Nigeria failed to achieve the Family Planning target of enabling more women and girls of reproductive age to have access to contraceptives by the year 2020.
Nigeria had an estimated population of 206 million as of 2020, according to the National Population Commission (NPC), and is projected to become the third most populous nation after China and India by 2050. The 2014 World Urbanisation Prospects also predicts that by 2050, 77 per cent of the country’s population will be urban.
But the population growth is not matched by economic growth, especially in infrastructure and job opportunities. This has been identified as a major factor in the security, poverty and other crises that have befallen Africa’s most populous country.
However, despite the existential threat, the Nigerian government does not seem to see an urgent need for family planning. For instance, President Muhammadu Buhari’s 2022 budget proposal has no provision for family planning.
The proposal allocates less than five per cent of the total budget to health, sustaining the country’s refusal to meet the commitment made by African leaders under the Abuja Declaration to allocate at least 15 per cent of annual spendings to the sector.
The budget proposes a total of N816 billion for public expenditure in the health sector, representing about 4.93 per cent of the N16.39 trillion budget, but there is no single line item for family planning.
Nigeria has failed to achieve the Family Planning (FP) target of enabling more women and girls of reproductive age to have access to contraceptives by the year 2020 partly because the government has repeatedly failed to meet its counterpart funding commitment for the goal, thereby hindering progress.
The Nigerian government’s refusal to include funding for family planning in the 2022 budget also occurs despite the country losing a key international funder for its family planning needs. PREMIUM TIMES reported how the UK government ended its annual three million pounds to fund family planning in Nigeria.
“Between 2012 and 2020, the UK government pledged and paid into the Nigeria FP commodities basket fund a total of 21million pounds for the procurement of FP commodities. UK government support contributed to saving the lives of millions of Nigerian women who would otherwise be unable to delay pregnancies and be at risk of maternal death,” Minnie Oseji, the National President of the Medical Women Association of Nigeria under the Partnership for Advocacy in Child and Family Health At Scale, said.
The government’s failure to include FP funding in the 2022 budget also occurs despite the country launching a new Family Planning Blueprint (2020-2024) on October 12, 2020. The blueprint is Nigeria’s roadmap for safe motherhood through the healthy timing offered by modern FP commodities.
But efforts to get the reaction of the health ministry on why family planning received no funding in the 2021 proposal yielded no positive result.
On Thursday, PREMIUM TIMES attempted to speak to the minister but the ministry’s spokesperson, Olusegun Adesola, said the director of family health unit in the ministry, Salma Ibrahim, was in the position to respond to questions on family planning.
Though Mr Adesola provided the telephone number of the director, Ms Ibrahim could not be reached at the time of filing this report. All calls put across to her phone did not go through and neither did she respond to our reporter’s text messages many hours after they were sent.
The budget proposal
The 2022 budget proposal of N16.39 trillion represents a 12.9 per cent increase over the N14.57 trillion appropriated for 2021. However, the capital budget falls by 9.04 per cent. And out of the three key development sectors, including security and education, health has the lowest allocation in the 2022 proposal.
The N816 billion proposed for health amounts to just 4.93 per cent of the total budget proposal. The allocation comprises N462.63 billion (57 per cent) for recurrent expenditure and N194.60 billion (24 per cent) for capital projects. There is also N104.87 (13 per cent) for Service Wide Votes for health care, such as grants from the Global Alliance for Vaccine and Immunisation (GAVI) to support immunization and N54 billion (six per cent) for Basic Health Provision Fund (BHCPF).
While the proposed 2022 health budget is higher in actual amount than the N547 billion for the outgoing year, it is lower as a percentage of the total budget. The 2021 health budget is about seven per cent of the national budget of N13.08 trillion, but the 2022 proposed allocation is less than five per cent of the total estimates.
Despite alternative funding from service-wide vote (contingency budget) and Nigeria’s Basic Health Care Provision Fund, federal allocation to the health sector in Nigeria has never surpassed seven per cent of annual budgets. The peak of 6.2 per cent recorded in the 2012 budget is still far below the 15 per cent commitment of the Abuja Declaration.
Family planning advocates kick
Recently, the Partnership for Advocacy on Child and Family Health (PACFaH@Scale), a coalition of 23 civil society organisations, gathered in Abuja to review the budget proposal.
The health advocates noted that the budget seems not to have any specific information or plan to address family planning and the threat of population explosion in Nigeria, warning that lack of funding would adversely affect ongoing family planning targets and services deemed the silver bullet for Nigeria’s burgeoning population.
In a joint release signed by Okai Haruna Aku, the executive director, Parenthood Federation of Nigeria, the coalition said the omission of specific funding for family planning in the proposed budget may scuttle future targets if not addressed.
“With a rapidly growing population rate confronted by pandemic, epidemic, climate change, food insecurity and social uprisings, the entire budget has no mention of specific budget line item for family planning, child spacing, provision of contraceptives or public awareness campaign on child spacing,” the statement said.
According to an analysis by PACFaH@Scale, a coalition anchored under the development Research and Projects Centre (dRPC), the total estimated healthcare investment on a Nigerian in the proposed 2022 budget is as low as N11 per day.
The group said despite the increase over the 2021 budget’s monetary figures, the 2022 proposal, when measured as a percentage of the total spending plan, is still a far cry from the 15 per cent Nigeria agreed with other African nations in 2001 to set aside in their annual budgets for the sector.
The bulk of the proposed budget will be consumed by recurrent expenditure – that is, payment of workers’ salaries, training of staff, cost of running offices and other related matters, leaving a lesser amount for the much needed critical intervention to revamp the country’s ailing health sector.
Health experts described the spending proposal as inadequate, considering the enormous health challenges Nigeria is facing, warning that poor funding undermines the country’s coronavirus response and will severely impact already strained services.
Abuja Declaration
In April 2001 in Abuja, African heads of states and governments under the African Union (AU) made a commitment to a benchmark of 15 per cent allocation of annual budgets to the health sector.
While countries like Rwanda and South Africa have met the commitment by allocating at least 15 per cent of their total budgets to health, Nigeria has not found the way or the will to do so.
A review of the budgetary allocation to the health sector in the last 20 years revealed that Nigeria has never met the 15 per cent target agreed in the Abuja Declaration.
Allocation to the sector in the 2022 proposed budget is just 4.93 per cent of the entire budget. This is even in spite of the biting consequences of the coronavirus pandemic.
COVID-19 pandemic
The 2022 budget proposal came at a time when the world is still battling the COVID-19 pandemic, which has infected 212,359 persons in Nigeria, killing about 2,900 people. A sum of N45.81 billion was budgeted for various COVID-19 interventions in the 2022 proposal.
The amount, mainly from the health capital budget, constitutes about 23.54 per cent of the total capital budget for health and 5.6 per cent of the overall ₦816.15 billion health budget.
Meanwhile, there is no specific budget line for the procurement of vaccines. Nigeria, like many other African countries, leaned heavily on COVAX, the WHO vaccine distribution programme, for donated vaccine doses. The African Union also buys vaccines for its members under the African Vaccine Acquisition Task Team (AVATT).
But both COVAX and AVATT have been struggling to get vaccines with manufacturers such as Moderna, which have been accused of prioritising bilateral deals with richer countries, leaving African nations at the end of the queue.
Health experts speak
A public health expert with the Department of Family Medicine, Federal Medical Centre, Nguru, Yobe State, Adamu Alhassan, said the budget cannot cover everything in the health sector. He said the compounding factor of the COVID-19 pandemic is enough for the health sector to get a higher allocation.
“This is the time for the government to be committed to improving the budgetary allocation to health. I hope that the government will do the needful in the supplementary budget,” he said.
Mr Alhassan said although there is an increment from the 2021 budget, “The reality is that we are still not anywhere considering the fact that in the 2021 budget, only about 4.18 per cent was allocated to health.”
“Unfortunately, this is where we are in Nigeria and this is a major reason why we are still struggling to develop in terms of health infrastructure and development, in terms of human resources and development and in terms of welfare for the health workers.
“This is also the reason health workers are becoming frustrated and going to other countries where they have better conditions of service,” he said.
The National Coordinator of Africa Health Budget Network (AHBN), Aminu Magashi, said it will be very difficult to achieve the 15 per cent budgetary allocation pledged by African leaders. He noted that though the percentage is still around five per cent, the health budget for 2022 has increased compared to 2021.
Reacting to a question on whether the proposed allocation will go far in the fight against COVID-19 and meeting other health sector needs, he said; “The allocated fund will not be adequate to address the COVID-19 pandemic and address the emergency nature of the health sector. But if it is efficiently utilised, the funds will go a long way to tackle issues in the health sector.”
Mr Magashi pointed out the need to ensure that provision of family planning commodities is adequately catered for in the 2022 approved budget.
Downward trend
In the past few years, budgetary allocation to the health sector has indicated a downward trend.
In 2016, the Federal Government had a budget of N6.06 trillion, out of which it earmarked N550 billion to the health sector. The amount represented 4.1 per cent of the budget.
In 2017, the total national budget was N7.4 trillion. The health sector got N304.1 billion, representing 4.0 per cent. In 2018, the National budget was N8.6 trillion of which the health sector got N340 billion, representing 3.9 per cent. The budget remained low in 2019, 2020 and 2021 respectively even as the country struggles to contain the pandemic.