There are so many challenges with the federal health budget proposal for the year 2023. If approved by the National Assembly in its current form and substance, Nigeria’s health indicators may worsen and the expenditure will not produce value for money. The traditional approach of health enthusiasts is to demand increased funding but it needs to be emphasised that we need to get more value from the extant and available resources.

It is imperative to start this discourse with the revenue potential and capacity to contribute to the public expenditure of health ministries, departments and agencies. The major poser is the basis of the retained revenue projections of agencies in the health sector budget.  Is it based on the empirical evidence of previously retained revenue or the proposals of the agencies, or the calculation of the ministry or Budget Office of the Federation/Ministry of Finance?  For instance, the University College Hospital, Ibadan has a projection in excess of N4bn in the proposed 2023 health budget while the Lagos University Teaching Hospital has a projection of a paltry N48m and the Ahmadu Bello University Teaching Hospital only N8.1m. 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 and other agencies 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.

Out of the ministry’s total capital vote of N404.075bn, the sum of N319.667bn is reserved and programmed for the ministry’s headquarters. This is 79.11 per cent of the entire capital vote. However, the headquarters’ share of the entire health vote is 29.76 per cent. This is the over-centralisation of resources at the headquarters. It should be disaggregated and only those resources needed for operations at the headquarters should be retained and others sent to the responsible agencies.

 There are allocations of huge sums of money without details at the ministry’s headquarters totalling N310.252bn. This opacity is usually the foundation of the absence of value for money and creates opportunities for the mismanagement of funds. These include ERGP25195089 on Multilateral/Bilateral Tied Loans-Nigeria COVID-19 Preparedness and Response Project-World Bank in the sum of N43.557bn; Multilateral/Bilateral Tied Loans-Accelerating Nutrition Results in Nigeria-World Bank in the sum of N24.5bn; ERGP25195091 Multilateral/Bilateral Tied Loans-Immunization Plus & Malaria Progress by Accelerating Coverage and Transforming Services-World Bank in the Sum of N67.966bn; and ERGP25195092 on Multilateral/Bilateral Tied Loans-Nigeria COVID-19 Preparedness and Response Project-Additional Financing-World Bank in the sum of N174.228bn. There is also the provision for special interventions in Sustainable Development Goals one and two under Service Wide Votes in the sum of N55bn and N10bn respectively. These interventions would definitely include SDGs on health. However, there are no details and disaggregation beyond the lump sum provisions.

This is not acceptable in this day and age. 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.

The Nigeria Family Planning 2030 Commitment states, “By the end of 2030, Nigeria envisions a country where everyone including adolescents, young people, populations affected by crisis and other vulnerable populations are able to make informed choices, have equitable and affordable access to quality family planning and participate as equals in society’s development.” Nigeria promised to improve financing for family planning by leveraging both existing and additional innovative domestic mechanisms but there is virtually no provision for FP in the health proposal. However, Nigeria had committed and cost the sum of family planning for 2023 to N24.881bn. According to the Nigeria Family Planning 2030 Commitment, the health budget should make provision for the sum of N24.881bn to meet the policy standard.

The National Strategic Plan of Action for Nutrition (2021 – 2025) Intervention projects a moderate and ambitious scenario. The moderate in 2023 is to cost N39.5bn while the ambitious will cost N57.5bn. The bulk of the resources provided for nutrition is Multilateral/Bilateral Tied Loans- ANRN-World Bank in the sum of N24.5bn. However, funding nutrition and its related projects with borrowed money are not sustainable in the short, medium to long term. And the funding neither meets the moderate nor ambitious scenario targets. The budget should meet the target.

Maternal newborn and child health constitutes a core content of the right to health as well as the minimum core obligation of the state. It is very strategic for the realisation of the rights of women, girls and the rights of the child. Essentially, it is a part of the right to health that is very inseparable from the right to life, from the context of dealing with life-bearing and life-saving issues. Considering Nigeria’s poor MNCH indicators, it is evident that the proposed vote of N19.371bn (calculated from all MNCH related expenditure in the ministry) will not be sufficient to deal with existing and emerging challenges. This needs to be increased.

There are expenditure heads considered frivolous, inappropriate and wasteful totalling N1.666bn. Considering the huge deficit funding requirement of the 2023 federal budget, expenditures should be targeted at yielding the best value for money. There is a “one-stop special publication on the achievement of the Federal Ministry of Health and all its agencies” in the sum of N110m. A one-stop special publication should not cost this much. There is already a vote for the publication of the annual state of health in accordance with the National Health Act- ERGP25156739. There is the “articulation of policies and strategic plans for retention of medical and health workers to stem brain drain in Nigeria” in the sum of N159.669bn. This is a waste because everyone knows why they are leaving and the government is not ready to address the issues. There is a redundant demand for vehicles including Prado jeeps. All these sums should be saved and re-programmed to the already identified areas in need of more funding.

In conclusion, the budget needs to be reworked and critical issues prioritised. Nigeria cannot be doing the same things over the years and reaping failure and still refusing to change.