The numbers have been crunched and the budget is in, but it is set to leave health stakeholders in jaw-dropping shock.
Health was only mentioned once in President Muhammadu Buhari’s entire budget speech before the National Assembly on Tuesday-and that in connection with recurrent expenditure.
Now analysts are doing the maths.
Health sector gets N221.7 billion in recurrent spending, compared with N369.6 billion for education, N294.5 billion for defence and N145.3 billion for the interior ministry.
“This will ensure our teachers, armed forces personnel, doctors, nurses, police, fire fighters, prison service officers and many more critical service providers are paid competitively and on time,” the president told Nigerians on live TV.
The 2016 budget of N6.08 trillion is big on capital spending-N1.8 trillion, compared with N557 appropriated for capital spending under President Goodluck Jonathan last year.
Capital spending alone makes a third of the entire budget, and President Buhari intends future hikes in its proportion in future years.
What’s not certain is how much capital spending comes to health, and how to go on with the newfangled zero-base budgeting.
Take the cost of immunising Nigeria’s children. Vaccines and the services that surround immunisation next year will cost $1.4 billion, according to official estimates.
At N197 to a dollar, that’s N275.8 billion. In context, $1.4 billion is one-sixth the worth shaved off Aliko Dangote’s fortune since February by a combination of Naira slump and falling stock prices, according to Forbes.
Getting the vaccines could be some headache for the National Primary Health Care Development Agency, which coordinates immunisation nationwide.
NPHCDA says it has “secured” a $148 million from GAVI-the Global Alliance for Vaccines Initiative, which helps procure and move vaccines around the world. A counterpart $166 million from federal government is uncertain, and so is the rest of the money.
“NPHCDA should be ashamed to say it has secured GAVI funding,” one health expert said. “What we should be looking for is how to fund our vaccine needs ourselves.”
The present 2015 is a lesson. With proposal of N232.3 billion for personnel, N5.2 billion for overhead and N20 billion for capital spending, a shortfall meant Nigeria couldn’t cough up its counterpart spending for immunisation, and the World Bank stepped in to pay up.
Watchers of Nigeria’s health sector worry about overweening dependence on foreign donors-amidst concerns many are tightening their purse strings and cutting back funding.
GAVI procurements favour low- and middle-income countries. A rebased GDP under President Jonathan made Nigeria’s economy the largest in Africa, the 26th largest in the world, and cost it GAVI privileges for low-income countries.
It means finding a way to pay for its own vaccines, full. It also means allotting funding and backing allocations with cash.
The 2016 budget mentions N200 billion special intervention but health stakeholders are more interested in the National Health Act and its guarantee of 1% of consolidated revenue as additional funding for health care.
The Act’s implementation is still in the works, and the concern is that “the one percent is not being discussed,” explained one expert at a meeting days before the budget presentation.
“Outside the technical team of the health sector, there’s not much awareness of the National Health Act among politicians.”
It is debatable when President Buhari even knows about the special funding arrangement, he adds.
And nothing can come of it if it doesn’t get figured into the budget. Now the wonder is whether it is too late.