“Health is wealth” is a popular adage universally referenced whenever it comes to comparing importance of competing public sector expenditure. This buttresses the imperative of the sector in the determination of the wellbeing of a people, which also justifies the general clamour for enhanced public investment in it.
Unfortunately, from records, the Nigerian health sector has over the years suffered severe underfunding. Each budget year, the majority of health advocates lament the federal government’s inability to meet the Abuja Declaration’s target of allocating at least 15% of the country’s budget to the health sector. Consequently, the sector has continued to dwindle in service quality with the resultant capital flight occasioned by medical tourism. The brain drain a.k.a Japa syndrome depleting human resources for health and the preponderance of quacks in the sector are all part of the consequences of poor investment in the sector.
In many parts of Nigeria, the primary and secondary healthcare sub-sectors which are meant to serve over 70% proportion of the population, especially in the hinterlands, have been badly affected by the poor funding to the extent that most of the Primary Healthcare facilities have acutely fallen short of service delivery expectations.
In Ebonyi State particularly, the past eight years before the present administration witnessed gross marginalization of the sub-sectors to the point of almost zero human resources for health, especially Doctors, pharmacists and laboratory scientists. Most of the primary healthcare facilities were manned, not by qualified nurses but by Community Health Extension Workers (CHEWs). Equipment and capacity building were left for international partners alone to drive.
Although the present administration has given tremendous attention to the sector through employment of professional health workers for basic health care, equipment of general hospitals and increased incentives among others, record shows that health budget performance for first quarter of 2024 in the state remained statistically very poor.
Worried by the development, a group of eight Civil Society Organizations codenamed “Green-the-Red Health Sector Cluster” has been carrying out campaign for improved fund releases to the health sector as a means of achieving at least 70% performance of the health budget.
The Cluster, led by Development and Integrity Intervention Goal Foundation (DIG) is currently implementing a USAID-SCALE project, “Addressing Accountability and Budgetary Concerns for Sustainable Healthcare in Ebonyi state, ABC4SHE.”
For the past one month, the cluster has been carrying out a lot of activities including a multi- stakeholders health sector strategy session on improving budget releases and Health sector advocacy alliance for media and CSOs.
The events offered the cluster the avenue to engage and consult with both State and non state actors, including legislators, relevant Ministries, department and Agencies of government, the traditional institution, Community leaders as well as other Civil Society Organizations and the media. The essence being to secure their commitment and support to achieving the goals of the Green-the-Red project in the state.
The Cluster team lead and Executive Director, DIG Foundation, Oliver Chima Aja, explained that the concept of Green-the-Red was an initiative aimed at ensuring that the statistical reds signifying zero or poor health budget performance over the years are changed to statistical green signifying at least, above average in the performance table.
In all the engagements, Aja always re-emphasized through a presentation that out of the N9 billion approved health budget for the state Ministry of Health in 2024, only N9 million, representing only 0.10% was released in first quarter.
He also stressed that apart from the State Health Insurance Agency which got N41,164,312.7 out of its approved budget of N470,000,000, representing 8.8%, no other Department and Agency in the Ministry got any releases from their approved budget throughout the first quarter.
Discussions at the events centered on how to change the narratives. Stakeholders prescribed capacity building for concerned MDAs staff on compelling memo writing skills, observing that some MDAs often failed to secure budgeted fund releases because they do not ask.
Intensive advocacy to identified bureaucratic authorities, governmental and nongovernmental influencers were also highlighted, all geared towards galvanizing collective voice and action on health sector funding in Ebonyi State.
Interestingly, the meetings all ended with sincere commitment on the part of all stakeholders. The Chairman, Nigeria Union of Journalists, Ebonyi State Council, Comrade Sampson Nwafor, on behalf of the media and Hajiya Saidatu Aja for CSOs undertook to build alliance to achieve the advocacy agenda of the project. Certain key Media Organizations in the state were also identified to be joined as partners.
Meanwhile, recognizing that an effective budget is that which recognizes citizens participation and incorporates real priority needs of the people, the Cluster has gone beyond the Advocacy for improved budget performance to galvanizing citizen’s participation in the next budget process.
Ward Development Committees, Town Union members and other Community based Organizations (CBOs) across the three senatorial zones of the state have so far been trained on Budget process and the use of Community Charter of Demands (CCD) approach for health sector budget input. They are to drive engagements that would be facilitated by the cluster to generate the priority needs of communities for inclusion in the 2025 budget, through the MDAs.
The Permanent Secretary, Ebonyi State Ministry of Budget and planning, Mfon Williamson, who has been at the centre of the strong partnership between Ebonyi CSOs and government was always available to add value to the engagements.
Representing the Commissioner for Budget and planning, Mrs Chinwe Okah, through the meetings, Williamson acknowledged the invaluable contributions of CSOs in the state, promising that the Ministry would always collaborate with them in promoting development indicators in the State through responsive budgeting, not only for the health sector.
While assuring that the present administration in the state was concerned about the general wellbeing of the people, she observed that the issue of available revenue at any moment of assessment may affect budget performance. She also pointed to the rigorous process of procurement as possible factors which may account for the statistical poor health budget performance for the first quarter, assuring that subsequent quarters will record tremendous improvement.
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Williamson further appreciated the Cluster and it’s sponsor, the USAID-SCALE for the initiative which she noted would impact positively in the health and other sector budgets in the state.
Williamson said: “CSOs have been our strong partners in the development of the state.
“With this, you have always simplified our job.
“But let’s not see this just as a yearly ritual.
” What you are doing today will surely impact positively in the State budget.”
It is believed that at the end of the project, it’s impact will continue to progressively enhance health sector budget allocation and performance in the State.
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