The document summarizes trends in Nigeria's national health budget from 2013-2015 and analyzes how budget allocations align with commitments to improve health outcomes. Key points: - Health budget allocations have remained below the recommended 15% of total budget and have declined in actual monetary terms from 2013-2015 despite percentage increases. - Recurrent expenditures have risen while capital expenditures have declined, limiting investments in health infrastructure and programs. - Budget allocations for critical areas like immunization, maternal healthcare, and disease control programs have also declined over this period. - Nigeria still faces challenges in achieving Millennium Development Goals for reducing child mortality, improving maternal health, and combating HIV/AIDS, tuberculosis, and

1. Nigeria
Transformation
Agenda and
Trend Analysis
of National
Health Budget
(2013-2015)
Paper Presented at Civil Society
Dialogue on 2015 Budget
Ipoade Omilaju

2. Background
There is no doubt that the Health sector has been one of the most under funded in the past few
years. Not even the AU Heads of Government declaration of April 2001 that promised to allocate
15% budget for health has been able to rescue the situation. For the past one decade, the Nigeria
budgetary allocation to health has been at best of 6% in 2012 while all the other years saw the
allocation moving between 4-5% of the Total Budget. If at the time when Nigeria oil revenue was at
its best, we had such a meagre allocation for health, there is no guessing for too long that sector will
still experience gross under funding as long as this revenue challenge lasts.
In February 2011, at the lunch of the Federal Government Presidential Committee on Key Policies,
Programmes and Projects (KPPPS), it was clear the prioritized direction and focus of government in
achieving sustainable and holistic development across key sectors within the country. As one of the
key priority areas, health would have received a more attention than been observed in budgetary
allocation since inauguration of the Presidential Transformation Agenda. Considering the health
sector allocation from 2011 to date, the Federal Government has not only failed to honour a
declaration made at a meeting that was host by this government but has also not allocated funds to
health sector to respond to the Transformation Agenda of Mr. President. The Health allocation in
2011 was 4.10%, 2012 (6.00%), 2013 (5.70%), 2014 (6%) and 5.9% has been proposed for the current
Year 2015, a fraction lower than the previous year.
Matching Figures with Needs and Commitments
Analysing the allocation in actual monetary terms and not percentage reveals drastic reduction even
though there is percentage increase from 2013 to date. In 2013 at 5.7% the allocation was
273billion, 2014 at what seems an increase at 6%, the actual monetary value was N262billion
amounting to a 6.7percent decrease as against 2013. Now in 2015, at 5.7%, the actual monetary
value is N257billion also amounting
to a further decrease of 2percent
from 2014 allocation and 6percent
decrease from 2013 budget. This
unacceptable decline in Health
sector allocation is not only
insensitive but a further show of
non-commitment to the National
Strategic Health Development Plan
(NSHDP). The NSHDP is the guiding
principle for actions government and
he partners at all levels of the health
care service delivery system which
seeks to galvanise and promote support for the achievement of the Millennium Development Goals
(MDGs) and other local and international targets and declaration commitments. The document is
also the underpinning policy for the inputs towards achieving the human capital development goal
of the Vision 20:2020 strategy.
Figure 1: Nigeria Health Budget Allocation (2013-2015)

3. 0 200 400
2013
2014
2015
223,7
216,4
237,5
55,7
46,3
20
Expenditure (=N=Billion)
Year
Capital Expenditure Vs. Recurrent Expenditure
Capital
Expenditure
Recurrent
Expenditure
This inadequate allocation is also against the backdrop of unimaginable drop in the price of crude oil
which constitutes about 80% of government revenue. Nigeria relies heavily on crude oil revenue to
fund government spending and oil accounts for about 15% of Nigeria’s GDP. 1
The Budget proposal
has aggregate revenue of N3.602 trillion made up of oil revenue of N1.918 trillion and non-oil
revenues of N1.684 trillion (implying a ratio of 53% oil revenues to 47% non-oil). With the recent
persistent drop in oil price across the globe, the meagre amount allocated to health now stands at
the risk of mere appropriation pronouncement that will end up with a fraction release.
Over the years, the development effort of Nigeria has been plagued with lack of continuity,
consistency and commitment to agreed policies, programmes and projects. This has grossly affected
the lives and livelihood of an average Nigerian. The happening within the Health sector is a clear
example where there is a no consistency in pursuing the government plans and aspiration in the
sector. While there is a gross decrease in
available resources for the sector, the
recurrent expenditure has been on the rise
with very limited resources available for
capital project. Out of the eight areas of
focus (goals) of the MDG, three are
specifically responding to tackling health
challenges globally.
MDG 4: Reduce Child Mortality with clear
Indicator that says
 Reduce by two thirds, between 1990
and 2015, the under-five mortality
rate”.
MDG 5: Improve Maternal Health having an Indicator that says;
 Reduce by three quarters the maternal mortality ratio and
 Achieve universal access to reproductive health
MDG 6: Combat HIV/AIDS, Malaria and Other Diseases. The three clear indicators are
 Have halted by 2015 and begun to reverse the spread of HIV/AIDS
 Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
 Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
No doubt the country has made some progress in these areas; however, it is obvious that the targets
set in these three goals will not be met. According to the 2
Nigeria 2013 MDG Report, under MDG
Goal 4, Nigeria has made some progress in reducing child mortality, although this has been slow. In
1990, the infant mortality rate (IMR) was estimated at 91 deaths per 1000 live births. However, by
2008 the IMR had fallen to 75 deaths per 1000 live births and by 2012 it further declined to 61
deaths per 1000 live births as against the 2015 target of 30.3 deaths per 1000 live births.
Similarly, substantial improvements have occurred in the U5MR. From 191 deaths per 1000 live
births in 2000, it dropped to 157 per 1000 in 2008; it dropped further to 94 deaths per 1000 live
births in 2012. However, Nigeria is still short of the 2015 target of 63.7 deaths per 1000 live births.
1
www.pwc.com/ng: Nigeria’s 2015 Budget Fiscal and macroeconomic analyses
2
Nigeria 2013 MDG Report
Figure 2: Capital Vs Recurrent Expenditure Analysis

4. 92 96 93
8 4 7
0
20
40
60
80
100
120
HIV TB Malaria
%Contribution
Disease Area
Budget Contribution (2013-2014):
MDG Vs Govt
MDG
Govt
Also the country has recorded some progress in Goal 5. From a high of 1000 deaths per 100,000 live
births in 1990, maternal mortality fell to 800 deaths per 100,000 live births in 2004, 545 deaths per
100,000 live births in 2008 and 350 deaths per 100,000 live births in 2012. Maternal mortality
declined by 20.0% between 1990 and 2004 and by 36.0% between 2004 and 2008. However,
Nigeria's current status, estimated at 350 maternal deaths per 100,000 live births, is still 40.0% short
of the 2015 target of 250 maternal deaths per 100,000 live births.
AIDS, TUBERCULOSIS AND MALARIA
With the HIV prevalence rate of 3.4%3
, Nigeria is second to South Africa of nations with the highest
cases in Africa. Nigeria accounts for about 14% (3.1million) of the estimated burden of HIV in Sub-
Saharan Africa and 10% of the global burden. Globally, 80% of pregnant women have no access to
Antiretroviral treatment and Nigeria
alone contribute 32% of this PMTCT
gap. Before the outbreak of HIV, the
country had been able to make a
remarkable progress in controlling
Tuberculosis. It is unfortunate that this
progress has been eroded because of
the impact of HIV on infected persons
by lowering the immune system which
has invariably led to increase cases of
TB.
Malaria is another major source of
death in Nigeria. This disease is a major
public health problem and it accounts for more cases and deaths than any other country in the
world. 4
Malaria is a risk for 97% of Nigeria’s population. The remaining 3% of the population live in
the malaria free highlands. There are an estimated 100 million malaria cases with over 300,000
deaths per year in Nigeria. This compares with 215,000 deaths per year in Nigeria from HIV/AIDS.
Malaria contributes to an estimated 11% of maternal mortality.
Presently, HIV/AIDS, Tuberculosis and Malaria are being funded by external donors under the Global
Fund for AIDS, Tuberculosis and Malaria (ATM), UK Department for International Development,
USAID etc. However, with the increased donor fatigue, Nigerians suffering from these diseases will
resolve to seek alternative which most of the time is not available.
It is also pertinent to note that MDG has contributed the largest chunk of the resources available for
the three popular disease areas of AIDS, Tuberculosis and Malaria. This is not encouraging if the
function of MDG Fund as a buffer is understood and adhered to, as against seeing the fund as the
principal source of funding the Health intervention programmes. Between 2013 and 2015, the Fund
has contributed more than 90% of the available resources to control AIDS, Tuberculosis and Malaria
in Nigeria.
3
National HIV&AIDS and Reproductive Health Survey (NARHS Plus II, 2012)
4
Nigeria Malaria Fact Sheet (2011)
Figure 3: Funding Sources (2013-2014) for ATM: MDG Vs Govt

5. YEAR
FUNDING SOURCES
BUDGET ALLOCATION PER DISEASE AREAS (N)
HIV/AIDS TUBERCULOSIS MALARIA
2013 MDG 1,284,000,000 210,000,000 1,000,000,000
Main Budget 148,369,138 61,850,392 80,365,178
Total 1,432,369,138 271,850,392 1,080,365,178
2014 MDG 1,648,620,000 300,000,000 1,175,480,000
Main Budget 115,499,827 85,653,207 85,920,148
Total 1,764,119,827 385,653,207 1,261,400,148
2015 MDG 984,236,065 172,295,521 791,152,904
Main Budget NA NA NA
Total 984,236,065 ? 172,295,521 ? 791,152,904 ?
Figure 4: Allocation Along AIDS, Tuberculosis AND Malaria (ATM)
National Health Insurance Scheme (NHIS)
The Nigeria Health Insurance Scheme meant for the citizens has also recorded an insufficient total
allocation of N751, 912,010, of which just N642, 200,000 is available for Capital expenditure, thereby
translating to an average of N3.8 Insurance premium available for each of 170million citizens. It is
obvious that MDG 6c; “…halt by 2015 and begun to reverse the incidence of malaria and other major
diseases…” is not realistic.
Taking each component of the MDG focus one after the other and considering the
financial/budgetary commitment reveals further facts. For instance the budgetary allocation for
National Primary HealthCare Development Agency (NPHCDA) has been on decline from 2013 to date
with a whopping 53% decrease in allocation. While this is happening, the Recurrent Expenditure has
jumped by 16% and Capital Expenditure reduced by 60.4%. This allocation is obviously not in
conformity with the policy provision of this government as regards the Transformation Agenda and
National Strategic Health Development Plan (NSHDP).
The National Health Insurance Scheme (NHIS) is worst hit in terms of reduction in allocation.
Between 2013 and 2015, the budgetary allocation for the NHIS has witnessed a downward
movement by 85.4% talking about Total allocation. Taking the analysis further to look at the Capital
Expenditure also shows a sorry state of the Agency which has witnessed 83.1% reduction in this
Capital Expenditure budget between 2013 and 2015.
MDA YR Recurrent (N) Capital(N) Total Allocation
(N)
NPHCDA
2015 N2,218,271,588 N7,208,200,001 N9,426,471,589
2014 N1,768,254,072 N10,008,365,000 N11,776,619,072
2013 N1,864,332,712 N18,202,163,900 N20,066,496,612
NHIS
2015 N109,712,010 N642,200,000 N751,912,010
2014 N2,095,225,296 N2,573,898,743 N4,669,124,039
2013 N1,328,038,164 N3,814,179,081 N5,142,217,245
Figure 5: Budget Allocation Trend in Critical Health Department and Agencies

6. Immunization and Maternal Health Care
Immunisation of pregnant women and children less than one year is a MDG target; however from
2013 till date, there has been a gradual decline in the amount allocated to this component of
intervention. There are 774 LGAs in Nigeria spread across the 36 States and the Federal Capital
Territory. Immunization is the most important component of the Primary Health Care Services
because of the protection of new-born and mother against preventable diseases, some of which that
can lead to a lifelong disability. Beyond Immunization, it is also important to ensure that care for
pregnant women are done by skilful personnel whose training and retraining should be seen as very
germane. What has been allocated for this purpose from the past three years is not only inadequate
but grossly so; thereby making the yearly reduction unacceptable. From 2013 to 2015, the Midwife
Service Scheme (MSS) has recorded 32.5% decline in budgetary allocation.
Year Total Capital
Allocation for
NPHCDA
Unit Allocation
% of NPHCDA
Capital Budget
Immunization
2015 N7,208,200,001 N2,615,055,925 36.28%
2014 N10,008,365,000 N2,156,300,000 21.5%
2013 N18,202,163,900 N2,750,000,000 15%
Midwife Service
Scheme (MSS)
2015 N7,208,200,001 N1,012,685,607 14%
2014 N10,008,365,000 N1,441,821,640 14.4%
2013 N18,202,163,900 N1,500,690,676 8.2%
Polio Eradication
2015 N7,208,200,001 N2,568,442,234 35.6%
2014 N10,008,365,000 N3,650,775,386 36.4%
2013 N18,202,163,900 N 4,309,399,324 23.7%
Figure 6: Allocation Trend within MDG Focus Areas
Recommendations
• There is need for consistency within government as regards its own policies with
programmes and project.
• Fund allocation to priority areas is key to be able to meet up with obligation and social
contract with the citizen.
• Government should see Funds such as MDG, Sure-P as buffer and not main source of
funding annual programmes or budgetary provision.
• It is high time GoN started de-emphasising donor funding as regards major diseases such as
HIV/AIDS, Tuberculosis and Malaria, show willingness to own and scale up interventions,
strengthen systems and controls to ensure global targets set are met.
• Maternal, Newborn and Child Health (MNCH) should be priority of government in line with
fulfilling development targets and goals.

7. • Budget line Items should be more specific and cost realistic. Travels, refreshment, drugs and
other unrealistic items should have budgets cuts which will be used to fund important areas
such as the community and vulnerable groups insurance scheme.
• The Medium Term Sector Strategy process which is the platform for CSO and private sector
participation in the budget process is still not being effectively utilised. This process should
be enhanced and expanded to involve community representatives to reflect development
realities in the context of the beneficiary.
• CSO participation budget process has the potential to promote people-focused budgeting
and can support the MDA to align their programmes in a people-centred manner and make
the process accountable and results oriented.
Conclusion
The observed gap in budgetary provision to march the various policies pronouncement with
appropriate action has shown that more needs to be done by the government to ensure adequate
healthcare provision for the citizens.