The Right to Health Cluster of the USAID-SCALE Project implemented by Palladium has organised the 2022 Civil Society Summit on the Health Budget in Abuja. The two-day summit which started on Thursday 24 November, 2022 ended on Friday November 25, 2022. The Centre for Social Justice (CSJ) is the anchor organisation for Right to Health with other seven CSOs drawn from Rivers State, Bauchi State, Sokoto State, Imo State, Ekiti State, Adamawa State and Nasarawa State as cluster members.

The summit analysed the federal health budget proposal presented to the legislature from various prisms. The first objective checked for policy consistency in the policy, plan and budget continuum and also reviewed compatibility of the budget with fit and good practices in public finance management. The second objective extracted frivolous, inappropriate and illegal expenditure proposals and proposed new expenditures from the savings while third, fourth and fifth prisms involved gender, disability, youth and vulnerability mainstreaming reviews of the budget.

The analysis found that the total sum allocated to the Ministry of Health out of the overall expenditure of N20,507,942,180,704 is 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% of the proposed budget expenditure. This is just about one-third of the 15% Abuja Declaration commitment. When the sector’s proposed budget is compared to the 2022 vote, a 53.61% increase is observed.

However, there are other provisions related to health in the budget vis, provisions for the National Health Insurance Scheme fund of MDAs, NHIS for military retirees, NHIS for Corps members and GAVI/Immunisation counterpart funding. The total health provision will come up to N1,282,552,959,029 being 6.25% of the proposed overall expenditure, a shortfall of 8.75% from the Abuja Declaration.

There was also a review of the progression and trajectory of health votes since 2015. The highest percentage allocation of 5.78% was in the year 2015, followed by the current 2023 proposal of 5.35% while the third highest percentage of 4.22% was in 2019. The least percentage allocations of 3.91% respectively were recorded in 2018 and 2020. The average percentage allocation over the 9 years has been 4.41% of the overall vote.

On funding gap analysis, that is the variance analysis between the 15% benchmark and the appropriations, the highest gap of N 1.978 trillion is for the 2023 proposal while 2022 comes second with N1.854 trillion and 2021 comes third. The least gaps were recorded in the years 2015 and 2016 – N414.252 billion and N659.038 billion respectively. The total funding gap for the nine years amounts to N10.267 trillion.

In a goodwill message, Mr Iliya Yohanna, the Advocacy and Engagement Advisor for the USAID-SCALE project being implemented by Palladium said one the achievements of the Right to Health Cluster of the so far is facilitating the signing into law of the National Health Insurance Authority Act. He added that because USAID’s interest in the health and education clusters and with the successes recorded so far, there is an expansion of the Right to Health Cluster to include some of the partners that are coming from the integrated health project.

The Lead Director of CSJ, Eze Onyekpere made the first paper presentation on the Review of Health Standards Relating to the Budget and noted that Nigeria is a state party and has ratified a multiplicity of international standards on the right to health. The implication of this is that Nigeria as a contracting party to these legal regimes is responsible for taking effective measures that will lead to the actualisation of the highest attainable standard of physical and mental health through the creation of conditions that would assure medical services and medical attention in the event of sickness for all Nigerians. That, in short, makes it incumbent on Nigeria to fulfil its duties and obligations under international and national laws guaranteeing the right to health. It is therefore expected of Nigeria to take positive measures including appropriate budgeting through dedicating the maximum of available resources, implementation of plans and policies; promotion of health fostering factors for example through WASH; disseminating appropriate nutrition and lifestyle information, and supporting people, to make informed choices about their health, among others. He noted that the right to health is a right to struggle and said that the commanders of the system will never give it to anyone for free. “We’ll all have to fight for it. In this regard, the right to health is not grants by the state and since there is a systemic inaction to freely grant access to such right, the courts must be able to find ways of overcoming these obstacles on the presumption that the legislature cannot legislate to oust the obligations into which a state has freely entered into,” he said. Fidelis Onyejegbu, a programme manager at CSJ also made a presentation on Nigeria’s health indicators. The last presentation for the first day of the summit was the first part of a review of the 2023 Budget Proposals.

The second day of the summit began with the second part of the review of the proposed 2023 Health Budget and the revenue potential and capacity of agencies and departments in the ministry of health to contribute to the public treasury. It was observed that University College Hospital Ibadan has a projection in excess of N4 Billion while the Lagos University Teaching Hospital has a projection of paltry N48 Million and Ahmadu Bello University Teaching hospital only N8.1million. The gap was seen as very wide and unaccounted for. The summit recommended that 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. The summit ended with a group work and a validation of the Advocacy Memorandum on the 2023 Federal Health Budget Proposals by all civil society partners present at the meeting.