THE Federal Ministry of Health out of the overall expenditure of N20,507 ,942,180,704 in the proposed 2023 federal budget got N1,097,703,830,504 inclusive of the N47,649,312,042 provided for the Basic Health Care Provision Fund (BHCPF). This is 5.35 percent of the proposed budget expenditure. This is just about one-third of the 15 percent Abuja Declaration commitment. However, there are other provisions related to health in the budget vis, provisions for the National Health Insurance Scheme fund of MDAs (N105,797,840,669), NHIS for Military Retirees (N4,481,145,223), NHIS for Corps Members’ (N5,000,000,000) and GAVI/Immunisation Counterpart Funding (N69,570,142,633). These add up to an extra N184,849,128,525. This increases the health vote to N1,282,552,959,029 being 6.25 percent of the proposed overall expenditure. This is just 41.5 percent of the Abuja Declaration. 15 percent of the overall budget vote would have amounted to N3,076,500,000,000. The extant health vote leaves a funding gap of N1,978,796,169,496.
From the proposals above, 29.76 percent of the votes went to the Ministry of Health headquarters, the National Primary Health Care Development Agency got 1.82 percent, National Hospital Abuja got 1.48 percent, the Basic Health Care Provision Fund got 4.34 percent and the Teaching Hospitals respectively got an average of 1.33 percent of the health vote. The Teaching Hospitals got 31.85 percent of the health vote. The National Centre for Disease Control got 0.35% of the vote. Ten regulatory agencies got a total vote of 4.42 percent. The allocation to the three Institutes of Child Health was a pittance and amounted to 0.0014 percent of the health vote. Certain critical issues can be isolated from the above proposed health sector expenditure. First, it is imperative to start with the revenue potential and capacity to contribute to the public expenditure of health MDAs.
The major poser is the basis of the projections in the health budget. Is it based on the empirical evidence of previously retained revenue or the proposals of the agencies or the calculation of the Mother Ministry or Budget Office of the Federation/Ministry of Finance? For instance, University College Ibadan has a projection in excess of N4 Billion while the Lagos University Teaching Hospital has a projection of a paltry N48 Million and Ahmadu Bello University Teaching hospital only N8.1million. The gap is very wide and unaccounted for. Many health agencies that should contribute to the revenue have zero contributions. There should be a transparent, accountable empirical standard, on the basis of which these Teaching Hospitals operate. As such, the variance between their respective retained revenue should be within respectable margins. Beyond Teaching Hospitals, this empirical approach should be applicable to the retained revenue of other agencies under the Ministry.
It is important to note that Section 15 (1) (a) & (b) of the National Health Act provides that Minister, in respect of a tertiary hospital, and the Commissioner, in respect of all other public health establishments within the State in question, may- (a) determine the range of health services that may be provided at the relevant public health establishments; and (b) in consultation with the relevant treasury, determine the proportion of revenue generated by a particular public health establishment classified as a hospital that may be retained by that hospital, and how those funds may be used. On the basis of the foregoing, it is imperative for the legislature, in collaboration with the executive, to design a transparent, accountable and empirical standard, on the basis of which all agencies, including Teaching Hospitals under the Ministry of Health, would account for their independent revenue and ensure that it is part of the budget figures.
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Again, there are challenges in understanding health agencies without retained independent revenue. Under what circumstances and calculation was zero retained revenue recorded for Irrua Specialist Teaching Hospital, Federal University of Health Sciences Teaching Hospital, Otukpo, Benue State, Rasheed Shekoni Federal Teaching Hospital, Dutse, Jigawa State and University of Benin Teaching Hospital? This is happening at a time when other Teaching Hospitals are projecting in billions and hundreds of millions. Again, there should be a transparent, accountable empirical standard on the basis of which these Teaching Hospitals operate. As such, the variance between their respective retained revenue should be within respectable margins. Beyond Teaching Hospitals, this empirical approach should be applicable to other similar agencies under the Ministry. It is also recommended that the vote to the Ministry of Health should be increased to at least 10 percent of the overall vote in the sum of N2, 050,794,218,070.4.If meeting the 15 percent benchmark is difficult because of lean resources, the budget should at least target two-thirds of the benchmark. However, the Ministry’s headquarters should not also retain 79.11 percent of the entire capital vote.
It should be disaggregated and only those for operations at the headquarters retained there and others sent to the responsible agencies. Again, the details of all bulk votes without details totalling N310,252,155,300 and the service-wide votes for health should be provided to the National Assembly and made public to the Nigerian people.
- Okeke writes in from the Centre for Social Justice (CSJ) Nigeria.
