The National Assembly just passed the 2017 budget on May 11, 2017, five months after the first proposal was brought to a joint session of the National Assembly by President Muhammadu Buhari on December 14, 2016. The new budget was increased by NGN 143 billion (2%) to bring the approved total to NGN 7.441 trillion. Termed the ‘Budget of Recovery’, some aspects of the improved budget will surely elicit cheers, while other areas will provoke jeers. The 2017 budget brings with it a good number of firsts.
Take the fact that it is the first time the National Assembly has made the full details of the total budget available to the public. Certainly that is a small victory for open government and a boon to the #OpenNASS hashtag. Thus with an increase of over 20% from the 2016 budget, the 2017 budget brings much clarity and should gain the interest of civil society organizations, the media and concerned individuals who seek to engender transparency and accountability in its implementation. For the first time, capital expenditure – which takes care of provisions for social infrastructure – has reached 30% of the total budget. Following comments from the Deputy Senate President, Ike Ekweremadu, it is also the first time since the democratic dispensation that the Appropriation Bill, which he called the most important bill of the National Assembly, has received a public hearing. This portends some good fortune that subsequent budgets will allow enough days for public hearings that would engage more people on the content of these budgets.
Harping on that thought train, it will be recalled that the House of Representatives Committee on Health Services organized a public hearing on ‘Financing Healthcare and Revitalising Primary Health Care in Nigeria’ on the floor of the National Assembly in November 2016. The public hearing was attended by WAVA, the National Immunization Financing Task Team (NIFT) and stakeholders from the Health Sector Reform Coalition (HSRC). Fast forward today, and we now have an allocation of NGN 308.46 billion to health in 2017. What we know about 2016 was that the health budget was cut by 30%. This year, the vaccine component of the health budget was intact. As a proponent for vaccines, this is a victory for our advocacy. I’m also happy with the fact that we have adequate stock of vaccines to take care of every single child in Nigeria for the year 2017. However, my joy seems abated on the outlook of vaccines financing from 2018 and beyond.
So far, there is still a funding gap for vaccines in the year 2018 and yonder. In October last year, NIFT in partnership with WAVA organized a retreat for legislators on immunization, health sector financing and the National Health Act. Of the three major asks in that retreat, we have only achieved one – the provision of adequate funds for immunization in the 2017 budget. The allocation of not less than 1% of the Consolidated Revenue Fund (CRF) to finance the Basic Health Care Fund (BHCF) in the 2017 budget is yet to be actualized. With the current allocation to health at NGN 308.46 billion, there was no increase in percentage allocation of the total budget to health. It still stands at 4.1% of the total budget – the same percentage allocation of the total seen in the 2016 budget. This does not reflect the ‘ask’ for 6% of the total, in a drive to steadily increase this percentage until we attain 15% allocation as stated in the Abuja Declaration. So going forward, what can we take away as advocates or what can we do to change this trajectory?
I believe we have reached a critical stage in the country where we can build on the aforementioned successes achieved. Nigeria needs to follow the footsteps of countries like the UK and Sweden which make health a priority and are better off for it. Stakeholders in the health sector are more than ever aware of the need for increased and sustainable vaccines financing. What we must now do as vaccine advocates is to focus attention to non-health stakeholders – particularly those in the Ministries of Finance, Budget and Planning, and the Presidency. The Honourable Minister for Health, Prof. Isaac Adewole echoed these words during an advocacy meeting with WAVA and members of the Primary Healthcare Revitalization Support Group (PHC-RSG). We must speak their language in terms of numbers and show that spending on health is an investment, not an expenditure. We must also demonstrate good stewardship of the funds provided and show that money given is well spent. A good starting point should include the expedient close out of the Gavi audit. The media is also a crucial ally in its mandate to inform, educate and shape public opinion surrounding immunization issues.
Any effort to strengthen the primary healthcare system is also an effort to strengthen the routine immunization programme, funding included. It is encouraging to know from the Health Minister that a primary healthcare summit with immunization as a priority topic is in the offing this 2017. We must channel our voices and influence to ensure the allocation of 1% CRF from 2018. Nigeria cannot keep thriving on loans for its immunization programme. We must think long term and devise a plan that should provide funds for immunization. If Nigeria is to host the world on a sustainable immunization financing colloquium next year, the country must have concrete examples of how she has made progress in tackling vaccine financing. We must remain resolute in our advocacy and keep in mind that advocacy never stops till we achieve our goal. Fortune as they say favours the brave, hence we can never get anything if we don’t ask for it. I believe that sustained advocacy will get us to our resting place.
Obinna M. Onuoha
Direct Consulting and Logistics/International Vaccine Access Center (DCL/IVAC)