Accountability and Transparency in the Implementation of the Basic Health Care Provision Fund

Accountability and Transparency in the implementation of the Basic Health Care Provision Fund

Submission by Centre for Social Justice (CSJ)

Do We Have a Basic Health Care Provision Fund as Contemplated in the NHA?: The NHA provides for a Fund to be financed inter alia by not less than 1% off the Consolidated Revenue Fund of the Federal Government. The implication of this provision is that the Fund is to be partly financed by a statutory transfer, not an ordinary provision in capital supplementation in Service Wide Votes. The difference between a statutory transfer and what we have in the 2018 budget bill as approved by NASS is the fact that statutory transfers must be released as they are not generally affected by paucity or shortfall of funds. They take pre-eminence over other releases. See section 28 of the Fiscal Responsibility Act on the power to restrict further commitments; it states as follows.

 28. Power to restrict further commitments.

(1) Where, by the end of three months, after the enactment of the Appropriation Act, the Minister determines that the targeted revenues may be insufficient to fund the heads of expenditure in the Appropriation Act, the Minister shall, within the next 30 days of such determination, take appropriate measures to restrict further commitments and financial operations according to the criteria set-in the Fiscal Risk Appendix.

 (2) Where the targeted revenues are re-established, either in part or in full, the appropriations for which further commitments were restricted shall be restored proportionately.

 (3)The provisions of subsections (1) and (2) of this section shall not apply to statutory or constitutional expenditure.

Considering that the President did not make a provision for the Fund in the Appropriation Bill sent to NASS and the Budget Office of the Federation has consistently been opposed to the establishment of the Fund, the possibility of the executive holding on to the money, using all manner of excuses and refusing to release same will not be far-fetched. We are all living witnesses that year after year, our revenue projections have never been realized. So the excuse for not releasing the Fund is already available. 

Recommendation: It is therefore our recommendation that NASS reassigns the Fund to statutory transfers before sending the Budget Bill to the President for assent. If this is done, it will take charge of the issues of releases and cash backing.

 What Transparency Mechanisms Do We Need?: There is a lacuna in the law which needs to be cured by the regulations for the operationalization of the Fund. There is silence on transparency issues. Also, civil society and health monitors are missing in the equation. It is still a government business from the federal, state to local governments. But government has always failed to deliver without a second and third party over-sighting them.

Recommendations: Release of funds from the BOF to the Fund should be publicized in the print, electronic and social media. Also, release of money from the Fund to the states and local governments should be publicised with the exact details of projects, purpose and locations, etc. Quarterly or half yearly briefings by the respective managers on the performance of the Fund should be the norm. Federal and state governments should establish interactive portals or sites that give a blow by blow account of the operations of the Fund. CSOs should form state level coalitions that monitor and report on the performance of the Fund in a monitoring as it unfolds fashion. They should also be enabled to lodge complaints and issues about the management of the Fund in the firm knowledge that genuine issues will be addressed by the authorities.

3. Any Lessons from Similar Funds?: The implementation of the Universal Basic Education Fund provides a unique canvass from which lessons can be drawn. The UBEC funds are available while states cannot draw down despite the poor state of basic education across the country. States have refused to provide money and prioritise their counterpart funding for UBEC education whilst many of the states could not give a good account of previous disbursements to qualify them for a new one. The provision of subsection 6 of section 11 of the NHA is clear.

 (6)     The National Primary Health Care Development Agency shall not disburse money to any-

(a)     Local Government Health Authority if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of this Act;

 (b)     State or Local Government that fails to contribute its counterpart funding and;

 (c)     States and local governments that fail to implement the national health policy, norms, standards and guidelines prescribed by the National Council on Health.

 Recommendation: Federal Ministry of Health, NPHCDA, CSOs, etc. should begin advocacy for the establishment of a similar Fund at the state and local government level which will provide matching funds as counterpart to the federal fund.

4. Are the Guidelines for the Operationalization of the Fund Ready?: This raises the power of whether the provisions of subsection 7 of section 11 of the NHA have been strictly followed.

Recommendation: The rule of law and strict adherence to its provisions should reign supreme in the development of an appropriate operational framework and guidelines for the administration, disbursement and monitoring of the Fund.