Posted on: Thu 09-01-2025

Civil society groups had divergent views on the proposed N2.39 trillion allocations to the health sector in the 2025 federal budget.

While some groups lauded the Federal Government’s new initiatives, others criticised its failure to invest and deploy resources to attain physical and mental health, as well as activate the National Health Insurance Authority Act.

They told The Guardian that the shortfall reflects a longstanding failure to prioritise healthcare, leaving Nigeria unable to address its health crises or meet its international commitments adequately.

The Executive Director, Civil Society Legislative Advocacy Centre (CISLAC), Auwal Rafsanjani, said the health budget reflects some steps forward but remains fundamentally inadequate to address Nigeria’s vast healthcare needs.

He stressed that Nigeria has the resources to meet the 15 per cent Abuja Declaration target but lacks the political will and accountability mechanisms to redirect funds from wasteful expenditure, as well as corruption.

He said: “Though insufficient, the 2025 health budget includes some commendable initiatives. If transparently and effectively utilised, the N402 billion for infrastructure investments in the health sector could improve access to quality care.

“The N282.65 billion for the Basic Healthcare Provision Fund (BHPF) is crucial for strengthening primary healthcare systems. Provision for essential drug procurement aimed at reducing dependency on imported medications and improving availability in public healthcare facilities.”

Rafsanjani said the allocation cannot sufficiently fund the infrastructure, personnel, and resources necessary to bridge the existing healthcare gaps, and is grossly inadequate to tackle Nigeria’s health challenges.

“The dismal Doctor-to-Patient ratio of 1:6,000 is far below the WHO-recommended 1:600, Nigeria faces a severe shortage of healthcare workers, exacerbated by brain drain as medical professionals seek better opportunities abroad.

“Nigeria accounts for 20 per cent of global maternal deaths, with a maternal mortality rate of 512 per 100,000 live births. The child mortality rate is equally alarming, with one in eight children dying before their fifth birthday,” he said.

Rafsanjani deplored the immunization gaps in the country, noting that immunization coverage remains inadequate, with millions of children missing essential vaccinations, contributing to outbreaks of preventable diseases like measles and polio.

He said: “The nation’s capacity to handle health emergencies, such as Lassa fever outbreaks, is severely limited. There are inadequate road ambulances for rural and urban areas, and Nigeria lacks the operational capacity for well-maintained air ambulance services.

“Achieving Universal Health Coverage (UHC) with the current budget is implausible. Primary healthcare systems remain underfunded, with poor access to healthcare services in rural and underserved areas.

“The lack of road ambulances, trained personnel for emergency response, and necessary infrastructure limits Nigeria’s ability to provide equitable and accessible healthcare. The rejection of victims of attacks by hospitals pending police reports further reflects a systemic failure in emergency response protocols, often leading to preventable fatalities.”

Rafsanjani urged the government to prioritise primary healthcare by strengthening rural healthcare delivery systems to ensure equitable access to basic services.

He also appealed to the government to pay serious attention to maternal and child health to address the high rates of maternal and child mortality through improved antenatal care, immunization programmes, and access to skilled birth attendants.

According to him, increasing recruitment and retention of medical professionals through competitive remuneration, training programmes, and improved working conditions is imperative, while hospital management training should be prioritised to sensitise hospital staff on ethical standards and emergency protocols to prevent delays in treating victims of accidents or attacks

Rafsanjani also called on the government to expand road ambulance services to rural areas and introduce air ambulances for urban centres and remote regions to enhance emergency response.

He implored the government to invest in health research to address local challenges and reduce dependence on imported drugs and medical equipment.

Rafsanjani also stressed the need for robust monitoring mechanisms to ensure transparency and accountability in healthcare spending, adding that funds must be tracked from allocation to implementation, and the public should have access to detailed reports on how budgeted funds are utilised.

He noted that corruption in the health sector remains a significant barrier to achieving impactful results, with inflated contracts, ghost projects, and misappropriation undermining progress.

According to him, bridging the gap between policy and implementation requires transparency, prioritisation of key areas, and a commitment to meeting international benchmarks.

He noted that reports of misappropriation in previous healthcare budgets highlight the need for greater transparency and accountability. For example, funds earmarked for equipping hospitals are often diverted, leaving facilities without essential equipment. Additionally, over-reliance on imported drugs and medical equipment drains resources that could be used to build local capacity and invest in research.

Also, the Executive Director, Centre for Social Justice, Eze Onyekpere told The Guardian that the amount allocated to the health sector is infinitesimal compared to the challenges facing the sector.

Onyekpere lamented that the resources allocated to the health sector over the years have not been managed in a value-for-money tradition that involves more health services emanating from available resources.

He observed that the efficiency of health service delivery has fallen below available budgetary resources and meeting the goal of universal health coverage will be a mirage.

“Nigeria has failed to invest and deploy the maximum available resources for the progressive realisation of the right to the highest attainable standard of physical and mental health. Resources include human, environmental, technology, information and financial resources,” he said.

Onyekpere criticised the authorities’ refusal to activate the National Health Insurance Authority Act, which has made health insurance mandatory and compulsory for all residents in Nigeria while providing for the states to finance access to health for the poorest of the poor who cannot pay health insurance premiums.

He noted that a functional health insurance regime will generate at least N6 trillion in premiums to provide quality health care to Nigerians and when added to federal and state appropriation, not less than N9 trillion will be available for the sector yearly.

“A functional health insurance regime will activate the citizen’s demand for rights to perform public and contractual duties. But the unaccountable system is not ready for rights claims,” he added.

The Coordinator, Africa Health Budget Network (AHBN), Dr Aminu Magashi, commended the allocation to the health sector, stressing that it will address critical areas of intervention, including maternal healthcare, infectious disease control, and other vital health initiatives.

Magashi noted the allocation of N150 million and N50 million as counterpart funding for the National Cancer Health Fund and Childhood Cancer Health Funds in Nigeria, respectively.

He stated that by prioritising investments in national and childhood cancer health funds, the government has demonstrated a progressive approach toward reducing the burden of cancer and ensuring equitable access to life-saving interventions for all Nigerians.

SOURCE: GUARDIAN NEWSPAPER

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