Budgetary Allocation to Health: Shame of a Nation

The lack of commitment on the part of the federal government of Nigeria to increasing the budgetary allocation needed to improve the health of Nigerians remains a disturbing one. Recently, it was reported that Nigeria earmarks 3.5 per cent of its national budget to the health sector. With the well documented intrigues surrounding the release of budgetary allocations, no one is even sure if all the earmarked funds are ever gets released, and if released what percent is spent on services or lining pockets. With this level of allocation, Nigeria ranks just above Burundi in Africa in budgetary allocation to health. It is shameful that a nation that ten years ago hosted African Heads of State and Government at a conference in Abuja and led in the pledge for governments to allocate at least 15 per cent of their national budgets to health does not even allocate a paltry 5 percent of its budget to care for the health of its citizens. According to Ademola Olajire, a Nigerian and the Director at the Social Affairs Department at the African Union Commission, only six countries have achieved the target set in Abuja. It sure must break Mr. Olajire’s heart to provide such information that gives Nigeria a black eye. The six countries, namely Rwanda, Botswana, Republic of Niger, Malawi, Zambia and Burkina Faso that have passed the 15 per cent mark are all less endowed than Nigeria. Leader of Africa, who are you leading.

Did someone say “Cry my beloved country”, oh no I am the one who said it. As a healthcare professional, the healthcare infrastructure in Nigeria breaks my heart every time I think of it. As one of my colleagues said “because we all have parents and relatives in Nigeria who depend on this healthcare system and cannot afford to fly them out to countries with better facilities every time they fall ill, we cannot fold our hands and watch without doing anything.” The question is what can we do as non-politicians to force the hand of the government to allocate more resources to delivery of healthcare services to Nigerians? At a National Association of Resident Doctors’ roundtable in 1987, Nigerian physicians were called out for forgetting the “Hippocratic Oath” and not insisting on receiving needed resources when they become commissioners or ministers of health. It will be recalled that the late Professor Olikoye Ransome-Kuti extracted a committment from Babangida before he accepted the position of Minister of Health that the resources needed by the ministry will be provided to ensure that programs are implemented. He remains the only minister in recent memory to have done this. He got most of what he wanted albeit during a military regime.

In an interview with The Guardian after delivering a speech at the on-going Conference of African Ministers responsible for Finance, Economy, Planning and Economic Development in Addis Ababa, Ethiopia, Nigeria’s Minister of Health Professor Onyebuchi Chukwu said “funds allocated to security and the electoral system, among other competing needs in Nigeria, might have robbed the health sector of much-needed higher allocation in the budget.” The minister’s statement does not provide any succor to many Nigerians who still rely on government provided healthcare. In addition, the minister’s assertion that government's per capita expenditure on health was rising steadily and it's about $20 contradicts independent sources including the Africa Public Health Info which puts the figure at $10.

This is not surprising as anyone following the political debates and campaigns in Nigeria would have noticed that none of the candidates at the local, state, or national levels including the presidential candidates have mentioned or articulated any strategies to improve the health of Nigerians or arrest the decay that is the Nigerian health infrastructure. As the elections are conducted, winners announced, and executive councils formed, it is time for the Nigeria Medical Association that have done a good job of insisting on physicians running the ministry of health to go a step further to insist on improved allocation to the health sector and preventing its members from accepting health commissioner and minister positions as a form of protest if government allocation is not increased. Professor Olikoye did it and it still can be done if the focus is on the overall interest of Nigerians and not on holding a political position. When it is all said and done, physicians are going to be reminded that they presided over the decay of the Nigerian healthcare system.