2016 Fed. Health Budget Proposal: Analysis of allocations to MNH

Esther AgbonBudget Advocacy Advisor

MTEF Budget Assumptions

• Bench mark price of $38 per barrel

• Crude oil production of 2.2million barrels per day

• Exchange rate of N197 to $1

Reality

• Current price of Crude @ $27per barrel

• Crude oil production @ 2.0million as at Sept 2015

• Exchange rate @ parallel market -N295 - N310

Focus of Analysis

• This analysis focuses on 3 key agencies with direct roles for MNH

- FMOH HQ - NPHCDA and - NHIS• The traditional tertiary hospitals, institutions

of learning and research centres are excluded

Trend in Health Budget Allocations

Share of the FMoH Budget – N257bn

- proposed 2016 FGoN total budget of N6.07tr

- health budget reduced nominally by N2.369bn

- previous year N259,751,742,847 96%

4%

Total Budget Health Budget

The Health Budget

• Capital = one part out of about 7 parts of the total Health Budget

14%

86%

Capital Recurrent

Capital - N35.67bn

Increased allocations to key agencies with direct MNCH Roles

FMoH HQ NPHCDA NHIS -

2,000,000,000

4,000,000,000

6,000,000,000

8,000,000,000

10,000,000,000

12,000,000,000

14,000,000,000

16,000,000,000

18,000,000,000

20152016

Significant allocations in FMoH HQ BudgetItems Amount Remarks

Blood related procurement, supplies, equipment's, donation care etc ( addition of 9 line items)

1,267,214,278 Two line items are same with different amounts

Upgrade, modernization & equipping of 6 Tertiary Hospitals across geopolitical zones

1,096,612,966

3% annual mobilization to VAMED E. for PPP of Euro 400 million

2,614,772,831 What is the PPP project on?

Training for selected tertiary facilities in six geopolitical zones

376,835,812

Where is the money for FP contraceptives?

0 No line item on budget

National Primary Health Care Development Agency

NPCDA will spend a 88% of its budget on Capital

12%

88%

Recurrent Capital

NPHCDA’s Capital BudgetLine Item Amount

PROCUREMENT OF VACCINES AND DEVICES (SIA) 4,062,408,000

DEVELOP NATIONAL LOGISTICS SUPPLY CHAIN 3 HUB SYSTEM; FINALIZE AND ADOPTBEST RE-DESIGN OPTION FOR NATIONAL LEVEL (RUN HERMES MODEL FOROPTIMIZATION, BRING IN ARCHITECTS TO DETERMINE OPTIMAL HUB COLD STOREREDESIGN), RECRUIT OR TRAIN STAFF TO FILL GAPS WITHIN NEW SYSTEM, IMPLEMENTREDESIGNS TO EQUIP THE THREE HUBS TO RECIEVE INTERNATIONAL SHIPMENTS

11,611,346,700

previous budget lines for Community health, Primary Health Care under one roof, and midwife service scheme have been scrapped

Per capita budget for Vaccine

• N156 annually per child for vaccines excluding logistics for about 26 million children (excluding state contributions)

• How much does routine immunization cost per child annually?

• Donors are currently heavily subsidizing vaccine procurement

• But the villa will spend N3,914,197,062 on maintenance• And N3,890,629,221 on one State Health Medical Centre

ROUTINE IMMUNIZ. MSS COMM HEALTH POLIO ERAD. SURE-P Polio0

500,000,000

1,000,000,000

1,500,000,000

2,000,000,000

2,500,000,000

3,000,000,000

3,500,000,000

4,000,000,000

A look at NPHCDA’s 2015 budgetAl

loca

tions

National Health Insurance Scheme

• Total Budget of N852,870,015 for medical equipment

• Budget is not disaggregated• What medical equipment is this supposed to

fund?• Where are the funds for free MCH insurance

scheme?

Summary of findings• Lump sum budgeting with jam packed items• Other previous MNH budget line items scrapped in FMoH HQ

(FP, IMNCH, ANC/Newborn, Nutrition)• Major focus on blood donation and supply equipment's by

FMoH HQ ( 9 0ut of 28 line items)• NPHCDA budget’s all of its capital on vaccine procurement and

logistics - N15bn for vaccine logistics supply chain, recruitment etc

• NHIS budget is not disaggregated• The NH Act 1% CRF additional funding not captured

Our AskTransparent budget allocations• Create clear budget lines for

maternal neonatal and child health spending

• Lump sum budgeting should be discouraged

• Make budget line item more descriptive

• What are funds for VAMED Engr paying for?

Adhere to funding obligations• Abuja 15%• $11.35m annual Family

Planning budget commitment

• NHAct 1% of CRF (statutory allocation)