Since politics has a far-reaching impact on how health decisions are made, experts have urged all Nigerians, especially stakeholders in the healthcare delivery space, to interrogate political office seekers on the level of priority they intend to accord health. MOSES EMORINKEN reports that investment in health is a direct investment in the overall economic well-being of the country.
Statistics and other numbers for health have not been kind to Nigeria, as the country has one of the worst health indices in Africa and globally. The 2018 Nigeria Demographic and Health Survey (NDHS) showed that for every 100,000 women giving birth, approximately 512 will lose their lives due to sundry avoidable complications. Also, 1 in 8 children in Nigeria die before their 5th birthday.
With respect to nutritional status of children, 37 per cent of Nigerian children aged 6 to 59 months are stunted (short for their age), 7 per cent are wasted (thin for their height), 22 per cent are underweight (thin for their age), and 2 per cent are overweight (heavy for their height). Furthermore, the trends for communicable and non-communicable diseases like hepatitis, tuberculosis, diabetes, cancer, stroke, etc., are on the rise, placing millions of Nigerians at a very high risk of disabilities and deaths from one or more of the diseases.
All these, coupled with other socio-economic factors like poverty, insecurity, insurgency, flooding, inflation, etc., have further driven more Nigerians below the social security lines, such that they can hardly afford or access quality healthcare without catastrophic cost. All these unenviable health indices, coupled with a high fertility rate of 5.3, which is more than the economic growth rate of 3.2, further worsens the economic health of the country, reduces productivity and further reduces Nigeria’s overall Gross Domestic Product (GDP).
Therefore, experts have posited that investment in health is a direct investment in the overall economic well-being of the country. Galvanising more public funds for the health sector was the center of conversation by critical stakeholders during this year’s Future of Health Conference, with the theme: “The political economy of health: investing in the future of Nigeria,” organised by the Nigeria Health Watch. The Managing Director of the Nigeria Health Watch, Mrs. Vivianne Ihekweazu, stated that politics has a far-reaching impact and implication on how health decisions are made. She noted that politics plays an overwhelming role in ensuring that health is prioritised, even with scarce available resources to go round all the sectors.
She further explained that as the country approaches an election year in 2023, it is pertinent that all stakeholders in the health space, and all Nigerians, interrogate the agendas of politicians, to ensure that they make health a priority – in words and actions. “We must ensure that when we engage our political aspirants, we tell them about what we want them to do if they are to win our votes. We must seize this opportunity to engage with our political leaders to ensure that health gets its priority,” Ihekweazu said.
Getting economic value by prioritising healthcare
Reports have it that since the Abuja Declaration in 2001, where African leaders, including the then President Olusegun Obasanjo, promised to allocate 15 per cent of their budgetary allocation to health, till date, the highest Nigeria has allocated to the health sector is about 7 per cent. It currently hovers around 4 per cent.
With this meagre allocation, health experts have argued that this will not only affect the health and well-being of the people, but will further exacerbate poverty and slow down the country’s economic growth and development. According to Dr. Olumide Okunnola, a World Bank Specialist on Health, “Nigeria has perhaps one of the highest out-of-pocket expenditures in the world. Also one of the lowest levels of public financing globally, considering the fact that Nigeria is a rich country. For livelihoods to increase, your economy needs to do much better. With what COVID-19 has done to this economy, for livelihoods to get to where it needs to be, you have to have extraordinary economic growth.”
Prof. Obinna Onwujekwe of the Lancet Commission in Nigeria noted that while the nexus between health and economic development is quite clear, the government needs to stop seeing health as a consumer, and start seeing the sector as a major contributor to economic development. He said: “One powerful thing we need to do going forward is linking the cost of action to the cost of inaction. We need to provide such estimates to show clearly what we are going to lose when we are not investing in health, and the loss is usually in terms of development and low GDP growth. “From the Lancet Commission, as we think about the future of health in Nigeria, if we don’t get the governance right, nothing will work. Therefore, governance and the prioritization of health are the first place to start.”
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A Senior Health Specialist with the World Bank, Dr. Onoriode Ezire, believes that aside the need for negotiation and political compromise, the country needs accurate and timely data on population size, sex and age profiling, and the degree on absolute poverty, in order to be able to prioritize health. He said: “In resource allocation, we must consider two things: if you want to allocate resources based on needs, it is very challenging because we need accurate data. There is no data available in the country in terms of quality and timeliness. Also, when we allocate resources by need, we must make sure that it does not dis-incentivize people from doing the right things. We must make sure Governors that are doing well in health like Kaduna state, are encouraged to do more and not dis-incentivise them.”
Private sector, government make case for healthcare investment
The impacts and contributions of the private sector to the health sector cannot be overemphasised. A shining example is during the wake of the COVID-19 pandemic. The private sector rode gallantly to save the already ailing health system from total collapse. Their roles in providing infrastructure, equipment and consumables, training of health workers, and a host of other functions saved the country from doomsday prophecies and projections during the heat of the pandemic.
Founder of Flying Doctors Investment Company, Dr. Ola Brown, is of the opinion that investment in health can actually solve not just Nigeria’s healthcare problems, but all of Nigeria’s problems. Highlighting the high migration rate, especially of young people, as a fall-out of the state of healthcare in the country, alongside other factors like insecurity, availability of opportunities for employment, inflation etc., she stressed that investing in health has a humongous potential to solve the issues.
She said: “The largest employer of skilled labour in the entire world is the United Kingdom (UK) National Health Service (NHS). Also, if you look at every state in America and look for the employees, you see them in either healthcare or education. If you can employ people in a sector that has massive job creation potential, then you are able to solve security and unemployment problems.
“Healthcare has not been seen as essential to the economy. If we reposition healthcare at the level of the Presidency, House of Representatives, Senate, as not just solving a health problem, but as a solution to ‘all of Nigeria’s problems,’ then, we can get the government to focus on health like they do in other sectors.”
The Chairman of Metis Capital Partners, Hakeem Belo-Osagie, added: “We need to look at our health spending within the context of an overall economy of a government. We should not just be interested in health, but also how the economy is run as a whole. In the real sense, the amount of time, focus and resources that can be given to health is really dependent on whether the government is able in totality, and what it chooses to spend that money on.
“It is of crucial importance that all of us interested in health should be interested in ensuring that the spending rate of our government is one that allows a substantial part of that money to go into health. If the overall expenditure of a country drops for whatever reasons, whether it has to do with oil theft, insecurity, etc., it affects the expenditure for health.”
Speaking on behalf of the Federal Government, the Director-General of the Budget Office of the Federation, Ben Akabueze, said: “Health is high on the development agenda of Nigeria. In lieu of the immense social and economic returns of healthcare investment, a key objective of the National Development Plan (NDP) for 2021 to 2025 is to enable a healthy populace.
“The budget office is of the view that we are yet to have a comprehensive data on the actual amount that we invest in health, one that takes into consideration the allocation to the Ministry of Health headquarters and its agencies, Basic Health Care Provision Fund (BHCPF), allocation for immunisation, the Internally Generated Revenue (IGR); these different agencies from the Ministry of Health, and health-related spendings in other sectors. Critically too is other investments by partners – through multilateral and bilateral funding and grants.
“We also need to take into consideration the different fiscal systems. Sub-national governments are by-and-large fiscally independent. We will need to get data from the 774 Local Government Areas (LGAs) and the 36 States plus the Federal Capital Territory (FCT), so that we will be able to know how much exactly goes into health. The Federal Government budget for the health sector has more than doubled over the past five years. Allocation to the sector was increased by 170 per cent, from N305.1 billion in 2016, to N823.5 billion in 2022, and further by 33 per cent to N1.1 trillion in 2023. This figure is exclusive of health-related expenditure in other Ministries, Departments and Agencies (MDAs), and grants which are health-heavy.”
The Special Adviser to the President on Finance and Economy, Dr. Sarah Alade, added: “One of the four strategic objectives and pillars of the NDP is to enable a vibrant, educated and healthy populace. Healthcare is very important because if you are not healthy, you can get education or any other thing. So, the nexus between health and the economy is being amplified more than ever before, especially during the COVID-19 pandemic. Now we understand the importance more. In the words of Tedros – when health is at risk, then, everything is at risk.”
The National President of the Society for Gynaecology and Obstetrics of Nigeria (SOGON), Dr. Habib Sadauki, stressed that for the country to make meaningful progress in its health outcomes and reap economic dividends, it must take the issue of population growth very seriously. He said: “It is expected that by 2050, we will reach a population of half a billion people in this country. Our fertility rate is 4.6 from the last Multiple Indicator Cluster Survey (MICS), but has been hovering around six to eight.
“Family Planning helps the whole family, empowers women, and gives them economic power to make decisions and take control of their lives. That is what we need to have a good workforce across the nation. What has happened in this country is that over the years, in family planning funding, it started growing from about 2011 and then went to the peak in 2018. Since then, for the last three years, we have been seeing a drop. In fact, this year 2022, there is no budget line for family planning. This is very important because if we are talking about economic development, and then we are not putting money for family planning, then we have a serious problem.”
Mrs Yosola Akinbi, the Coordinator of the Core Working Group on Human Capital Development across MDAs, said: “A strong political will is important, but it is also important that we as citizens also join forces with the government to actually monitor, track and see where we are in terms of health. We need to improve and work on the people; investment in the people is one that works for all of us in Nigeria and all over the world.”