A recent report by the Nigeria Governors’ Forum has revealed that the 36 states of the federation allocated a mere 1.22 per cent of their health budgets to medical appliances and equipment over a two-year period.
The ‘Health Sector Expenditure and Institutional Review’ report highlighted significant disparities in health spending, raising concerns about the prioritization of healthcare delivery.
The report, obtained on Sunday, disclosed that 61.83 per cent of the total health budget between 2021 and 2023 was allocated to public health services and administration.
This allocation left only 38.17 per cent for hospital services (26.17 per cent), outpatient services (10.5 per cent), medical products and equipment (1.22 per cent), and health research and development (0.28 per cent).
In terms of overall health spending, the states collectively spent N505 billion in 2022, amounting to seven per cent of their total expenditures, up from N484 billion in 2021. By 2023, their budget for the health sector had increased to N923.31 billion, an 83 per cent rise compared to the actual spending in 2022.
However, with budget performance averaging 63 per cent year-on-year, the report warned that actual spending for 2023 could fall significantly short of the budgeted amount.
On average, state governments allocate N14 billion annually to healthcare, with considerable variations among the states. However, only 15 states had a Medium-Term Health Sector Strategy extending to the 2024 budget year.
While some states relied on alternative planning tools at the ministry level, these frameworks often served as substitutes for MTSS, prescribing activities, outputs, and outcomes for resource allocation.
The report also noted a lack of detailed health expenditure categorization by services—such as primary, secondary, and tertiary healthcare—or by disease type, including infectious and non-communicable diseases, maternal health, and child health.
This limitation arises because the National Chart of Accounts modeled on the global Classification of Functions of Government does not include these specific classifications.
The NGF suggested that implementing the programme segment of the NCOA could resolve these challenges in future years.
A key finding was the skewed ratio of capital to recurrent spending in the sector, which averages 33 per cent to 67 per cent, reflecting a focus on healthcare administration over capital investment.
However, some states bucked this trend, such as Ebonyi (85 per cent:15 per cent), Rivers (72 per cent:28 per cent), and Kaduna (63 per cent:37 per cent), where capital expenditures surpassed recurrent spending.
The report cautioned, however, that certain recurrent expenses, such as drugs and medical supplies, were often miscoded as capital spending.
State governments also rely on external sources for 16 per cent of their health budgets, including aid, grants, and loans.
The report emphasized that “grant and international aid programmes were the primary sources of non-discretionary capital funding for most States,” noting that less than a quarter of the states pursued loans for financing capital projects.
This reluctance was attributed to either challenges in securing loans or a lack of interest in such financing options.
