Health Funding: Endless wait for Abuja on Abuja Declaration

The Uyo hospital

When member countries of the African Union converged on Abuja in April 2001 to agree 15 per cent of their annual budget to the health sector, there was a victory dance across the African continent.

However, the celebration that heralded that agreement was short-lived; 15 years down the line, only a few African countries have implemented what has come to be known as the Abuja declaration.

The case of Nigeria is perplexing: while the agreement was reached in Abuja, Nigeria has remained a perpetual defaulter.

For instance, documents sighted by PREMIUM TIMES indicate that budgetary allocation to the health sector in Nigeria has consistently hovered around the 5 per cent mark at best.

Besides defaulting on the 15 per cent budgetary allocation to the health sector, the Nigerian government is yet to comply with the National Health Act of 2014 on 1 per cent consolidated revenue fund (CRF) for basic health care provision. According to the National Health Act 2014, the Basic Health Care Provision Fund shall be financed from the CRF, but that is not being respected by the federal government of Nigeria.

Fatai Aremu in his presentation on Situation Analysis of the Challenges in Nigeria’s Health Sector noted that the CRF has in the last six years ranged from N25.7 billion to N38.55 billion and it is anticipated to amount to N30 billion with production cuts in oil in 2016. He, however, noted that the 2016 budget is in breach of the national health act in this respect.

For his part, Lanre Tejuosho, Chairman of Senate Committee on Health, said legislators will continue to encourage the executive to abide by the National Health Act on one per cent CRF.

“We are going to keep on encouraging the executive to obey the recommendation of sister countries and also our laws in the national assembly that 1 per cent of the consolidated revenue fund must be allocated for basic health fund that we need. These are all the things that we are going to go home with,” said Mr. Tejuosho.

WHY NIGERIA LAGS

The question among development experts is why has been unable to implement the Abuja declaration despite being an agreement that was signed on the Nigerian soil. There have been diverse answers, but Senator Sonny Ogbuoji attributed it to bureaucratic bottlenecks.

“We need to rejig and retool our implementation process so that we can get at least a fair measure of whatever a budgetary allocation that is given to health,” said Sonni Ogbuoji, deputy chairman Senate committee on Appropriation.
“I want to say that if you say we are budgeting below the 15 per cent that is recommended for health and our budget is say 8 per cent, we need to see 8 per cent on ground so we can tell ourselves that if we improve it to 10 per cent, we shall get 10 per cent and if we now make it 15 it will be Eldorado.”

For his part, Jones Onyereri, chairman of House Committee on Banking and Finance, added that while it behoves on Nigeria to respect the Abuja declaration on 15 per cent allocation to the health sector, the legislators are mindful of the enormous challenges the Nigerian economy is facing at the moment.

In the same vein, Mr. Tejuosho said it is the duty of the executive to propose 15 per cent budgetary allocation while the Senate makes a case for its implementation.

The impact of Nigeria’s default on the Abuja declaration is evinced in the World Health Organisation ranking of the Nigerian health system at 197 out of 200 countries surpassing only DRC, CRA and Myanmar. Similarly, Nigeria’s life expectancy lags in comparison with countries such as Ghana, Ethiopia and Kenya. According to the World Bank data of 2012, Nigeria’s life expectancy is 52.11years while Ghana, Ethiopia and Kenya are 60.95 and 62.96 and Kenya is 61.8 years.

THE RETREAT

In response to the quest for a better funded health sector in Nigeria, legislators from the Nigerian lower and upper chambers converged at Pan African Parliament in Midrand, Johannesburg to brainstorm with fellow parliamentarians from southern African countries. The legislators comprised member of the health and appropriation committees.

The two-day legislative retreat on health budgeting with the theme, Health for development, attracted legislators from Swaziland and Zimbabwe, who provided benchmarks for health funding in their countries.

Adeyemi Fajingbesi, Director of Training and Research at the National Institute of Legislative Studies, NILS,
in Abuja told PREMIUM TIMES that the essence of the retreat was to create a forum for interaction between the appropriation committee and the health committee towards compliance with the 15 per cent Abuja declaration on health funding.

“Statistics show that over the year, funding of health in Nigeria and in most other countries have not been adequate and we felt there is a need to create this particular forum to deepen the understanding of members of the appropriation and health committee as it concerns the importance of health in development process,” said Mr. Fajingbesi.

“What we have come to do here is to create this opportunity for members to see why it is important for health to be adequately funded. The appropriation committee is necessary for funding while the health committee would make a case for improved allocation to the health sector in line with the Abuja declaration.”

Sonni Ogbuoji, Ebonyi South Senatorial district and vice chairman of Senate committee on appropriation told PREMIUM TIMES that the aim of the retreat is to interact with their counterparts from Southern Africa with a “view to picking out those aspects of their own health programmes that have worked and also find out why ours is not working”.

The retreat commenced on November 28 with a welcome address by the Director-General of NILS, Ladi Hamalai, who wished the legislators fruitful deliberation and positive outcome.

After a two-day deliberation which resulted in exchange of ideas between Nigerian legislators and their

compatriots from Southern Africa, the Nigerian legislators resolve to work towards an improved funding for the health sector.

In a communiqué issued at the end of the two-day retreat, the legislators agreed that there shall be increased appropriation by the National Assembly to the health sector in 2017 in line with the Abuja declaration of 2001. They also expressed their resolve to ensure that the provision of the National Health Act, 2014 which stipulates that 1 per cent of the consolidated revenue fund be dedicated to the health sector is adhered to in the 2017 budget.

Mr. Tejuosho explained further that the only way the Nigerian health sector can function is to increase allocation to it.

“I believe if we want to make the health sector work in Nigeria we have to increase our allocation to the health sector and also try to achieve the minimum recommendation by Africa.”


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