Vanguard, TUESDAY, OCTOBER 15, , 2019<strong>—</strong>21
22 <strong>—</strong> Vanguard, TUESDAY, OCTOBER 15, 2019 Furore over Buhari’s 2020 health bud<strong>get</strong> proposal .Less than N300 allocated for each <strong>Niger</strong>ian; Stakeholders predict <strong>do</strong>om in healthcare sec<strong>to</strong>r LAST week, President Muhammadu Buhari, proposed a capital expenditure of N46 billion for the Ministry of Health in the 2020 appropriation bud<strong>get</strong> submitted <strong>to</strong> the joint session of the National Assembly in Abuja. The proposal is N4 billion and N10 billion short of the 2019 and 2018 capital expenditures respectively. The President also proposed N44.5 billion for the Basic Health Provision Fund, BHCPF - a fundamental healthcare funding provided by the National Health Act, first introduced in<strong>to</strong> the National bud<strong>get</strong> in 2018. An examination of the 2020 bud<strong>get</strong>ary proposal shows that health is 11th on the hierarchy, trailing a number of less fancied Ministries. From an aggregate expenditure of N10.33 trillion for the 2020 bud<strong>get</strong>, the allocation <strong>to</strong> health is a paltry 0.4 percent which is a far cry from the 2001 Abuja Declaration tar<strong>get</strong> of 15 per cent. For decades, health watchers have decried the abysmal bud<strong>get</strong>ary allocation, bedevilled by late release or non-release and poor implementation which have led <strong>to</strong> <strong>Niger</strong>ia having one of the worst maternal, infant and Under-5 health statistics in the world. Good Health Weekly team, Sola Ogundipe, Chioma Obinna and Gabriel Olawale spoke <strong>to</strong> major stakeholders in the health sec<strong>to</strong>r. Thy bare their minds on their fears, worries, disappointments and expectations. Excerpts: I see <strong>do</strong>om about access <strong>to</strong> healthcare <strong>—</strong> Dr Casmir,Publicity Secretary, AMLSN In the views of the Publicity Secretary, Association of Medical Labora<strong>to</strong>ry Scientists, AMLSN, Dr. Casmir Ifeanyi said: “The proposed allocation for health in the 2020 bud<strong>get</strong> is inadequate. <strong>What</strong> we need <strong>to</strong> look at is the Abuja AU declaration for funding <strong>to</strong> health sec<strong>to</strong>r, That N46 billion <strong>do</strong>es not represent that. We also need <strong>to</strong> avert our mind <strong>to</strong> what percent of N10.3 trillion that the N46 billion represents and if you look at it, you will see that 10 percent of 10 trillion is 1 trillion, that simply means that 46 billion is less than 10 percent of 10 trillion, and therefore it can rightly be said that in fact 0.4 percent of 10 trillion, that is very abysmal. That is nothing near <strong>to</strong> AU L-R: National Pubility Secretary, AMLSN, Dr Casmir Ifeanyi; President PSN, Pharm. Sam Ohuabunwa; President, NMA Dr Francis Faduyile and the National President, Association of General Private Nurses Practitioners of <strong>Niger</strong>ia, Balogun Ajiboye. declaration which was <strong>do</strong>ne in Abuja <strong>to</strong> encourage countries <strong>to</strong> make 16 percent of their bud<strong>get</strong> available <strong>to</strong> health sec<strong>to</strong>r, if out of N10 trillion we are only appropriating N46 billion, for a population said <strong>to</strong> be over 200 million people, that is shameful, and speaks volumes as <strong>to</strong> how <strong>Niger</strong>ians’ health is being valued particularly by the present government. This is the government that promises <strong>to</strong> put an end <strong>to</strong> medical <strong>to</strong>urism, unfortunately the head of government continue <strong>to</strong> engage in medical <strong>to</strong>urism, now in the bud<strong>get</strong> we cannot find provision <strong>to</strong> support the end <strong>to</strong> medical <strong>to</strong>urism. In the build up <strong>to</strong> this bud<strong>get</strong>, <strong>Niger</strong>ians were <strong>to</strong>ld, even though it was <strong>do</strong>ne secretly, that about 20 federal health institutions had been in concession for PPP, nobody is discussing that, I think that is the reason why they are making paltry allocation in the 2020 bud<strong>get</strong>, having concluded a deal through the ICRC <strong>to</strong> filter away health services at the tertiary health institution, where over 20, and they call it pilot study in<strong>to</strong> the hand of private people, if you take away the health of our people and hand it over <strong>to</strong> capitalist I see danger, I see <strong>do</strong>om, I am worried about access, the whole campaign about access <strong>to</strong> health, availability of health service, universal coverage begins <strong>to</strong> border me, if you divide N46 billion, with 200 million, that simply means that our government is allocating just a little over N200 for the health of every <strong>Niger</strong>ian walking the street. That is very discouraging, it is terrible that we have come <strong>do</strong>wn. Almost N300 billion is provided for work, what we expect is a similar provision for health sec<strong>to</strong>r and education, these are critical areas but not up <strong>to</strong> health sec<strong>to</strong>r. It is after health sec<strong>to</strong>r that you can talk about infrastructure and education, you have <strong>to</strong> be alive <strong>to</strong> <strong>do</strong> other things. I here appeal <strong>to</strong> the National Assembly, led by Dr. Ahmed Lawal, and Gbajabiamila, <strong>to</strong> <strong>do</strong> the needful. They have been perceived as people's assembly, we want <strong>to</strong> urge them <strong>to</strong> prevail on the Executive <strong>to</strong> revisit this paltry allocation <strong>to</strong> health sec<strong>to</strong>r and make it up so that we can revive the sec<strong>to</strong>r and curtail medical <strong>to</strong>urism. <strong>Niger</strong>ians also need <strong>to</strong> resist the concession of our health system in<strong>to</strong> private hands, that PPP template in health sec<strong>to</strong>r. It is robbing Peter <strong>to</strong> pay Paul.” It is a huge misnomer <strong>—</strong> Adeniran, Chairman PSN Lagos State In her submission, Chairman, Lagos State Pharmaceutical Society of <strong>Niger</strong>ia, PSN, Pharm. Bola Adeniran said: The N46 billion capital bud<strong>get</strong> for the health sec<strong>to</strong>r is a huge misnomer as it represents less than 1 percent of the N10.3 trillion bud<strong>get</strong>. Some of the realities are that for the 5th time running, the Federal government has not fac<strong>to</strong>red the 1 percent Consolidated Fund which should energise the procurement of drugs at PHC level and social health insurance which are twin drivers for Universal Health Coverage. As usual the Federal government has not made provision for Research & Development in the research institutes notably National Institute of Pharmaceutical Research & Development, NIPRD, and <strong>Niger</strong>ian Institute of Medical Research, NIMR. Government has, from a superficial perspective, not bud<strong>get</strong>ed enough <strong>to</strong> take care of personnel costs especially specialist allowances and funds for adjustment of CONHESS scale as was <strong>do</strong>ne with CONMESS since 2014 for health workers. These are issues that usually lead <strong>to</strong> avoidable strike actions in our volatile sec<strong>to</strong>r. We <strong>do</strong> hope that government is not calculating dividends of its ill-conceived concession arrangements in 22 Federal Health Institutions, FHIs, as there are reflections of income generation in the 2020 bud<strong>get</strong> estimates from privitisation. On the flipside, Federal government ineptitude continues <strong>to</strong> encourage unprecedented corruption in most of the FHIs and agencies in healthcare. Government <strong>must</strong> therefore <strong>do</strong> more than it is <strong>do</strong>ing <strong>to</strong> rescue dwindling fortunes in the health sec<strong>to</strong>r. There is need for greater prioritisation of health <strong>—</strong>Dr Faduyile, NMA President The details are not yet out but looking at the disclosed ones, especially when the fiscal space is contrasting. For instance, Basic Health Provision Fund, BHCPF, trajec<strong>to</strong>ry in 2018 was N55.1bn, in 2019- N51bn and now in 2020- N44.8bn. So, the 1 percent BHCPF is reducing. But the NMA appreciates the government for <strong>do</strong>miciling the BHCPF rightly where it is prescribed <strong>to</strong> be by the National Health Act - Statu<strong>to</strong>ry transfers as against the service wide votes in previous years. For Capital allocation, in 2018 it was N71.11bn, 2019, it was N46bn and now 2020 it is now 48bn. This proposed capital expenditure cannot <strong>do</strong> much <strong>to</strong> achieve the rehabilitation of certain tertiary hospitals as earmarked by the federal government in the effort <strong>to</strong> mitigate medical <strong>to</strong>urism. No information yet on proposed <strong>to</strong>tal government expenditure on health for the 2020 fiscal year. There are outstanding issues in salaries and emoluments for medical and other health care workers. The NMA prays that they are captured in the 2020 Appropriation <strong>to</strong> forestall industrial upheavals in the already ailing health sec<strong>to</strong>r. Summarily, there's a need for greater prioritisation of health in the national expenditure profile <strong>to</strong> accelerate the nation's aspiration <strong>to</strong>wards UHC. My worry is how the bud<strong>get</strong> will be utilised <strong>—</strong>Ohuabunwa, President, PSN On his part, President, PSN, Pharm. Sam Ohuabunwa said: The real issue is not the size of the bud<strong>get</strong> <strong>to</strong> health. First, will it be cash-backed and second will the bud<strong>get</strong> be efficiently utilised? When you combine the direct allocation <strong>to</strong> the Health Ministry and the statu<strong>to</strong>ry transfer <strong>to</strong> the health fund provided by the National Health Law, we have a fairly tidy sum. My worry is how the bud<strong>get</strong> will be utilised <strong>to</strong> address the key issues affecting <strong>Niger</strong>ia's health care. How much will go <strong>to</strong> providing primary care and improving access <strong>to</strong> quality medicines. How much will be used on taking care of the civil servants? How much will actually go in<strong>to</strong> preventive healthcare, ameliorating infectious diseases and noncommunicable diseases. That is the real question, not just the size of the bud<strong>get</strong>. Can we <strong>get</strong> value for money? Bud<strong>get</strong> grossly inadequate for 200 million people <strong>—</strong>Ajiboye, National President, AGPNP Corroborating their views, National President, Association of General Private Nurses Practitioners, AGPNP, Balogun Ajiboye, said: “It is the general belief that health is wealth and an unhealthy society cannot achieve maximum productivity level. Therefore, for any nation <strong>to</strong> develop, healthcare <strong>must</strong> be funded adequately. If Universal Health Coverage is about giving all <strong>Niger</strong>ians affordable, accessible and available healthcare services, regardless of their economic status, sex, religion, location and tribe, ensuring healthy lives and promoting the wellbeing at all ages is what the sustainable development is all about, N44.5 billion for BHCPF and N46 billion for health <strong>to</strong>talling N86.4 billion out of N10.33 trillion bud<strong>get</strong> is grossly inadequate for the health care of 200 million unhealthy population like <strong>Niger</strong>ia. Also, if we want <strong>to</strong> base this proposal on precedence, it is not impossible that 60 percent of the capital project will not be released or probably released in December, and which might likely go for Christmas bonus for the boys.
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