The Nigeria Governors’ Forum’s health sector expenditure and institutional review report showed that 36 states allocated only 1.22 per cent of their health budget to medical appliances and equipment in two years.
The state-level report obtained on Sunday noted that “61.83 per cent of the aggregate health budget of the 36 States from 2021-2023 was allocated to public health services and health administration, leaving 38.17 per cent for hospital services (26.17 per cent), outpatient services(10.5 per cent), medical products appliances and equipment (1.22 per cent), and health research and development (0.28 per cent).”
It also stated that the total health expenditure by the 36 states of the federation was N505bn in 2022 – at seven per cent of their total spending – up from N484bn in 2021.
It revealed that in 2023, the 36 states budgeted N923.31bn for the sector – an increase of 83 per cent from the total actual expenditure in 2022.
The report notes that budget performance for the sector averages around 63 per cent year-on-year, indicating that the actual spending for 2023 may fall well below the N923.31bn target.
The report emphasised that state governments spend an average of N14bn annually on health care, with wide variations from State to State.
“Only 15 states had a Medium Term Health Sector Strategy covering at least the 2024 budget year. Evidence showed there were other cases of alternative planning documents and frameworks used internally by the health ministries to guide resource allocation for the sector.
“Some of these alternative tools provide a prescription of the activities, outputs, and outcomes similar to what is attainable in the MTSS, although driven at the health ministry level,” it said.
It added that states’ inability to present their health expenditure by specific services (e.g. primary care, secondary and tertiary healthcare programmes) and disease categories (e.g., infectious diseases, non-communicable diseases, maternal and child health) is because the National Chart of Accounts was developed based on the global standard Classification of Functions of Government which did not provide these classifications of health spending.
It, however, said full implementation of the programme segment of the NCOA will help rectify this issue in future years.
The report also showed that the average ratio of capital to recurrent spending for the sector is 33 per cent:67 per cent, indicating greater focus by State governments on the administration of healthcare services. Some States have not followed this trend.
“In Ebonyi (85 per cent:15per cent); Rivers (72 per cent:28 per cent); Kaduna (63 per cent:37 per cent); Delta (59per cent:41per cent); Sokoto
(58 per cent:42 per cent); and Jigawa (55 per cent:45 per cent) capital spending outweighs recurrent spending.”
The report however noted instances of miscoding some recurrent items (e.g. drugs, and medical materials like PPE) as capital expenditure.
It highlighted that state governments depend on 16 per cent of their health budgets from external sources, including aid, grants, and loans.
“Grant and international aid programmes were the primary sources of non-discretionary capital funding for most States, with less than a quarter of them, seeking loan options to finance their capital projects in the sector. This low uptake could be due to limitations in securing loans, or a disinterest in pursuing these financing options,” it added.
