2023 Budget: Health security reduction to limit Nigeria’s emergency preparedness

Despite impact of the Coronavirus (Covid-19) pandemic on the country’s healthcare system, Nigeria’s investment in health security remains woefully inadequate. Africa’s biggest economy has allocated N1.17 trillion for its health sector out of the total N20.5 trillion it budgeted for the 2023 fiscal year.

Although allocation to the sector increased to 5.75percent from 4.7percent in 2022, the capital health budget was increased to 94.83percent, while the recurrent health budget was also increased to 25.54percent.

Nigeria will cut spending plans on critical public health security projects in 2023, a move that could potentially undermine the capacity to curtail unforeseen public health crises in a country that has recently endured a myriad of health challenges, including the Covid-19 pandemic, Ebola Virus, Lassa Fever, and measles outbreaks.

Health security encompasses the activities required to minimise the danger and impact of acute public health events that endanger the collective health of people, according to the World Health Organisation (WHO).

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In 2018, the Federal Government of Nigeria developed a five-year National Action Plan for Health Security (NAPHS) as an approach to close identified gaps in health security to prevent, detect, and respond to public health threats.

The NAPHS provides a roadmap to improve health security in Nigeria; from 2018 – 2022, and in the same vein from 2021 -2025 to be achieved through a multi-sectoral approach hinged on the principles of ‘One Health’ and this has to do with relevant government ministries including the Federal Ministries of Health, Finance, Budget, and National Planning, Science and Technology, and others.

However, there have been challenges in implementing the plan due to low budgetary allocation to health security, and the unavailability of direct national funding for outbreak response at all levels. Also, there are noticeable gaps in the commitment of the Ministries and the Departments and Agencies (MDAs) directly involved with implementing the National Action Plan for Health Security (NAPHS).

When the Covid-19 pandemic spread to Nigeria in 2020, the Federal Government raised numerous health security budgets and even made fresh procurement of health equipment to boost surveillance, monitoring, and control of diseases that affect public health. Many of those expenditures were either significantly slashed or completely removed in the 2023 spending plan.

For instance, there were no provisions for surveillance activities to prevent and control pandemics in Nigeria’s port health services in 2021. A year later, more than N37.8 million was allocated for the same project but only half of that amount N18.9 million is budgeted for 2023, which is approximately a 50 percent reduction.

The same situation also applies to primary health centres, which are the first point of contact for many Nigerians in times of outbreaks. Procurement of vaccines, devices, and operational costs at the National Primary Health Care Development Agency is estimated at N3.6 billion from more than N4 billion this year.

While Covid-19 cases have dropped, Nigeria is at risk of many diseases preventable by vaccines. For the first time in three years, the development, printing, and dissemination of the Nigerian vaccine policy got no allocation after the sums of N14 million and N29 million were previously approved for the program in 2022 and 2021, respectively.

Prevention is one of the goals identified as gaps in health security. Despite that allocation to strengthening public health emergency preparedness and response, and global health security and coordination show that there is a 50 percent variance indicating the sum of N56.7 million was allocated in 2022 but half of that amount N28.3 million is budgeted for 2023.

Also, there is a 50 percent variation in spending for the development of national policies on disease surveillance and response. In the previous year, N23.6 million was allocated and N11.8million is planned for 2023.

The COVID-19 pandemic response research for health security strengthening the national out from the 50 percent variation, having allocated with the sum of N189.2 million in 2022, and in the year thereof is expected to receive N94.6 million allocation.

Deploying and installing 30 DTR in states for real-time monitoring of cold chain equipment functionality, procurement of freezer and fridge tags for NSCS and the six zonal cold stores, and development, printing, and dissemination of Nigerian vaccine policy got no allocation, it represents a 0% after the sums of N96.7 million, N 53 million and N14.1 million were previously approved for 2021 respectively.

Nevertheless, the agency coordinating the implementation of the NAPHS, the Nigeria Centre for Disease Control (NCDC) capital budget is estimated at 1.721 billion from more than N1.959 billion in 2022, which is a merging of 12percent variation.

The analysis comparison shows that these MDAs have fallen short of the public investment and the realisation of the all-set goals outlined in the health sector in the National Development Plan for 2023.

The federal government might hope the general increment to the health budget with 5.75percent is progress on health spending for its citizens. But under this administration, it replicates that the budget still amounts to a wide range of collective decision worries such as debt servicing and petrol subsidies are more important than responding to healthcare needs.

Nevertheless, the conservative funding gap in the health sector estimates still takes into account the impact of Nigeria far from its projection and expression in the commitment to allocating 15percent of its total budget to health made by the Africa Leaders under the declaration to allocate at least 15 percent of their government budget to health in 2001 Abuja Declaration.

“There is a need to revisit the proposed investment plan proposed for the sector in the NDP as it is counterproductive to the health budget estimates. The proposed investment for the sector should be realistic and there is also a need to ensure timely publication of the health budget implementation report for accountability,” according to a document by the Partnership for Advocacy in Child and Family Health At Scale (PACFaH@Scale), a coalition anchored under the development Research and Projects Centre (dRPC) titled “A Glance Review of the Federal Government of Nigeria’s 2023 Health Budget Estimates.”

Following the 8th edition of the Future of Health Conference organised by the Nigeria Health Watch and other partners in Abuja. Prof Ben Akabueze, director general, of the Budget Office of the Federation, in his presentation on how to sustainably fund healthcare in Nigeria, stated that it is crucial for economic development and progress that access to better healthcare services be increased.

“Healthcare investment is a driver to the economy, there is no better time to discuss strategies for nationwide effective healthcare delivery and health security, including adequate funding for preparedness and response to emergencies,” he said.

Analysts attribute increased investment in the public health system as important to reduce catastrophic health expenditure since households living in poverty with huge numbers lacking access to quality care may be pushed further into poverty and increasing disease burdens.

These proposed health budget spending will still grow by a little more than inflation between 2023. Increasing pressures on services and a looming general election might mean these spending plans are revised upwards between now and the end of the parliament.