As 2020 gets underway, we take a closer look at what Nigeria wants to spend on health as contained in the country’s approved 2020 budget.
In his address to lawmakers, President Muhammadu Buhari said his administration is interested in improving the lots of the health sector and this was a major reason for the increase in value-added tax (VAT) rate draft as communicated through the Finance Bill, from 5% to 7.5%.
“As such, the 2020 Appropriation Bill is based on this new VAT rate. The additional revenues will be used to fund health, education and infrastructure programmes. As the States and Local Governments are allocated 85% of all VAT revenues, we expect to see greater quality and efficiency in their spending in these areas as well,” Buhari said.
Basic Health Care Provision Fund
Components of the budget that directly affect the health sector in Nigeria include the N44.5 billion earmarked for the Basic Health Care Provision Fund (BHCPF). The goal of the fund is to substantially increase revenue and improve Primary Health Care (PHC) as contained in the country’s National Health Act.
In September 2019, the Nigerian government through the Minister of Health, Dr Osagie Ehanire, launched the first phase of the disbursement of N13.775 billion of the BHCPF to states through the National Health Insurance Scheme (NHIS) gateway.
According to the minister explained that the funds would be administered through three gateways; namely NHIS, National Primary Healthcare Development Agency (NPHCDA), and the Federal Ministry of Health (FMoH).
While there has been debates over the ideal procedure for the disbursement of the fund, the health minister said the funds would be administered through three gateways; namely NHIS, National Primary Healthcare Development Agency (NPHCDA), and the Federal Ministry of Health (FMoH).
“The government has commenced the release of funds for provision of much needed health services to all Nigerians, especially the vulnerable population. Indeed this commitment is strongly expressed by Mr President at his 2019 inaugural speech where he said; `we will accelerate investments in primary, secondary and tertiary healthcare programmes and interventions,” the minister said.
The benefiting states received: N301, 555, 179.38 (Edo), FCT got N118, 147, 776.18, Katsina received N638,901,129.34 and Yobe was allocated N270,149, 839.29. Delta reportedly received N394,169,317.88, Lagos got N671,976,881.02, Adamawa earned N342,739,335.59, while Kano received N948,413,317.14. Anambra on the other hand received N338,907,796.94 and Imo got N301,685,098.74.
For 2020, a total of N44.5 billion is expected to be allocated under the fund and this represents just about 8% of statutory transfers of which the national assembly received the biggest share of 22.5% (N125 billion) and the judiciary received N110 billion (about 20%) of the statutory transfers.
It is also worthy to note that the allocation for 2020 was lower than allocated sum of N51.22 billion for 2019.
Capital expenditure
For 2020, the health sector received a capital spending allocation of N46 billion which was just N2 billion lesser than the country’s allocation for education, it was a N4.15 billion lesser than the capital expenditure allocation for health in 2019 which was N50.15 billion.
In 2018, Nigeria allocated N71.11 billion as capital expenditure for health and is the 4-year lowest since 2017 when N51 billion was allocated for capital expenditure in the health sector.
Vaccines over other issues
As far as available information on the planned expenditures for health in the 2020 is concerned, the Nigerian government is committing more of its resources for the health sector on vaccines and immunisation efforts.
Out of the nearly N91 billion capital allocation for the health ministry, N44.5 billion is for the BHCPF, leaving N46.5 billion for other activities. According to the list of the major capital expenditures reflected in the budget, a significant proportion is for the prevention of vaccine-preventable diseases.
Specifically, N22.73 billion is budgeted for GAVI/Immunization, N4.8 billion for Polio Eradication Initiatives and N815 million for the procurement Of Non-Polio SIA Vaccine and N4 billion for Procurement of RI Vaccines & devices.
Community health and midwifery
Nigeria is paying N5.5 billion for counterpart funding including global fund/health, it is also planning to spend N554.92 million on the procurement Of Kits And Commodities For Community Health Influencers.
The Nigerian government has also set aside N1.41 billion for its expanded midwives service scheme. While this is not a new venture, year 2020 is quite symbolic for the scheme considering the World Health Organisation (WHO) has declared year 2020 as the Year of the Nurse and Midwife, in honour of the 200th birth anniversary of Florence Nightingale. The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage.
The Nigerian Midwives Service Scheme (MSS) was created in December 2009 to help lower maternal and infant mortality rates in rural, underserved areas of Nigeria. The scheme addresses the shortage of skilled obstetric care providers and poor access to basic emergency obstetric care by: recruiting and deploying newly qualified, unemployed, and retired midwives, and equipping clinics to provide basic emergency obstetric care.
The program’s goal was to double the proportion of deliveries attended to by skilled birth attendants and lower maternal and infant mortality in target areas by 60 percent by December 2015.
Phase 1 of the MSS took place in 652 primary care clinics across all of Nigeria’s 36 states, serving more than 10 million people. The scheme is administered by the National Primary Health Care Development Agency and is funded by a special MDG-DRG (Debt Relief Gains) Account.
The MSS is a public sector initiative and a collaborative effort between the three tiers of government in Nigeria. A memorandum of understanding between the Federal, State and Local governments sets out clearly defined shared roles and responsibilities, which are supported by the strategic partners of the MSS. The MOU has been signed by all 36 states of Nigeria and the aim is to facilitate an increase in the coverage of Skilled Birth Attendance (SBA) to reduce maternal, newborn and child mortality.