Nigeria in 2016 officially slipped into recession after months of speculation. From initial debates, around ‘recession being just a
word’, Nigerians have come to grapple with the reality. While recession is marked by a fall in GDP, a rise in unemployment and increased fiscal pressure on the government, the health impacts are huge. As it stands, it appears the present government has not given much consideration to this in its Social Protection Policy and mitigation plans.
As the global economic recession gripped the world in 2007, the World Health Organization in its 2009 Report on ‘The Financial Crisis and Global Health’ cautioned that ‘it should not come as a surprise that we continue to see more stresses, suicides and mental disorders’; ‘the poor and vulnerable will be the first to suffer’; and ‘defending health budgets’ will become more difficult.
More importantly, the evidence showed that that economic crisis led to a deterioration in public health marked by an increase in rates of mental health disorders, suicides, and epidemics. Recent media reports allude to an increasing rate of suicide among Nigerians since the recession. It calls for a deliberate and strategic efforts by government to provide psycho-social support to Nigerians through public health education on the potential effects of recession on their health and coping skills.
Health budgets are one of the victims of government’s fiscal tightening in times of economic crisis. From a high of 6% budget
allocation in 2012, the health budget as a percentage of the total government’s budget fell to 5.8% in 2015, and plunged further down to 4.23% in 2016. In stark terms the budget is N659billion short of the 15% commitment made by African Heads of State in Abuja in 2001. Save for the advocacy efforts by the Minister of Health, and health budget advocates, some key maternal and child health interventions such as the Midwives Service Scheme, contraceptives/ family planning as well as integrated maternal newborn and child health services would have received no allocations.
The recession notwithstanding, the imperative of protecting and ring-fencing government’s spending on health can’t be overemphasized.The country needs to raise domestic funds to finance the health-related sustainable development goals, especially universal health coverage (UHC) which includes universal financial risk protection of the population from catastrophic spending on health services, which further impoverishes already poor and vulnerable households.
Starting from 2016, Nigeria needs to commit N29billion to fund its immunization programmes and needs to raise about N63billion by 2020 upon final graduation from GAVI support which starts in 2017. Between 2017 and 2018, Nigeria needs to provide $181million out of the $264million needed to for immunisation of children to be jointly funded by Nigeria and GAVI. This is in addition to the funding needed to rebuild the fragile health system in the North East, and response to the wild polio virus which is on a resurgence, and against the backdrop of meeting the critical health needs of over two million internally-displaced Nigerians, amongst whom are hundreds of thousands of malnourished children. This calls for huge financial investments from the government and development partners.
Ahead of Buhari’s submission of the draft 2017 budget to the National Assembly in the weeks ahead, it is important that stakeholders in the health sector be vigilant to ensure that critical health interventions are provided for in the budget; including a ring-fencing of at least 1% of the Consolidated Revenue of the Federal Government for the establishment of the Basic Health
Care Provision Fund to finance the provision of a basic minimum package of healthcare services to ALL Nigerians as stipulated in the 2014 National Health Act. Rather than reduce budget allocations to the health sector, the government should put in place strong public finance management measures to improve fiscal discipline and efficient use of public resources to deliver results.
A situation where the Federal Ministry of Health and its agencies rank lowest in the Fiscal Responsibility Index among other MDAs is not acceptable. Civil Society and the Media need to pay closer attention to the health budget for increased transparency and accountability through budget tracking and monitoring of projects in the sector.
In dealing with the health impact of the current economic recession, the Ministry of Health should consider setting up a Health and Financial Crisis Monitor similar to the one set-up during the economic recession in Europe by the Observatory of Health Systems and Policies which generated and used evidence to inform policy makers and stakeholders about the impact of the economic crisis on health and health systems in Europe. With such evidence, advocates can fight to protect public spending and other investments in the health sector, without which critical health services for saving lives would not be possible. The 2016 National Health Policy currently being developed by the Federal Ministry of Health should articulate strategies for providing financial risk
protection of the citizens in this austere times!
Felix Abrahams Obi is a Physiotherapist and Health Systems & Policy Expert. He can be reached via email@example.com & Twitter via @MallamPelliks
(This piece was originally Published in Africa Health, Nigeria Edition – http://africa-health.com/wp-content/uploads/2016/10/AH-Nigeria.pdf)