Donor funding, a philanthropic charity that has kept Nigeria’s healthcare afloat for decades, has been receding but the government still slumbers on, failing to build its own shock absorber against epidemic outbreak in the least.
The goal of most international donor organisations is equipping their recipients for a future when such development assistance will no longer be necessary. The funding structure of Nigeria’s healthcare, however, appears ill-prepared for that future.
The burden of managing scourges – including human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), malaria, maternal and child health, reproductive health and tuberculosis – has mainly rested on charity at a time citizens of donor sources are constantly querying the impact of such capital flight on their local economy.
The Global Fund, Gavi, the World Bank and Global Financing Facility are the leading multilateral providers of financing assistance for health globally, deploying $10 billion yearly in Africa.
Prevalence of HIV/AIDS in Nigeria dropped from 3 percent in 2015 to 1.4 percent in 2019, according to the Federal Ministry of Health. Malaria declined to 27 percent in 2018 from 42 percent in 2016, with the number of children receiving immunisation increasing to 57 percent in 2018 from 48 percent in 2015.
These results were made possible with backing from the Bill and Melinda Gates Foundation, Global Financing Facility of the World Bank, USAID, DFID, Global Fund and others.
But deadlines on some of these funds are approaching and Nigeria will no longer qualify.
Gavi, the Vaccine Alliance, for instance, targeted rounding off its mission to Nigeria by 2023, but reconsidered in first quarter of 2019, agreeing to extend vaccine funding to Nigeria till 2028. During President Muhammadu Buhari’s first term, Gavi committed $1.03 billion to vaccine financing initiative of the government. Its commitment sheet shows that $954.3 million has been disbursed between 2000 and 2019 from a total of $1.2 billion devoted.
BusinessDay monitoring of US expenditure in Nigeria healthcare through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative shows that funding has plunged from 75 percent in 2015 to 30 percent in 2018. It only rose marginally by 5 percent to $170.9 million in 2019.
The Global Fund, another international donor, allocated a total of $660.7 million to support HIV/AIDS, malaria and tuberculosis between 2017 and 2019.
In a recent flag-off of the USAID Integrated Health Program, the agency said it would spend $225 million over five years to strengthen access and quality of primary health services in five states including Bauchi, Kebbi, and Sokoto.
Since 2015, USAID has procured close to $900 million in commodities to treat HIV, tuberculosis, malaria, and support family planning, with significant investments in private distribution and warehousing to improve quality control and move commodities to the last mile.
As of March 2018, the UKAID said it had provided sustainable access to clean water to 3.5 million people and introduced 347,000 additional women and girls to modern methods of family planning between 2015 and 2017. The agency planned a combined £124 million for maternal and newborn child health programme, water, sanitation, and hygiene in Nigeria. These are few instances of grant activities which take live-saving care to Nigerians in hard-to-reach zones.
If these donor interventions are withdrawn, however, and government priorities to health remain unadjusted, Nigerians who rely on free antiretroviral vaccines for survival, free treated mosquito nets and public hospitals for maternal and child health would suffer the most, said Halilu Usman, communications specialist, U.S. Center for Disease Control and Prevention (CDC).
Usman said it was critical for the government to look inwards for alternative means of funding health, and curb excessive reliance on what donors can provide.
“If it means enabling local manufacturers with the enabling environment to produce and distribute drugs of local necessity, the government should do it. Donor sources are not a sustainable system to build healthcare,” Usman said fielding questions at US workshop on health reporting.
Like Usman, healthcare stakeholders have warned the government against using expectations of donor funding as an excuse for underfunding a health sector expected to look after over 200 million people out of which over 70 percent battle with poverty.
Too much of health funding in Africa comes from the wrong sources, especially external development fund and out-of-pocket spending, say Peter Sands, executive director of the Global Fund, Muhammad Alli Pate, global director for health nutrition and population at the World Bank Group, and Seth Berkley, chief executive of Gavi, the Vaccine Alliance, in an article entitled ‘How to get Adequate and Sustainable Financing for Health in Africa’.
Delivering truly universal health coverage will require massive step-up of health financing by African governments, which is not expected to happen of overnight, they say.
To achieve this, they propose the government could leverage on four components of ensuring it has enough fiscal resources; devoting enough of these resources to health; ensuring enough of these is allocated to the right priorities, and spending the allocation efficiently.
“Solving the problem of how to finance health will require a combination of brave political leadership and rigorous technical execution. Political courage is vital because financing healthcare for all inevitably involves taxation, significant redistribution from those who have to those who need, and tough trade-offs, since not everything can be financed,” they contend.
Health deficits
Over the past decade, Nigeria’s health indicators have remained stagnant as one in eight children die before their 5th birthday. Less than one in three have received all basic immunisations, accounting for the highest number of children in the world who remain unvaccinated against measles.
The health sector is equally plagued by inadequate number of trained health workers in rural and remote locations.
Government’s inability to commit more than 4 percent of total budget to health despite pledging 15 percent under the Abuja Declaration and delays in releases largely widen the gaps that donors work to fill.
Average individual spending on health in Nigeria was just about $5 in 2018, according to the World Bank, where the WHO estimates suggest at least $105 per person to deliver a basic package of health yearly. The US healthcare spending per person in 2018, for instance, was $10,586, while it was $3,992 across the 34 Organisation for Economic Cooperation and Development (OECD) countries.
Out-of-pocket health expenditure in Nigeria was 75.6 percent of total health spending in 2016 – a system which punishes the have-nots, pushes families into poverty when illness strikes and creates barrier for people in need of treatment.
According to Malaria Futures for Africa (MalaFA), an opinion research study, most academics, researchers and NGOs fear that maintaining the status quo would jeopardise meeting the 2030 malaria targets. The same fear is held for many other health indicators in the country.
