Malaria kills nearly 200,000 Nigerians each year, yet billions of naira are given to lawmakers to execute constituency projects that may have little or no impact on the people.
This year, lawmakers are getting nearly N740 billion (about $500 million) for constituency projects even when Nigerians will spend $1.1 billion (over N1.7 trillion) out of their pockets to treat malaria, according to the World Health Organization (WHO).
Though it may be argued that health issues are handled by the executive through the Federal Ministry of Health, experts say it amounts to misapplication of funds to allocate billions of naira to constituency projects when some Nigerians will die of malaria.
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The WHO says 68 million Nigerians suffer from malaria annually and nearly 200,000 of them will die of it.
“What we need the most to attain malaria elimination is a strong political will and honestly determined individuals at every stage of the malaria control programmes. Cabo Verde just attained malaria-free status, it’s no magic. We can do it, but the right people need to be at the decision-making table,” Alamin Usman, a research assistant at Our Future Health UK, said.
A report by Order Paper in partnership with Budgit, MacArthur Foundation, Tracka, among others, revealed that over 100 constituency projects in 22 states were abandoned despite 2022 budgetary allocations.
About 533 of those constituency projects had not commenced as at the time the civil society organisations authored the report in November 2023 – 11 months after the end of 2022.
Yet, the fight against malaria relies heavily on external support.
Only 21 percent of the $3.84 billion invested in malaria control since 2000 originated from domestic sources, excluding out-of-pocket expenditure by households, according to the WHO.
Direct allocation to Nigeria’s malaria program is generated particularly from the Global Fund which supports 13 states, and the US President’s Malaria Initiative which supports 11 states.
Thirteen Nigerian states lacked external support until a recent agreement with the World Bank and Islamic Development Bank.
In the 2024 budget, over N63 billion was allocated to various malaria interventions, including vaccination campaigns.
The amount however pales into insignificance when compared to the funds directed to constituency projects.
David Walton, global coordinator, the U.S. President’s Malaria Initiative, speaking recently on the challenges of malaria control and elimination at the Harvard Global Health Institute, acknowledged a potential misalignment between what the international organisations think is needed and what the countries battling malaria prioritise.
Walton identified a major funding gap in the fight against malaria, saying there’s a significant increase in malaria cases globally, but the funding to combat it hasn’t risen proportionally.
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“Countries that have a fair amount of malaria cases have doubled. But global funding has not doubled. We currently have a $3.7 billion deficit in what WHO has estimated we need versus what we have. At PMI, we are faced with how to help countries make these choices. What we are thinking versus what the countries are thinking don’t always see eye to eye,” Walton said.
At 22 percent, malaria is a leading cause of death among children aged five and below as the coverage of basic health services such as use of insecticide-treated nets and intermittent preventive treatment remain less than average.
Fourteen states including Sokoto, Kebbi, Jigawa, Bauchi, and KanO are ravaged by high under-five mortality rates, according to the 2021 Multiple Indicator Cluster Survey (MICS).
According to the 2018 Nigeria Demographic and Health Survey (NDHS), malaria prevalence in children under five was 23 percent, with the northwest geopolitical zone recording the highest rate at 34 percent.
A 2024 analysis of financing and governance constraints for the delivery of basic education and primary health care in Nigeria by the World Bank Group shows that the government’s health expenditure has fluctuated below 10 percent of the gross domestic product (GDP) over the past five years.
This has strained the ability of the public health system to deliver adequate essential services, especially through the universal health coverage, leaving a significant proportion of health spending on private pockets.
Nigeria’s out-of-pocket health expenditure was estimated to cover 77 percent of total health spending in the country as of 2022, almost double the African average of 37 percent and four times the world average of 18 percent.
This worsens the financial burden of many households already stretched by the country’s economic challenge.
On average, health-related expenses push more than one million Nigerians into poverty each year, according to the World Bank.
Among those who are not in the poverty threshold, a quarter of Nigerians face financial strains yearly due to high cost.
At $15 per capita, the World Bank analysis shows that public expenditure on health in Nigeria is inadequate by any standard. Of the $15, states spend $8.5, which compares poorly to Nigeria’s peers.
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The states spend more than the federal government, with N731 billion on health, compared to federal spending of N610 billion.
As a share of the budget, allocations to health were 6.6 percent of overall spending of federal and state governments in 2021, the analysis shows.
The two sectors with largest shares of the budgets were general public services (24.2 percent) and economic affairs (18.4 percent). Debt charges within general public services were the third largest expenditure item at 17.6 percent of the federal and state governments.
Social sectors including education, health, and social protection received together less than one-quarter of the national budget in 2021.
The analysis further indicates that the limited public funds allocated to health in Nigeria are predominantly directed toward secondary and tertiary care facilities, with a significant portion of the budget spent on curative services within these higher-level hospitals.
“This allocation strategy overlooks the crucial areas of prevention, public health, and primary health care, which are both cost-effective and have a high impact on overall health outcomes. The implications of this skewed spending pattern are twofold,” the World Bank stated.
“First, it results in scarce resources being unavailable for essential preventive and promotive health services that could yield significant health benefits. Second, it leads to high out-of-pocket expenses at the point of service. These costs deter service utilisation and pose a substantial barrier to accessing care, particularly for economically disadvantaged populations,” the report stated.
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