By  Eze Onyekpere

The 2001 Abuja Declaration of African Heads of State recommends 15% of a country’s annual budget to be dedicated to health care. The government takes the lead in health financing and the budget is a clear indicator of the level of commitment of a government to sectoral financing. Section 1(c) and (e) of the National Health Act provides for the state obligation to provide for persons living in Nigeria the best possible health services within the limits of available resources; and to protect, promote and fulfill the right of the people of Nigeria to have access to health care services. Nigeria, at the federal and state levels, hardly meets this benchmark. Other less endowed and resource-poor countries in Africa have dedicated larger percentages of their budget to healthcare. Considering the demands of other sectors, including the poor infrastructure and educational outcomes, what percentage of the budget will the party and its presidential candidate dedicate to the health sector?

Federal budget health funding between 2010 and 2021 shows that beyond appropriation, the real picture in terms of budgeted sums, released sums and utilised sums indicates that only 57% of the approved budget was actually utilized. How will the party address the variance between budgeted, released and utilised sums to ensure that the full budgeted sums get to the Federal Ministry of Health (FMoH) and is utilised for the appropriated purposes? Again, how will the party and its candidate ensure that the released sums are fully utilized and no money is returned to treasury considering our very poor health indicators?

Will the party retain the status quo in official health financing or will it increase or reduce the health budget? What reasons could possibly inform an increase or reduction of the health budget? Total expenditure on health as a percentage of Gross Domestic Product (GDP) is 3.03%. Thus, Nigeria spends less than 5% of its (GDP) on health, and annual per capita health spending is less than what is required to meet Universal Health Coverage. How will the party improve best value for money in the health sector? Paragraph 32 of the General Comment of the UN Committee on Economic, Social and Cultural Rights on the Right to Health states: “As with all other rights in the Covenant, there is a strong presumption that retrogressive measures taken in relation to the right to health are not permissible. If any deliberate retrogressive measures are taken, the State party has the burden of proving that they have been introduced after the most careful consideration of all alternatives and that they are duly justified by reference to the totality of the rights provided in the Covenant in the context of the full use of the State party’s maximum available resources”. Essentially, the commitment on the right to health is a forward ever obligation.

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Retaining the status quo in health financing will imply that extant health indicators are satisfactory and we are happy with them. Increase in financing may or may not translate into improved services, if value for money is not mainstreamed. Value for money comes with its three cardinal parametres of economy, efficiency and effectiveness. Economy – the practice by management of thrift and good housekeeping, acquiring human and materials resources in appropriate quantity and quality at the lowest possible cost. Efficiency – ensuring that the maximum useful output is gained from the resources devoted to each activity, or alternatively that only the minimum level of resources is devoted to achieving a given level of output, reducing waste in the system. Effectiveness is about ensuring a focus on policy outcomes, improving health indicators and realization of policy objectives.

Will the party adopt incrementalism in health financing or will it adopt the quantum leap approach or leapfrogging in a way and manner that delivers practical and realistic change – moving human and materials resources into the system at once? Incrementalism is a method of working by adding to a project using many small incremental changes instead of a few (extensively planned) large jumps. Logical incrementalism implies that the steps in the process are sensible. It implies change by degrees or gradualism. Quantum leap is about abrupt change, sudden increase, or dramatic advance. Health insurance and prepaid health care penetration is available to less than 10% of the population. It pools resources from a large number of insured for the treatment of persons who need the services; it facilitates access to health care and reduces the burden of out of pocket-expenditure. Nigeria’s out- of-pocket health expenditure is about 70.52% of total health expenditure (THE) while the country has the largest population of the poor in the world. For health insurance to be effective, it has to be universal and compulsory while the state intervenes to provide resources for the poorest of the poor who cannot afford to pay the premiums. What steps will the party and its presidential candidate take to ensure that health insurance coverage is available to not less than 95% of the population? The National Health Insurance Authority Act has made health insurance compulsory in Nigeria. The objectives of this compulsory regime include: ensuring that every Nigerian has access to good health care services; protecting families from the financial hardship of huge medical bills; limiting the rise in the cost of health care services; ensuring equitable distribution of health care costs among different income groups; and maintaining high standard of health care delivery services within the country. Other objectives are; ensure efficiency in health care services; improve and harness private sector participation in the provision of health care services; ensure adequate distribution of health facilities within the Federation; ensure equitable patronage of all levels of health care; and ensure the availability of funds to the health sector for improved services.

Nigeria has been borrowing to fund health care. How would the party respond to this development? Would the party continue to borrow for health care? Nigeria is heavily indebted and its debt service to revenue ratio is in excess of 90%. FGN has been borrowing money from the World Bank to finance Health Sector activities. Examples include the borrowing of USD200million to fund vaccines procurement in 2015 and the USD 500million loan being used for Saving One Million Lives Program-for-Results (SOMLPforR).

Although the health programmes are laudable, borrowing for health care financing is not sustainable; FGN should implement innovative local resource mobilization mechanisms to fund the health sector sustainably. This will include expansion of non-oil revenue. Creation of the enabling environment for the organized private sector and small businesses to thrive may help to improve the revenue profile of the country and improve quality of life.