2014 appropriation on health

Objectives of the meeting • To share ActionAid budget analysis on health

with key stakeholders in the sector• To identify and create a learning platform

among interested stakeholders• Map 2014 budget monitoring initiatives by

stakeholders• Facilitate a platform for budget planning and

advocacy

2014 Appropriation on Health

Background

• The 2014 Appropriation act was signed into law in May 2014

• A total of N4.67tn appropriated for as against N4.62 proposed

• FMOH received N264bn, 2bn increase from the proposed N262bn

2013 Context

• Dwindling resources from oil due to oil theft• Striking health workers• Slow implementation due to delayed passage

of 2013 budget• 11300 frontline health workers employed• 10,000 benefit from conditional cash transfers• Guinea worm control and wild polio virus

contained

2013 Context

• Commendation from United Nations towards achieving MDG 5

• 65 percent reduction in maternal mortality between 2000 and 2013

• increased skilled birth attendants from 17 percent in 2000 to 60 percent in 2013

• Nigeria is not listed in UNDP report of top 20 countries with accelerated performance

Objective of the study• To compare health funding vis a vis international

commitments on health by Nigeria Government

• To review 2014 appropriation act a view to ascertaining if the government is progressively addressing key programs for vulnerable groups in society including women and chidren

• To make recommendations highlighting key areas and alternatives that will impact on poor and vulnerable groups

Scope of the analysis

• The analysis is limited to four Key MDAs including NPHCDA, FMOH HQ and NHIS and

• Agencies with relatively higher allocations within the Ministry

Proposed Vs Enacted

Health 2014 proposal 2014 Enacted

Total health budget 262,742,351,874 264,461,210,950.00

Personnel 210,519,482,396 208,543,188,775.00

Overhead 5,883,484,772 6,400,641,451

Capital 46,339,384,706 49,517,380,725

Is Govt progressively funding health commitment?

The percapita spending on health for a population of 160m Nigerians is juN29,000

FMOH HQ

• Total budget N11.89bn• Capital N5.7bn (47%)• Introduced 16 new projects• Has 30 ongoing projects• N3bn to be spent directly on issues that

benefit integrated maternal neonatal and child health (IMNCH) including guinea worm eradication ( attached worksheets)

National Primary Health Care Development Agency (NPHCDA)

National Primary Health Care Development Agency (NPHCDA)

• NPHCDA,s budget primarily targets IMNCH issues

• From an initial proposed N11bn by Executives• N19bn got approved• 20 ongoing projects• 150+ new projects introduced – mainly on

construction of health centres across the country (N7bn)

Cumulative summary allocation on key areas

Budget Area Amount

R.Immunizatonn( MDG) 2,156,300,000

MSS 1,441,821,640

COMM HEALTH 1,000,080,000

NSHDP/PHC REVIEW 1,502,196,929

POLIO ERADICATION 3,650,775,386 Construction of Health centres N7bn

National Health Insurance SchemeNHIS BUDGET %

Recurrent 68,931,674.00 2.3

Capital 2,974,192,365 97.7

Total 3,043,124,039

NHIS MCH Budget

• N2,3993,253,000 to support Maternal and Child health insurance programme (MDG)

• Grossly inadequate for the population of child bearing women and children 0-5 years.

Additional Funds from SURE-P Item AmountRemarks

MATERNAL & CHILD HEALTH

12,050,000,000

NHISFMH-POLIO ERADICATION PROGRAMME

4,120,000,000 Is this operational

cost?

NPHCDA POLIO ERAD,PROGRAMME 2,500,000,000

COUNTERPART FUND FOR HIV/AIDS PROGRAMME

8,000,000,000

MDA not specified

Emerging Issues

• Reduction in mainstream funding to MDA and increased funding from SURE – P

• Too much focus on infrastructure as against skills acquisition, training and service provision

• Poor budget planning between executives and Legislature resulting in

Conclusion

• The 2014 budget came in to force in the middle of the year

• To what extent can this budget be implemented

• Considering most forth coming general election

• now is the time to monitor performance

Matters Arising

• Funding implication for MCH- adequate, underfunded or underspending

- Advocacy- Getting involved in the budget planning from the start- Setting MCH priorities/influencing the budget- - advocacy to Legislators

• Organizing for change- Capacity development on budget analysis for stakeholder- Strategic planning meeting