2016 Appropriation Act: Analysis of allocations to MNH in

Health Budget:

Esther Agbon Health Finance & Advocacy Advisor

MTEF Budget Assumptions

• Bench mark price of $58 per barrel

• Crude oil production of 2.2million barrels per day

• Exchange rate of N190 to $1

Reality

• Current price of Crude @ $45 per barrel

• Crude oil production drops to 1.6 million due to NDA vandalism

• Exchange rate @ parallel market – N350 - N380

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

The Health Budget

14%

86%

Capital Recurrent

Total Recurrent

89%

Total Capital

11%

Proposed:N 257bn Enacted: N 250bn

2016 Health Budget Deficit

• Additional N659bn required to meet the Abuja 15% commitment

Total Budget Abujadeclaration

2016 HealthBudget

Series1 6,060,677,358, 909,101,603,7 250,062,891,07

100%

15% 4%

2016 Health Budget

FMOH HQ Budget – N10.275bn

Capaital 51%

Recurrent 49%

Changes in allocations in FMOH HQ Budget

Items Proposed Enacted

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

1,267,214,278

18,162,902

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

1,096,612,966 22,200,776

3% annual mobilization to VAMED E. for PPP of Euro 400 million (VAMED teaching hosp rehab. Proj)

2,614,772,831 1,655,465

Training for selected tertiary facilities in six geopolitical zones

376,835,812 0

Training(ELS,LSS,procurement, etc) 0 84,911,607

Contraceptives, logistics &FP Training 0 797,406,909

IMNCH 0 20,404,623

Interesting new funding lines Items N

Health Care Financing Equity and Investment

18,894,706

Economic Analysis/Investment Case 986,701

NHA 2012-2014 ESTIMATION 2,411,936

STRENGTHENING MONITORING & EVALUATION OF THE HEALTH SECTOR

7,347,342

Nutrition 1,099,404

Infant and young Child feeding 729,136

National Primary Health Care Development Agency

12%

88%

Recurrent Capital

Approved 2016 Capaital Recurrent Total

15,694,635,719 2,050,738,213 17,745,373,932

NPHCDA’s Capital Budget Proposal Line Item Amount

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

DEVELOP NATIONAL LOGISTICS SUPPLY CHAIN 3 HUB SYSTEM; FINALIZE AND ADOPT BEST RE-DESIGN OPTION FOR NATIONAL LEVEL (RUN HERMES MODEL FOR OPTIMIZATION, BRING IN ARCHITECTS TO DETERMINE OPTIMAL HUB COLD STORE REDESIGN), RECRUIT OR TRAIN STAFF TO FILL GAPS WITHIN NEW SYSTEM, IMPLEMENT REDESIGNS 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

Analysis of NPHCDA’s approved Capital Budget

Line Item Nos N

Ongoing projects 11 14,375,816,843

New projects 37 1,318,818,876

Total Capital projects 48 15,694,635,719

*New construction projects 28 917,930,416

N12bn allocated for Vaccines

Trad Vaccines & frieght,

1,017,495,128 Logistics, 76,973,426

Polio Eradication, 9,821,331,311

Measles, Yellow fevr, others,

1,743,406,067

Hajj Vaccines, 220,473,202

Polio Eradication Budget

2014 2015 2016POLIO ERAD. 3,650,775,386 2,568,442,234 9,821,331,311

Amou

nt

Budget for Midwives Service Scheme

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

1,400,000,000

1,600,000,000

2014 2015 2016

Some General Hospital projects supported by NPHCDA

• Dialysis centre at General Hospital Agenebode – N10.5m

• Installation of Medical, Dental and Opthalmological Equipment @ Ughelli General Hospital- N35m

• Procurement of Radiology Equipment (Xrays) –N14m

• Completion of 250 bed hosp, Okene – N250m

National Health Insurance Scheme

• Proposed Capital Budget of N852,870,015

• Enacted reduced to N127m

• Capital budget now disaggregated

Breakdown of NHIS Budget Line Item N

UNIFIED MATERNAL & CHILD HEALTH PROGRAMME

63,000,000

PROCUREMENT OF 2NOS SUV UTILITY VEHICLES

35,198,109

PROVISION OF BOOKS AND PERIODICALS FOR THE NHIS

31,500,000

Summary of findings • Budget lines for Contraceptives/FP, IMNCH and MSS restored • Contraceptives/FP budget still short of FP 2012 commitment • Blood related donation and supply equipment by FMOH HQ

amounts reduced significantly • 3% annual mobilization to VAMED reduced significantly • NPHCDA capital budget reallocated to include rehabilitation

and construction of new PHCs • NPHCDA capital budget to provide for General hospitals • NHIS budget break down now available • However, 1% CRF additional funding to implement NHAct not

included

Our Ask Transparent budget allocations • Continue to make budget

lines for maternal neonatal and child health spending distinct

• Involve CSOs in budget planning processes at the MDA level

Adhere to funding obligations

• Abuja 15% • $11.35m annual Family

Planning budget commitment

• NHAct 1% of CRF

Make budget development transparent

and participatory #OpenMoH