While health budget allocations have risen across 30 Nigerian states over the past three years, most of these states remain underprepared for potential health crises such as infectious disease outbreaks, report by SBM Intelligence’s 2024 Health Preparedness Index (HPI), has shown.
The report evaluates health system preparedness at the subnational level. The findings from the third edition of the HPI reveal a concerning reality: not a single state in Nigeria scored above 30 points on the index, earning all states an ‘F’ grade.
This highlights the critical gap between budgetary increases and actual improvements in healthcare infrastructure, capacity, and readiness to handle emergencies. Despite recent efforts to boost health spending, the level of preparedness across the country remains alarmingly low, raising questions about how equipped Nigeria is to respond to future health emergencies, including global pandemics.
The index evaluates each state’s health preparedness based on various factors, including the doctor-to-population ratio, infant and child mortality rates, immunisation coverage, life expectancy, and the percentage of total state budgets allocated to health. These criteria provide a comprehensive assessment of a state’s ability to respond to health crises. However, even in states where health budgets have increased, the impact has been insufficient in addressing core issues, such as inadequate healthcare infrastructure and healthcare workers.
One of the most pressing concerns highlighted by the report is the doctor-to-population ratio, which is given the most weight in the index, at 30 points. Many states fall below the recommended standards for healthcare delivery, leading to an overstretched and under-resourced healthcare workforce. The report stresses that strategic investments must be made to address this critical gap if states are to improve their overall health preparedness.
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On a positive note, health budget allocations across states saw a notable improvement in 2023, with an average of 9.29 per cent of total state budgets dedicated to health. This represents a significant increase from the 4.65 per cent average in 2021.
However, this figure is still lower than the 11.80 per cent recorded in 2020, during the peak of the COVID-19 pandemic, when states had to allocate emergency funds to bolster health systems. Economic pressures, including inflation, are cited as reasons for the slower growth in health budgets.
A detailed breakdown of the HPI shows that 30 out of 36 states increased their health budgets between 2021 and 2023, but only 15 states managed to raise the percentage of their health budgets compared to 2020. This disparity suggests that while nominal health spending has increased, many states are struggling to maintain health expenditure at levels seen during the pandemic when there was a heightened focus on healthcare.
Among the states that performed better on the HPI, Lagos emerged as the top-ranked state, maintaining its leadership with a score of 25.09 points. Lagos’s relatively strong performance is attributed to its substantial health budget allocations and relatively advanced healthcare infrastructure compared to other states. In second place was Ogun State, with a score of 23.23 points, up from fourth place in the previous index. Notably, Ekiti State made the biggest leap, jumping from 13th place in 2021 to 3rd place in 2023, with a score of 23.04 points.
Bayelsa saw significant improvement, climbing from 11th place in 2021 to 4th place in 2023, with a score of 22.99 points. Ondo, however, slipped from 2nd place in 2021 to 5th place in the latest index, with a score of 22.86 points.
In contrast, states in Nigeria’s northern region continue to struggle with severe healthcare challenges, ranking lowest on the index. Zamfara, Gombe, Sokoto, Kebbi, and Yobe are the worst-performing states, with scores ranging from 11.83 to 13.04 points.
These states face significant challenges in healthcare delivery, including limited budget allocations, poor healthcare infrastructure, high infant mortality rates, and low immunisation coverage. Insecurity in some of these regions further exacerbates the situation, making it difficult for healthcare workers to provide adequate services.