‘Okonjo’ factor in Health Financing in Nigeria

The 2nd meeting on ‘Domestic Health Spending’ was for 2 days which commenced a day before the 1st one and also attended by many African Health Ministers to explore how African countries would beef up domestic health financing especially in mitigating the impact of HIV/AIDS, Tuberculosis and Malaria. I squeezed time to interact with some of the participants of the meeting on domestic health spending during lunch time at the corridor and almost everybody including this writer were lamenting of the spectacular absence of Nigeria’s Health Minister Professor Onyebuchi Chuku  in the 2 meetings.
Nigeria was scored abysmally low in fulfilling its commitment in line with FP2020. We were committed to in addition to our current annual commitment of US$3 million for the procurement of reproductive health commodities to add US$8,350,000 annually over the next four years from 2012 making a total of about US$45 Million. This was an increase of 300%. Regrettably as we are rounding up year 2013, the initial US$3 million was not released neither the additional US$8.3 million. Corroborating our lacklustre attitude and action, the preliminary findings of 2013 demographic health survey has revealed that our contraceptive prevalence rate still about 10% and has not improved over the last 5 years.  
As a follow up to the Addis meeting on domestic health spending in Africa rather than the Health Minister Professor Onyebuchi Chuku it was the Minister of Finance making a fresh financial commitment on behalf of the health sector. It was at a launch of the Global Fund’s Fourth Replenishment in Washington D.C, USA in December 2013. The Nigerian Minister of Finance and Coordinating Minister of the Economy Dr Ngozi Okonjo-Iweala announced US$150 million in new investments in HIV prevention and treatment in Nigeria and also announced a US$30 million contribution to the Global Fund. (
While we commend the Minister of Finance who doubles “supposedly as supervisory minister of health”, it is important to refresh her memory that health care spending in Nigeria is very low compared to any local and international benchmarks. It is still fresh in our memory that  Nigeria had played the chief host to over 50  African heads of States in a Special Summit of the African Union on HIV/AIDS, Tuberculosis and Malaria tagged ‘The Abuja + 12 Meeting’ holding in Abuja on Monday 15th and Tuesday 16th July 2013 in Abuja .  The meeting reviewed progress made 12 years ago to increase the proportion of health spending to 15% as well  in reversing the trend of infectious diseases. In 2001, Nigeria had promised to spend 15% of Nigeria’s total annual budget on health. In 2013, only 5.6% of the budget is being spent on health, and that number has been decreasing every year since 2011.
The Global AIDS Response Country Progress Report Nigeria GARPR 2012 has also observed that donor investment in the HIV response has however, continued to outstrip the government’s investment even though spending on HIV by Government increased from 7.6% in 2008 to 25% in 2010. Some of the challenges observed with respect to funding of HIV/AIDS which will impact on the Abuja declaration were observed in the 2009 National HIV/AIDS Policy Review Report that “the national response faces significant funding gaps, funding at all levels is predominantly donor driven and donor dependent. States’ political and resource commitment to HIV/AIDS remain extremely weak and in many cases have deteriorated as budget funds are seldom release and there is little or no allocation by LACAs. Governments at all levels have displayed reluctance to implement the one percent budget allocation to HIV/AIDS approved by the federal executive council.”
The report has also observed that there was monumental wastage of resources and capacity building at all levels of HIV/AIDS programme implementation due to staff attrition and bureaucracy. Private sector potential remains untapped. There was also the challenge of poor programme implementation, lack of transparency and accountability by stakeholders across the board which undermine the drive for diversified resources. The aforementioned is a rider for Nigeria to begin to factor why we are far from achieving 15% budget allocations to health.
Another significant action when taken that will help Nigeria jerks its budgetary allocation to health is for the national health bill to be passed in to law. Its serves as a veritable tool  to address funding gap in the health sector and ensures improved quality of care which is in line with Nigeria’s commitment to the United Nation Secretary General’s Strategy on women’s and children’s health. And it will also catalyse improved financial resources from the proposed 2% of the Consolidated Federal Revenue Capital that would be channelled to primary health care and national health insurance.
The bill was passed by both the 2 chambers of the national assembly sometime back but suffered a hitch when it was the turn of President Jonathan to assent it into law. This persistence challenge is linked to lack of commitment of the President Jonathan kitchen cabinet of which Dr Ngozi Okonjo-Iweala is playing a significant role. The advocates of the passage of the national health care bill rather than spending more time with legislatures should spend more time in convincing Dr Ngozi Okonjo-Iweala on its relevance and the impact its passage will make on the lives of women and children.
All comments to Dr Aminu Magashi at

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