Ebola and financing health care

The Ebola pandemic ravaging the West African sub-region and which has come into Nigeria is an ill-wind that blows death and destruction on its path. The ability of Ebola to decimate its victims is phenomenal – nine out of 10 victims do not survive. It is stated to have no known cure. However, in adversity, there is an opportunity to learn, draw appropriate lessons, learn from the best in class and improve in such a way that we can proudly say “never again” shall we be taken by surprise by any major health emergency or disease outbreak. This is possible but it requires some simple steps and commitments on the part of all stakeholders especially the government as represented by the political class.

It is imperative to appreciate that what is at stake in the Ebola pandemic is the right to health, a sub aspect of the right to life. Jurisprudentially, the right to life is the most fundamental of the fundamental rights because only the living enjoys rights with their concomitant obligations. The fact that Ebola Virus Disease infection has virtually become a death sentence raises the stakes in individual and governmental efforts to find an answer to the virus. Are we prepared to confront the Ebola outbreak and any other health emergency that may come up after this scourge? This brings us to the issue of the resource outlays we have been putting aside for health in national and state budgets and how they have been used since 1999.   Have we made the best use of available resources and explored new potential in the bid to progressively realise the right to the highest attainable state of physical and mental health? Have we prioritised health considering the aphorism that health is wealth and it is the foundation for increased production, economic growth, development and civilsation?

Our budgets show our national priorities. A brief analysis of what we have done for health in the budget will show where our priorities lie. Health funding as a percentage of overall budget between 1999 and 2013 has averaged 6.183 per cent. This leaves a shortfall of 8.8 per cent from the agreed benchmark of 15 per cent of the budget to be dedicated to health care. If you reduce the calculation to the period 2009-2013, health budget is just 5.08 per cent of the overall budget. Of this rather paltry percentage budgeted for health, 74.12 per cent is for recurrent expenditure leaving only 25.88 per cent to capital expenditure between 2009 and 2013. Also, 94.36 per cent of the recurrent expenditure between 2009 and 2013 has been for personnel cost leaving only 5.64 per cent for overhead costs. Beyond the percentages stated above, there is always a huge difference between the budgeted sum for capital expenses, the sum released by the fiscal authorities, the cash-backed sum and the amount eventually utilised by the Ministry of Health and its agencies. The figures again will speak: for the period 2009-2013, a total sum of N280.251bn was budgeted, N194.8bn was released while N186.9bn was cash backed. Finally, only N127.2bn was utilised in the five-year period which gives an average of N25.44bn every year in capital expenditure. This is just a utilisation rate of 45 per cent of the budgeted capital sum every year. Therefore, if you disaggregate the actual utilised percentage of the allocation to health as a percentage of the overall budget, it will be lower than 5.08 per cent for the 2009-2013 period!

What are the implications of these figures? The first is that we are witnessing declining commitment by the Federal Government to funding health care in violation of its national and international obligations and in utter disregard of the lives of citizens. The second is that the greater part of the health budget is committed to personnel expenses being the salaries and emoluments of health personnel and thereafter, very little goes to fund capital expenditure and overhead of the sector. Considering that salaries and emoluments must be paid, shortfalls in funding are strictly from the capital vote of the Ministry of Health. The third is that this leaves the sector with little resources to meet the huge funding gap required for equipment and infrastructure to bring our public health facilities up to speed with international standards and best practices. The fourth is the poor funding of public health institutions including research agencies beyond the payment of salaries: Thus, situations abound where researchers are paid and very little resources are committed to the actual research. Essentially, the researchers are made redundant and idle after drawing their emoluments. The fifth is that we are clearly not prepared to deal with pandemics of the Ebola type.

How do all these relate to the Ebola pandemic? The relationship is that nations plan and execute health policies and strategies to meet national priorities. High level policy documents are not made for political mileage and putting them on the shelves. If we had followed the dictates of Vision 20:2020, the National Health Policy and the National Strategic Health Development Plan, there would have been provisions and capacities for meeting emergencies and pandemics of this nature. Adequate provisions should have been made for research on a continuous basis related to the most prevalent disease conditions affecting the population. Research must also be proactive to deal with new pandemics as they come. For instance, there are reports of a research on this virus that was initiated many years ago with a team including a former INEC chairman and distinguished pharmacologist, Prof. Maurice Iwu. We had no presence of mind to conclude that research. Who is researching into a cure for Lassa Fever after it had claimed lives some years back in Nigeria? Are we waiting for another round of deaths before taking action?

This is not the way to go for a nation with a young population and ever increasing need of medical care. The health sector needs increased funding, up to the 15 per cent commitment, with a new attention focused on value for money. New sources of funding should be explored for the sector including funds for research and development of drugs for a multiplicity of diseases. The new sources should include the proposal for two per cent of the Consolidated Revenue Fund for primary health care funding; making health insurance compulsory for every adult who earns an income and the premium should be graduated according to income status. There have also been proposals to deduct some token amount of money from the tariffs we pay to GSM companies for mobile telephone services, which is projected to bring in not less than N500bn every year for health care financing. Of course, specific taxation on certain products and goods can be considered to fund health care. A thousand and one innovative and creative ways to raise money for financing health care in a way and manner that does not add any heavy burden on the populace exist. We would be amazed to have trillions of naira for health care financing in a couple of years if the political will and honesty of purpose are found in the leadership – just the same way we have over N4trn in pension funds.

Finally, the President and the governors should bring out their security votes to attend to the Ebola pandemic. For, what is security that does not start from ensuring that Nigerians are alive and kicking?

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