Despite continued advocacy for improved basic healthcare provision in Nigeria, the Federal Government reduced by 30 percent, the provision for health insurance enrolment and coverage. Even though it reduced this budget item, it retained two projects unrelated to health in the revised budget of the Ministry.
According to the budget document sighted by Dataphyte and being reviewed by the National Assembly, these unrelated projects are now worth ₦80 million. This is more than double (267 percent) the amount removed from the health insurance provision.
The global economic shock arising from the pandemic has impacted crude oil price and the revenue of the government. To address this, the Federal government hinted to review the 2020 budget. According to the Addendum to its Medium Term Fiscal Framework, the Federal reduced the benchmark oil price to $25 per barrel. Also, the daily oil production benchmark was fixed at 1.90 million barrels.
Likewise, the Ministry of Finance in the budget revision downsized from ₦10.59 trillion to ₦10.50 trillion. This showed a reduction of ₦84.71 billion, against the ₦1.5 trillion earlier indicated by the Minister. Surprisingly, the federal government slashed capital allocations to key ministries like Health, Education and Agriculture while it increased the overall recurrent expenditure by ₦85.55 billion. This recurrent expenditure was ₦4.84 trillion, but now ₦4.93 trillion.
According to the 2020 budget appropriation, ₦441 billion was allocated to the Ministry of Health out of the total budget of ₦10.59 trillion. In the revised budget submitted to the National Assembly for approval, ₦15 billion was removed from the capital allocation to the Ministry of Health. The initial allocation was ₦59.9 billion while the revised capital expenditure for the ministry is ₦44.73 billion. However, the approved overhead expenditures of ₦6.45 billion remain untouched.
Dataphyte had earlier reported how the Federal government cut the budget of the Ministry of Health and other key ministries such as education, power, and agriculture. However, in what seems like the Executive arm patronising the Legislative arm, the Zonal Intervention Project budget and the National Assembly Library budget were untouched.
₦30 million Cut in NHIS Enrolment and Coverage Budget
Further analysis of the capital budget cut for the Ministry of Health showed there are over 160 capital projects were reviewed in the 2020 budget. Among these budget lines, the NHIS enrollment and coverage budget had ₦30 million reduction. The initial budget of ₦100 million was reduced to ₦70 million. While there are founded justification for budget reduction especially, frivolous and non-essential items, it was disturbing to see such a large reduction in the national health insurance.
Basic healthcare provision in Nigeria has suffered from inadequate funding from both federal and state governments. A study has shown that health budget allocations are not based on evidence of demographic considerations or epidemiological factors such as disease burden.
National Health Insurance Scheme (NHIS) is a key policy of the Federal government. The goal of the Scheme is to provide financial risk protection for Nigerians and to reduce the high burden of out-of-pocket spending on individuals and households. Out of pocket spending is all private health expenditure for the primary aim of treating individuals or family members. It is generally described as any direct spending by households for health consultation, pharmaceutical drugs, medical equipment and other related services.
Sadly, this Scheme has faced equal funding challenges like other key health goals. For instance, out of pocket spending is one of the discouraging health indicators of Nigeria. As of 2017, out of pocket expenditure as a share of current health expenditure was 77.2 percent. This means out of ₦77 out of every ₦100 spend on health is from private individuals. The remaining ₦23 comes from a combination of government spending, local and international aids.
Analysis of key Capital Cuts in the Health Budget
A deep dive review of each line item in the capital schedule for the Health Ministry showed 162 line items were adjusted. Out of the 162 line items, 149 items were completely removed. While four items were cut in half (50 percent), eight had 30 percent cut. The last one had a 37.5 percent reduction.
In what seemed like a lazy job by the officials revising the Health Budget, a number of non-essential or unrelated budget items were either retained or had a small reduction. At least in comparison with the 30 percent budget reduction for NHIS enrollment and coverage.
Moreso, two key budget lines that were unrelated to health, to the tune of ₦80 million were retained. For instance, under the budget of the Federal Medical Centre, Bida, a line item – ERGP5146628 | FUMIGATION OF FARMS IN ISIALA NGWA NORTH LGA, ABIA STATE – was adjusted from ₦100 million to ₦50 million. Aside from the fact that fumigation of farms should probably be under the Ministry of Agriculture, the implementing Ministry is located in Niger State while the Project is located in Abia State.
Likewise, another line item under the Federal Medical Centre, Nguru Yobe – ERGP25146584 CONSTRUCTION OF 2 BLOCKS OF CLASSROOMS – was reduced from ₦100 million to ₦70 million. This is a project that should be under an Agency within the Ministry of Education.
Health advocates are putting their hopes on the National Assembly to do justice to the new proposed bill and prioritise health and other social development and infrastructural needs above frivolous and misplaced items.