obsolete or not functioning while most health infrastructures are dilapidated because the less than 30 per cent as capital expenditure cannot maintain equipment and infrastructure.
Management of resources is also an issue. All around the world, the importance of having health managers specifically trained to handle health resources have been emphasized. There is a need to have health managers to properly manage health resources even though they are not enough in order to avoid wastages while increased funding from the Nigerian governments is been awaited. This is also key to the performance of the health sector.
The inadequate funds to address other pertinent issues aside from personnel salaries which gulp all the funds to health sector affect the primary, secondary and tertiary level of care. Primary health care facilities that are supposed to help achieve the goal of “health for all” are no more than abandoned buildings with inadequate staff, poorly skilled personnel, lack of drugs and consumables as well as activities that are not expected of a health centre. This is happening because there is no proper investment in the health sector.
Despite spending most of the health budget on paying salaries, health workers still down-tool almost every now and again because there is little or no money for human capital development. However, it is true that health workers are more concerned about issues of safe working environment; good management practices; opportunities for career advancement and continuing education; adequate supply of drugs and consumables; security; good employment conditions; standard infrastructure, equipment and facilities than remuneration. Though non-financial, all these incentives require money which is not available with the past and present level of health budget. They are important if the mission and vision of the Ministries of Health must be achieved.
Government’s expenditure for health as percentage of GNP is about 5.4 per cent and this translate into about $3 per person per year in total health expenditure—a further establishment of the fact that governments are not making proper investment in the health of the Nigerian people simply because health is not considered a national priority.
The Defense and Police Ministries which get the largest chunk of the budget have not justified these amounts with the incessant Jos killings, continued kidnapping of innocent citizens, menace of Boko Haram, spate of bombings, Niger Delta militancy, high level of crimes and criminality, boundary disputes, political violence and so on. Security is also an important issue but health comes with the benefit of ensuring economic development and reducing poverty level.
For a long time in the history of budgeting at all levels in Nigeria, security has been accorded great importance among other issues begging for government’s attention. Health of the Nigerian people have so far been neglected that the people have to sacrifice their lives and have been made poorer as a result of this. The crude death rate, life expectancy, infant mortality rate, human development index, maternal mortality rate, the proportion of GNP spent on health services are testaments to this fact, the above indicators do not show that Nigeria is a country that supports the survival of the Nigerian people in a world where their fellow human beings live long enough due to increased life expectancy and proper investment in the health of the people.
It is often believed that only wealthy nations can possibly increase life expectancy and reduce infant and maternal mortality rate as recorded in countries like United Kingdom, Germany, Italy, Spain, France, Japan, Canada, Australia, Sweden, Chile, USA etcetera but donor funds to developing countries which is expected to bridge the financing gap have not been properly utilized for the improvement of the citizen’s health status. If these funds were judiciously used, Nigeria would have recorded great gains in the quality and direction of life of her people whose health status have refused to improve over the years. Partner funds as one of the major method of financing the health system of a nation will no doubt assist governments in moving towards achieving the goal of health for all, where every citizen would be productive enough to contribute to the economic development of the country and the attainment of government’s vision 20:2020.
The impact of donor funds is yet to be felt on the teeming population of Nigerians. Also, the total amount of money spent on health has not been tracked for many years. But the National Health Account is now used to track all funds getting into the health sector and what they are used to purchase. The importance of properly utilizing donor funds for the benefit of Nigerian people cannot be overemphasized because it is critical to funding the Nigerian health system. One can only i
magine what the state of the health system would have been if there was no fund coming from bilateral and multilateral agencies, international foundations etcetera.
In spite of the several billions of dollars in aid coming to Nigeria annually to underscore the importance of health, governments at all level do not deem it necessary to make health of the Nigerian people a top priority. Politicians keep playing politics with their promises to provide free health care to poor Nigerians as a sign to show their commitment towards improving the health of the Nigerian people and invariably assuring that health will be ranked first on the state and federal budgets.
Political leaders with manifestos and agendas that do not put the health of the Nigerian people first may as well be seen as the enemies of the people rather than those who would ensure their survival. Currently, life is easily wasted in Nigeria than in all the crisis and disasters occurring around the world. The simple reason is that there is no political commitment and will on the part of Nigerian leaders.
A federal and state budget that does not have health as a top priority in a country where most of its citizens are poor and cannot afford basic health services due to the cost of illness which is more than the cost of treatment is not a budget meant for the poor. The impact of injury, disease, sickness and disability is not just taking a toll on the Nigerian people but also impoverishing them even further.
The lack of political will and commitment by past leaders on the issue of health of the Nigerian people has made the health care delivery system of Nigeria inefficient, ineffective and inequitable –a notion that was also expressed by the Minister of Health, Professor Onyebuchi Chukwu at the flag-off of free eye surgeries for patients of sight defects by an American agency earlier this year.
Political leaders and decision makers at the federal, state and local government levels need to begin to take that decision to make health of the Nigerian people a top priority. They have to show Nigerians that they are concerned about their survival. Their right to life. And, that leaders of governments are not the enemies of the Nigerian people.
Nigeria is ranked 10th among the producers of crude oil in the world but despite this oil wealth, the citizens remain poor because they do not have good health.
If the oil wealth of a nation translates to better health of the citizens, Nigeria should be highly ranked among countries with better health indices but unfortunately for leaders of government, it is the good health of the people that leads to a nation’s real wealth.
