2013 Health Budget Review (before it was passed)

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1. Summary

The health budget has a number of remarkable highlights, and is seen to show rich investment in key areas, especially in regards to scaling up maternal and child health services. There is also some significant investment in improving a number of the federal health facilities across the country. The budget is however riddled with only 20% capital expenditures, numerous duplications and inconsistencies, inadequate investment towards universal health coverage and an inclination towards catering for the upper class and the civil servants, more than the masses. Special effort must be made to re-distribute the excesses and wastes within the budget, and increase capital expenditures, as well as aim to invest more in catering for the health care needs of the most vulnerable, of our society. It will also be imperative, to encourage government to provide a more significant allocation to health, than the less than 6% of total national expenditure for the coming fiscal year.

2. Initial Observations

  • Only 20% of the total budget goes to Capital expenditures
  • 6% of the total health budget is being spent on the Ministry Of Health Headquarters alone
  • Less than 2% of the total budget is being spent to make health care affordable to the masses, through the functioning of the National Health Insurance Scheme (NHIS) and the provision social health insurance
  • Institutes of Child health get no capital expenditures, and only have recurrent expenditures. Considering the need to scale up research and interventions in the area of child health, as well as our poor child health indices, you would expect more significant investment across the institutes of child health
  • Capital expenditures for National Hospital, a relatively expensive teaching hospital, designed to cater mostly to the Abuja elites is about twice the capital expenditures of any of the other Federal hospitals (with the exception of Ahmadu Bello University Teaching Hospital, Zaria). This is a huge discrepancy, considering the population balance and the strategic geo-political locations of some of the other Federal hospitals
  • Lots of duplications in the overhead costs of the Ministry Of Health Headquarters, the strategic agencies and across most of the federal centers in the country
  • A disconnect in health spending, in the sense that some of the expenses captured in the budget, should be clearly overseen and funded at the local and state government levels, who would most likely be providing budgetary allocations for some of the same projects
  • Budget is over-zealous in some places and so you would expect more ambitious primary health care projects, or bigger investments in social health insurance, which are surprisingly absent

3. Commendable Highlights

– Significant investments in maternal and child health through investments in

  • On-going procurement and distribution of contraceptive commodities;
  • Capacity building for service providers and information management;
  • Implementation of integrated, maternal, newborn and child – health strategy: bi-annual Maternal & Child Health week, capacity building, etc.
  • Promoting school health initiatives, quarterly issue for family health programs;

– Significant investments in HIV/AIDS control through investments in

  • HIV/AIDS control: expansion of access to treatment, care and support to People living with HIV/AIDS;
  • Establishment, assessment and upgrading of addition 100 care sites nationwide, HIV test kits etc.

– Investment in vulnerable group social health insurance program, tertiary institutions social health insurance and piloting of community based social health insurance programs in 148 communities

4. Waste & Loopholes in the Budget

– Overhead costs in the Ministry of Health Headquarters, including expenses on “Magazines and Periodicals”, “Drugs and Medical Supplies”, some of which are irrelevant, as they are covered in other aspects of the budget, or appear to have been over-budgeted for

– Overhead costs that are not entirely comprehensible, such as “Motor Vehicle Fuel cost” vs. “Other transport equipment fuel cost” in Ministry Of Health Headquarters and National Primary Health Care Development Agency overhead costs. What other transport equipment is not a motor vehicle? And why do those other transport equipment cost seven times as much to fuel (as is the case in the Minister of Health Headquarters overhead costs)?

– Duplications in expenses, and some examples would include

  • “International Travel & Transport: Training” vs. “International Training” seen in the overhead costs of a number of the agencies, including the Ministry of Health Headquarters
  • “National Center for Disease Control (NCDC): Equipping the NCDC building at Gaduwa district, Abuja; Operationalization of the NCDC, etc.” vs. “MDG support for establishment of the National Center for Disease Control (NCDC), among the Ministry Of Health Headquarters capital expenditures
  • “MDG-support for strategic health management system strengthening (HSS)” vs. “MDG support for strategic health management system strengthening including support for the prevention and control of communicable diseases in Nigeria (SCD)” among the Ministry Of Health Headquarters capital expenditures
  • “Ongoing projects – Routine immunization (procurement of vaccines, including new vaccines for children below 1 year and pregnant women)” vs. “MDG projects ongoing – Routine immunization (Procurement of vaccines, including new vaccines for children below 1 year and pregnant women)”, among the National Public Health Care Development Agency capital expenditures

– Expenses, which should and probably will belong to the budget of a different entity, such as the state or local governments, or the institutions themselves, but are rather budgeted for in the Ministry of Health Headquarters capital expenditures. Some examples would include

  • Pre-installation works, upgrading and modernization of tertiary hospitals (UATH Abuja, ATBUTH Bauchi, UUTH Uyo and ISTH Irrua, FETHA Abakaliki) and upgrading of National Hospital to Quarternary hospital
  • Procurement of Narcotic drugs by Minister of Health Headquarters
  • Payment for 10 no. CT scan machines at some Federal Medical Centers (FMCs) and installation of the 10 no. CT scan machines.
  • Construction of health center in Uruezeani town, Alor in Idemili-South LGA of Anambra State.

– Presidential pledge of $10 million (NGN 1.6 Billion) to Global Fund, from a country that lacks investment in significant strategies to curtail the same diseases being addressed by the Global Fund. Money that would better serve us, if invested in Malaria, TB and HIV programs within the country. This allocation is captured in the Ministry of Health Headquarters capital expenditures, under “MDG Malaria program: Procurement and distribution of insecticide treated bed nets to Kogi, Delta and Osun and contribute to presidential pledge of USD10m to global fund”

– Discrepancies in certain exact expenses, across centers in the country, leading to a suspicion of significant over-budgeting in some centers. An example would be in the amount being spent on maintaining generators and purchasing new ones by some of the hospitals: University of Ilorin Teaching Hospital for example, has budgeted NGN54,256,701 to maintain and at the same time NGN21,414,490 to purchase a new one. When compared to UCH, Ibadan, a much bigger hospital’s NGN4,000,000 to maintain and NGN20,000,000 for a new purchase, and the amounts quoted by other centers, an obvious inconsistency can be noted.

5. Recommendations

  • Complete purgation of the duplicated expenses
  • Review of the overhead costs of a number of agencies
  • Scale up the amount being invested in the Social Health Insurance
  • Rescinding the presidential pledge to global fund
  • Review of expenses that are by design meant for the state and local governments
  • Investment in progressive digitalizing of Health Records considering cost of maintaining a Health Records Officers’ Registration Board of Nigeria
  • Rechanneling of the funds into more capital projects, especially in the area of maternal and child health, in line with the National Strategic Health Development Plan

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