Analysis of 2013 Federal Budget on Health Sector

By Esther Agbon

Background

• Life expectancy in Nigeria reduced from 51 yrs in 1991 to 48.4yrs

• Life Expectancy has a direct relationship to health services and disease burden

• Despite health reform efforts by FG, health indicators remain low

• Nigeria ranks 142nd out of 169 countries on the HDI

Background

• Maternal mortality decreased from 800 to 545/100,000 (MDG report 2010)

• Infant mortality rate is 75/1000 live births• 2.98million people infected with HIV• Several strategies and campaigns have been

designed to address poor health situation in Nigeria

Major Challenges

• Lack of effective stewardship of government• Fragmented health service delivery across the

three tiers of government• Poses a challenge on how health is funded and

tracking the funding• Weak Infrastructure• Inadequate and inefficient financing• Strategies and campaigns do not complement or

build on each other (safe motherhood campaign, IMNCH week. saving 1 million lives)

International Commitments

• Signed on to Africa Heads of Government declaration to commit 15% to health

• Recent commitment in 2010 to fund health up to $31.63 per capita

• To progressively meet the 15% target• At the Federal level health funding has been

less than 6% since 2009

Health Sector Funding

5.4%4.0% 4.10%

5.95% 5.70%

2009 2010 2011 2012 2013

Trend in Health Sector Funding

Focus of analysis

• Provisions for women and Children (MCH)- Immunization- Midwives Service Scheme• NHIS• TB/HIV/Malaria

Findings

• Total health budget, 5.7% of 4.920t amounting to N 279,533,895,955.00

Other DAs94%

FMOH HQTR6%

Total Health Budget

Share of Capital to Recurrent

80%

20%

Total health budget N279,533,895,955.00

Recurrent

Capital

General Observations

• Main Ministry receives highest funding, followed by NPHCDA, NAFDAC and NHIS

• Excluding university teaching hospitals- highest being N9b

02,000,000,0004,000,000,0006,000,000,0008,000,000,000

10,000,000,00012,000,000,00014,000,000,00016,000,000,00018,000,000,00020,000,000,000

FMOH HQTR

NHIS NPHCDA NAFDAC

TOTAL ALLOCATION

TOTALRECURRENT

TOTAL CAPITAL

Provision for Women

• NPHCDA allocates 33% of capital budget to immunization for pregnant women and children nationwide

• MDG contribution – N1.4b• NPHDA –N 4.5b• With an estimated

26.5million children of 0-5 yrs• Per capita amounts to N222

• > than the cost of a full dose of immunization

67%

25%

8%

NPHCDATotal Capital Immuniz MDG Immuniz

Midwives Service Scheme

• Award winning best practice• Counter part funding between FG and States• > N1.550,620,676 for Salaries and commodities• To cater for 5300 Midwives including training,

commodities and salaries• Sure – P recruits receive N40,000 and pregnant

women paid N5000 during antenatal• Why establish a parallel program when the

existing MSS is not adequately funded?

National Obstetric Fistula Care (NOFC)

• President’s promise one third of sufferers of VVFrepairs and economic rehabilitation

• There is an estimated 260,000 sufferers of which only about 5000 get treated yearly

• NOFC capital budgetless than travels for Main min.

• Reliance on donors or adhoc projects Travels Capital

Series1 462,304,672 383190780

0100,000,000200,000,000300,000,000400,000,000500,000,000

Axis

Titl

e

FMOH VS NOFC

NOFC

• Another N120,206,345 will be spent on construction and rehabilitation of new site

• NOFC grossly underfunded and cannot perform optimally

• More funds should be voted for treatment

HIV

• Federal govt will spend N198,369,138 to expand access to treatment, care and support to 100 sites

• Each site will get about 1.98m for upgrading, treatment, test kits and care and support

• Why are life saving services receiving such minimal funds?

TB

• MDG TB/leprosy funded up to 75% compared to 25% mainstream funds from the government

• Over dependence on external sources of funds

75%

25%

MDG VS GOVT funding for TB

MDG TB Govt Funding TB/Leprosy

Malaria

• Funding made for malaria centred mainly on distribution of ITNs

• N80,365,176 for distribution of ITNs in AMAC• 1.5m for procurement of ITNs for 3 states• Another lopsided allocation that is not focused

on service delivery

IMNCH

• To implement IMNCH strategy and observe IMNCH week the Main min. votes N90,210,305 whereas

• MDG on going project for procurement of contraceptives commodities and training of service providers provides N510,000,000

NHIS

• Community health insurance pilot for 148 communities allocated N46,416,833

• Each community will get a little over N300,000 assuming its shared equally

• 96% MCH/NHIS funded by MDG• Community projects require heavy funding

because the rural women and children die more than in urban areas

Bloated Allocations

• Despite monetization policy allocations are made for maintenance of residential quarters

• Provisions made for drugs and medicals after subscribing for NHIS

• Coordination of activities for saving I million lives gets N45m in main Ministry

• But udget for implementing the project sits with another Department

• Development of guidelines for Health bill gets N80m, bill is not yet signed into law

Recommendations

• Ad –hoc projects like SURE- P should be discouraged rather such funding should go directly to DAs

• MCH/HIV/TB/Malaria impacts greatly on Nigeria health indices, these diseases should receive priority in budget

• Funds should be given to people oriented developmental projects rather than focusing on distribution and monitoring which are administrative

Recommendations

• Travels, refreshment, drugs and other unrealistic items should have budgets cuts

• MTSS the platform for CSO/private sector participation in budget process at formulation should be encouraged

• CSOs can support MDA review programmes and make them more people oriented

• Reduce dependence on donor funded programs that have key health outcomes

Thank you for Listening