Nigerian lawmakers, seeking expanded health budgeting, point at “bureaucracy” as obstacle

A Hospital ward with health workers used to illustrate the story
A Hospital ward with health workers used to illustrate the story

Nigerian legislators from the Senate and House Committees on Health, Appropriation, and National Planning who are attending a legislative retreat in Johannesburg, South Africa, on budgeting for health, remarked on Monday that bureaucracy is the key obstacle to implementing the mandatory 15 per cent budgetary allocation to the health sector.

The meeting, which theme is Legislative Retreat on Budgeting for Health, is holding at the Pan African Parliament in Midrand, Johannesburg as a joint initiative between the Nigerian Institute of Legislative Studies [NILS] and its south African counterpart. The Nigerian delegation is led by Ladi Hamalai, the Director General of NILS based in Abuja.

The African Union in its famous 2001 Abuja Declaration proposed a 15 per cent budget spending to the health sector as a condition to achieve a “universal and better healthcare services” in each country of the continent.

Emphasising the challenge of bureaucracy, Sonni Ogbuoji, deputy chairman of Nigeria’s Senate committee on Appropriation told PREMIUM TIMES at the Pan African Parliament venue of the programme, in Midrand, Johannesburg, that “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.”

Mr. Ogbuoji stressed that “If you say we are budgeting below the 15 per cent as 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”

Jones Onyereri, chairman of Nigerian House committee on banking and finance added, in a more optimistic tone, 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.

However, Mr. Onyereri believes that the House of Representatives will get close to the vision of the Abuja declaration in the 2017 appropriation, hinting that “I believe that this won’t be a waste of time,” in reference to the retreat with compatriots from South African countries.

Nigerian civic sector actors in the public health community have run a three-year aggressive advocacy led by the Partnership for advocacy in child and family health [PACFaH] in the believe that expanded and increased health sector appropriation in Nigeria will help enable a universal health coverage and efficient primary health delivery in the country.

Nigeria’s current health sector appropriation is 4.64 per cent of the annual budget, according to Nigeria Health Watch. This is 10 per cent lower than the budget cap recommended by the African Union in its famous 2001 Abuja Declaration.

PREMIUM TIMES data team, working on ten years of Nigerian and South African health data [2006–2015] say that, based on proportion of national budget appropriated for healthcare, both countries have failed to achieve the threshold spending of the Abuja Declaration. However, the South African government has increasingly shown better parliamentary leadership through oversight and allocation to the health sector, two reasons which earned South Africa the hosting right for the study tour.  As the data below indicates, only in 2010 and 2015 did South Africa top Nigeria in health spending between 2006–2015 but its increase since 2012 had shown measured and continuous rise.

Health Budget as percentage of National Budget

With the graphic presentation, it is evident that funds committed to the health sector by the Nigerian government between 2006 and 2015 always hovered around 5 per cent but never got close to the recommended 15 per cent by the African Union standard. The 2010 appropriation was the worst over time with 3.9 per cent and has continued to decline since 2012.

South Africa Performed Better by Health Indicators

Despite Nigeria’s eight times lead in health appropriation over South Africa, data is leading to realisation that the problem is even more complicated than a mere case of financing. South Africa, performed better on the World Health Organisation [WHO] ranking of Health systems performance in 2015 ranking 175 out of 190 as against Nigeria’s 187th position. Over the years the government of South Africa have had a consistent health plan which successive government had followed through.

Analyzing available data and narrowing them to specific health indicators in four important primary health issues, nominal health budget proportion favours Nigeria, however the health output or indicator performance was unmistakably in favour of South Africa.

Healthcare experts believe that South Africa’s modest but steady performance in its health spending and outcomes owe more to  the commitment of every stakeholder, ranging from the political to technocrat class, as evidenced in the commitments of the ruling political party as highlighted in a 2011 DFID report.

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Malaria deaths

The malaria chart shows that while South Africa continues to persistently experience a decline in their malaria related deaths, Nigeria on the other hand continues to experience an upsurge, peaking at over ten thousand deaths in 2014. However, 2015 data shows a percentage decrease of 35.9 reported deaths signifying a great leap. While within the same time frame South Africa experienced a huge percentage increment 57.4 reported deaths.

Malaria - number of reported deaths per country
Malaria – number of reported deaths per country

Neonatal Deaths

Neonatal deaths in Nigeria still remains a major source of concern. It has continued on a scary increase compared to South Africa’s managed record of 15,000 in 2011 that stabilized at 14000 over the last two years while Nigeria continues to record hundreds of thousands in deaths.

Number of neonatal deaths (thousands)
Number of neonatal deaths (thousands)

Maternal Deaths

Perhaps one area where the south Africans may want to listen to their Nigerian visitors is how Nigeria is winning the war against maternal mortality. Based on World Bank data on both countries, Nigeria has made nominal progress in curtailing maternal deaths from 2005 while South Africa is still struggling to keep its decline in check.

Maternal mortality ratio (MMR) per 100 000 live births (lb)
Maternal mortality ratio (MMR) per 100 000 live births (lb)

Under 5 years Mortality
With respect to Under 5 deaths, data is revealing that both Nigeria and South Africa have good stories with the nominal decline.

Mortality rate, under-5 (per 1,000 live births)
Mortality rate, under-5 (per 1,000 live births)

A major direction for Nigerian legislative delegate to South Africa might be to seek insight on how oversight function and budget implementation monitoring has enhanced outcomes for South Africa than Nigeria.

Download the data used for this story here and you can also view full infographics here.

Data Sources:

Nigeria Budget Office, South Africa National Treasury, World Health Organization, and World Bank


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